The Information Transparency Effects of Introducing League Tables in the Health System in Malawi

Abstract

League tables are used to compare the performance of different entities in the health systems in developing countries. The aim of this paper is to study the implementation process and its effects related to a computerized league table application in Malawi. Focusing on the health district and using a field experiment research approach, the focus is on the implementation process and how it improves information transparency for health managers. Based on routine health data recording in the health management information system DHIS2, the introduced league table was used by the district health management teams in the pilot districts to rank and compare performance among their health facilities. While the introduction of the league tables was challenging, it also showed its potential through effects including improved visibility of information and accessibility for managers, better understanding of indicators, the identification of data quality issues, skills acquisition in computing and information use and improved communication and collaboration among stakeholders.

Information management in Malawi’s prevention of Mother-to-Child Transmission (PMTCT) Program: Health workers’ perspectives

“…This perception reflects a culture where information is not valued as integral to patient care. It also contributes to poor information management practice, which can ultimately lead to poor patient outcomes, as the health system cannot adequately order commodities or deploy staff thus impeding health information system goal which is aimed at improving data quality and decision making 22 .…”

Innovation in the fringes of software ecosystems: the role of socio-technical generativity

“…Another initiative extending the DHIS2 in Malawi is the League Table App. Feedback practices such as review meetings at health districts have been taking place at all levels for a long time in Malawi (Moyo, Frøyen, Saebø, & Kaasbøll, 2015;Moyo, Kaasbøll, Nielsen, & Saebø, 2016). The review meetings bring together various stakeholders such as District Managers and NGOs, to examine performance data, provide feedback and develop action plans to improve the data.…”

From Routine to Revolt: Improving Routine Health Data Quality and Relevance by Making Them Public

“…Similarly, based on action research in Kenya with the aim to establish mutually agreed activities among key stakeholders to improve data use for action, Manya et al (2015) argue that data quality audits must be organized at the same time with monthly data review meetings and training in data management in order to address the problem of little use of data. Moyo, Kaasbøll [15] also discusses the process of development and introduction of a League Table to compare the performance of different health districts in Malawi. They argue that the module is a useful tool to remedy the problem of information transparency.…”

“…Routine health data are often too complex to understand and use even for health professionals [15]. In order to attract attention of the public, the data need to be simplified and commodified.…”

“…Commodifying data also relates to the two aspects of information transparency which are disclosure and clarity [15,25]. While disclosure only focuses on the availability and accessibility of data to interested parties which are very often governmental agencies and not-for-profits organizations, commodifying also involves making sense of data to the public.…”