Blog: Achieving Data Excellence for Stronger Health Systems
By Deepak Joshi, HERD International
“Data is a precious thing and will last longer than the systems themselves.” – Tim Berners-Lee (inventor of world wide web)
Quality health data is crucial for informed, responsive decision making and resource allocation for improved health outcomes. But how do we ensure data is of a high quality and is used effectively by those making the decisions? There have been evident gaps in the capacity of healthcare professionals in understanding the District Health Information Software-2 (DHIS-2) interface, and how to use the platform to generate inferences and indicators. This capacity is important not only for the healthcare professionals to interpret the information in relation to their own patients, but also for them to share such information with wider stakeholders, including local representatives, to use for decision making and resource allocation. A needs assessment was conducted by the Pokhara Metropolitan City and HERD International in Nepal as part of the CHORUS project on understanding the approaches needed to strengthen service delivery of non-communicable diseases programmes for the urban poor. The extensive needs assessment included data from all 45 public health facilities across 33 wards and interviews with selected stakeholders at the system and institute level. The assessment identified a significant need to strengthen the health management information system, and healthcare professionals’ understanding of DHIS-2. What is DHIS-2? The Nepali government uses the DHIS-2 as a comprehensive information management system for health data. This platform allows for the collection, analysis, and visualisation of various health indicators at different levels of the healthcare system, from national to local. This system provides real time access to health data that helps healthcare professionals and policymakers to make informed decisions. The data includes disease prevalence, immunization coverage, healthcare service utilization, and demographic information. The DHIS-2 system is expected to contribute to improving public health outcomes by enabling evidence-based planning, resource allocation, and intervention strategies. However, this is not happening on the ground, particularly in the federalized context where local government has the mandate to fulfil these expectations.
Figure 1: Information cycle (source: https://hmis.gov.np/overview/)
The [above] figure presents the information cycle. It shows how data can be used by various individuals or teams to inform their decision-making. At each stage of the cycle, however, there is potential for data and information to be misused or misinterpreted, which impacts later stages of data and information use. This can ultimately impact plans and decisions. The needs assessment identified the importance of the capacity of the health workers in Pokhara to understand and increase usage of the DHIS-2 data, to inform decision-making.
CHORUS collaboration with Pokhara Metropolitan City Health Division
As part of the CHORUS study, we conducted an extensive needs assessment on health system readiness to respond to the rising NCDs within urban areas. The needs assessment involved actors from the local health system and health facility level, and assessed their capacity to deliver basic health care services. The assessment highlighted that the data quality and data use were key areas to address through the system. HERDi and the Pokhara Metropolitan City Health Division held several rounds of consultative meetings and workshops with public health care providers to co-design an intervention which could address this identified need.
We designed a series of capacity strengthening initiatives, to be embedded within the intervention. These included an intensive two-day training for all the public health facilities within the metropolitan city, in collaboration with the health division and Gandaki Provincial health directorate. The training was organized in two phases, with 58 health care providers, health facility in-charges and health division officials participating (24 female, 34 male). The sessions included:
- Introduction to DHIS2: This included development of the software, overview of the interface, server management, and how the system can ensure data quality.
- Data entry, pivot table & data visualizer: Elements of data entry, exporting data in excel, web-based pivot table that analyzes data along all data dimensions.
- GIS & dashboard: GIS features for mapping of areas, view facilities based on classifications, and visualize catchment areas.
- Standard Report: Customization of the report as per the need.