Researching, characterising, co-creating and testing innovations in Paper Health Information Systems (PHISICC) to support frontline health workers decision-making: protocol of a multi-country, transdisciplinary, mixed-methods research programme in three Sub-Saharan countries

Abstract

BackgroundHealth Information Systems (HIS) are crucial to provide data for decision-making and data demands are constantly growing. However, the link between data and decisions is not always rational nor linear and the management of data ends up overloading frontline health workers, who may have to compromise the health care. Despite limited evidence, there is an increasing push for HIS digitalisation, which faces enormous challenges, particularly in remote, rural settings in low- and middle-income countries. Paper-based tools will continue to be used and this warrants efforts to make them more responsive to local needs. Paper Health Information Systems (PHISICC) is a transdisciplinary, multi-country research initiative to create and test innovative paper-based HIS in three Sub-Saharan African countries.MethodsThe PHISICC initiative is taking place in remote, rural settings, in Côte d’Ivoire, Mozambique and Nigeria, through partnership with Ministries of Health and research institutions. We began with research syntheses to acquire the most up to date knowledge on HIS. These were coupled with field work in the three countries to understand the current design, patterns and contexts of use, and health care worker perspectives. Frontline health workers, with designers and researchers, used co-creation methods to produce the new PHISICC tools. This suite of tools is being tested in the three countries. Throughout the project we have engaged with a wide range of stakeholders and have kept the highest scientific standards to keep it relevant to health policy in each of the three countries.DiscussionWe have deployed a comprehensive research approach to ensure the robustness and future policy uptake of the finding. Beyond the resulting paper-based tool design innovations, our process itself was innovative. Rather than emphasizing the data management compliance aspects we focused instead on frontline health workers’ decision-making; by tackling the whole scope of health care areas in PHC rather than incremental improvement to existing tools, we developed an entirely new design approach and language for a suite of tools in Primary Health Care. The initiative is being tested in remote, rural areas where the most vulnerable live.