Establishing evidence-based decision-making mechanism in a health eco-system and its linkages with health service coverage in 25 high-priority districts of Uttar Pradesh, India

Abstract

Background Achievement of successful health outcomes depends on evidence-based programming and implementation of effective health interventions. Routine Health Management Information System is one of the most valuable data sets to support evidence-based programming, however, evidence on systemic use of routine monitoring data for problem-solving and improving health outcomes remain negligible. We attempt to understand the effects of systematic evidence-based review mechanism on improving health outcomes in Uttar Pradesh, India. Methods Data comes from decision-tracking system and routine health management information system for period Nov-2017 to Mar-2019 covering 6963 health facilities across 25 high-priority districts of the state. Decision-tracking data captured pattern of decisions taken, actions planned and completed, while the latter one provided information on service coverage outcomes over time. Three service coverage indicators, namely, pregnant women receiving 4 or more times ANC and haemoglobin testing during pregnancy, delivered at the health facility, and receive post-partum care within 48 h of delivery were used as outcomes. Univariate and bivariate analyses were conducted. Results Total 412 decisions were taken during the study reference period and a majority were related to ante-natal care services (31%) followed by delivery (16%) and post-natal services (16%). About 21% decisions-taken were focused on improving data quality. By 1 year, 67% of actions planned based on these decisions were completed, 26% were in progress, and the remaining 7% were not completed. We found that, over a year, districts witnessing > 20 percentage-point increase in outcomes were also the districts with significantly higher action completion rates (> 80%) compared to the districts with < 10 percentage-point increase in outcomes having completion of action plans around 50–70%. Conclusions Findings revealed a significantly higher improvement in coverage outcomes among the districts which used routine health management data to conduct monthly review meetings and had high actions completion rates. A data-based review-mechanisms could specifically identify programmatic gaps in service delivery leading to strategic decision making by district authorities to bridge the programmatic gaps. Going forward, establishing systematic evidence-based review platforms can be an important strategy to improve health outcomes and promote the use of routine health monitoring system data in any setting.

Maternal Service Coverage and Its Relationship To Health Information System Performance: A Linked Facility and Population-Based Survey in Ethiopia

“…The role of maternal education in maternal service utilization has been observed in many studies within Ethiopia and elsewhere. 11,39,40 The disparity of maternal service utilization by wealth index has also been wellestablished in other studies. 10,12 The negative effect of distance for SBA or maternal care at the health facility is visible in this study and others.…”

“…10 This process can be done through the regular review of routine health data and conducting root cause analyses of issues when needed. 11 , 12 …”

“…10 This process can be done through the regular review of routine health data and conducting root cause analyses of issues when needed. 11,12 There are a variety of factors that affect the utilization of maternal services. Client characteristics, such as education, residence, and socioeconomic status, consistently affect maternal service utilization.…”

Refining the Performance of Routine Information System Management (PRISM) framework for data use at the local level: An integrative review

“…Most studies used a questionnaire (33%), observation or document review (29%), or both (29%) to measure data use. The exception was a study that developed a decision tracking system which served as their data source for the number and types of decisions taken and actions planned and completed [ 51 ]. About a third of studies (33%) collected self-reported measures about data use from health facility and/or district-level staff, without verification through observations or document review.…”

Optimizing the Health Management Information System in Uttar Pradesh, India: Implementation Insights and Key Learnings

“…Greater investments are required to achieve this vision and to improve the quality of these data; the expectation is that data use will help improve data availability and quality over time. 19 These investments will be important for the GOUP to achieve its long-term vision of developing an integrated information communication technology architecture to allow the flow of health data across different data portals into a central dashboard repository that visually presents key program monitoring data to support management and decision making at various levels in the health system (unpublished data).…”