Improving health information systems for decision making across five sub-Saharan African countries: Implementation strategies from the African Health Initiative

Abstract

BackgroundWeak health information systems (HIS) are a critical challenge to reaching the health-related Millennium Development Goals because health systems performance cannot be adequately assessed or monitored where HIS data are incomplete, inaccurate, or untimely. The Population Health Implementation and Training (PHIT) Partnerships were established in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze advances in strengthening district health systems. Interventions were tailored to the setting in which activities were planned.Comparisons across strategiesAll five PHIT Partnerships share a common feature in their goal of enhancing HIS and linking data with improved decision-making, specific strategies varied. Mozambique, Ghana, and Tanzania all focus on improving the quality and use of the existing Ministry of Health HIS, while the Zambia and Rwanda partnerships have introduced new information and communication technology systems or tools. All partnerships have adopted a flexible, iterative approach in designing and refining the development of new tools and approaches for HIS enhancement (such as routine data quality audits and automated troubleshooting), as well as improving decision making through timely feedback on health system performance (such as through summary data dashboards or routine data review meetings). The most striking differences between partnership approaches can be found in the level of emphasis of data collection (patient versus health facility), and consequently the level of decision making enhancement (community, facility, district, or provincial leadership).DiscussionDesign differences across PHIT Partnerships reflect differing theories of change, particularly regarding what information is needed, who will use the information to affect change, and how this change is expected to manifest. The iterative process of data use to monitor and assess the health system has been heavily communication dependent, with challenges due to poor feedback loops. Implementation to date has highlighted the importance of engaging frontline staff and managers in improving data collection and its use for informing system improvement. Through rigorous process and impact evaluation, the experience of the PHIT teams hope to contribute to the evidence base in the areas of HIS strengthening, linking HIS with decision making, and its impact on measures of health system outputs and impact.

The use of continuous household surveys to generate timely data for annual programme outcome monitoring: Experience from the Integrated Family Health Program in Ethiopia

“…(Mutale et al 2013) data. These surveys unfortunately have several limitations: Firstly, the periodicity of these surveys is usually once every 2-5 years, which means that programme managers have to wait several years to assess performance of interventions on key health outcomes of interest in order to consider actions for course correction (Central Statistical Agency 2016;UNICEF MICS 2016).…”

“…Unfortunately, HIS data often have limited practical utility because of problems with completeness, timeliness, representativeness, accuracy of data capture and aggregation at multiple levels of the health system. Moreover, HIS data often do not have household-level statistics, which limits the utility of this data source (Mutale et al 2013). There is limited recorded continuous household survey implemented in Ethiopia.…”

Health Management: The Use of Information Systems and Knowledge Sharing for the Decision Making Process

“…20 It is hard for the ICTs by themselves to create the knowledge or guarantee its production. They can nevertheless favor the agility and information dissemination, mainly in the field of health production, where knowledge itself is a public good and, the more it is shared, the more its power tends to increase.…”

Strengthening paper health register systems: strategies from case studies in Ethiopia, Ghana, South Africa and Uganda

“…These case studies demonstrate that register systems inspired by grassroots solutions are often more accepted and more likely to be successfully scaled. Yet global and national standards are essential for consistent measurement and comparability of key health indicators [3,4]. While the data points included in registers should be aligned with global standards, standard registers designed by global organizations may not satisfy local needs.…”