Toward a health information system (HIS) helping decentralized actors in decision-making

By Cheickna Toure

From 16-18 December 2015, the Health Service Delivery Community of Practice (CoP HSD) organized a regional workshop in Cotonou (Benin) on the theme “From Health information system to collective intelligence: refocusing the health district on the population using ICTs”. We share here the key messages that came out of the workshop. 

In October 2013, with the support of Harmonization for Health in Africa partners, the CoP HSD organized a regional conference aiming to review the 25 years of implementation of the health district strategy in Africa. At the end of the conference, participants made a series of recommendations to update the health district strategy. One of these recommendations was to transform health districts into learning organizations and another put emphasis on the need to use the power of information and communication technologies (ICTs) to strengthen health information system (HIS) at the district level. Based on these recommendations, the CoP HSD organized the Cotonou workshop to reflect on an alternative health information system in sub-Saharan Africa.

 In Cotonou, designers and users of ICT solutions reflected on another type of Health Information System

Around 60 participants gathered for three days to share their analyses and experiences on the links between ICT and health system performance. Participants had diverse profiles: there were district medical officers, program managers, researchers, designers and developers of ICT solutions, policymakers, financial and technical partners… Together, they reviewed experiences of ICT use in health systems in sub-Saharan Africa. They looked at the empowering capacity of these experiences on local actors for carrying out their routine missions. You can access the agenda of the workshop with a link to all the presentations.

The workshop was organized in three parts. The first part was mainly conceptual. We explored conceptual frameworks and theories on local health systems, the performance of decentralized actors and tools for analyzing ICT solutions on HIS and their use. The second part focused on sharing experiences with ICT solutions implemented in sub-Saharan Africa with a particular attention on the way they facilitate or not decentralized actors’ autonomy and empowerment. These experiences included information sharing, follow-up of patients, distance training and support of health professionals, funding of health services, data collection, analysis and transmission, and community support technologies. The last part focused on co-creation activities. In small groups, participants deepened their knowledge and understanding of the key issues and challenges that emerged from the workshop.

Three ‘take home’ messages emerged

 Can we empower actors of the decentralized level using ICT solutions? Of course! The meeting was very creative. The report of the meeting shares the key strategies identified by the participants.

First of all, analysis of the shared experiences identified several strengths and weaknesses. The strengths included, among others, the increased coverage of internet and mobile phone in the recent years, the multiplicity of experiences of ICT use at all levels of the health system (from the community to the central levels), and the high involvement of donors and civil society in the development of ICT solutions for health systems. Some of the weaknesses include the fragmentation of experiences and models implemented within the health system and even in the same health district and the lack of pro-active attention, during the pilot phase, to scaling up strategies. Furthermore, participants noted the orientation of many solutions towards a bureaucratic logic of data collection and transmission and the low implication of decentralized actors’ and other sectors’ needs during the design and implementation of the ICT solution. Low internet and irregular electric supply in some health districts are also bottlenecks to ICT deployment.

Secondly, participants noted some promising factors that can contribute to improve the performance of local health systems. The development of integrated management approaches in HIS such as DHIS2 and of software for empowering first line health providers (DataSanté), political will and involvement of donors in the development of well-performing HIS are some of these factors.

Finally, to develop intelligent local health systems, participants highlighted that ICT solutions should better integrate the needs of decentralized actors. This integration should start during the design of the solution and include strategies for getting more value from available data. However, it was noted that ICT technology is not a panacea. Indeed, the key HIS challenge remains transforming data into knowledge that is used by all actors for decision-making. Consequently, actors in local health systems should not be viewed as simple data or information producers but should become the first users of data for action. During the workshop, it was reiterated that local health system actors are not only made up of health professionals, but include communities and users, local authorities, and other sectors’ actors who have an impact on health (agriculture, hygiene and sanitation, education, social affairs, road and rural development…).

Set a course for the development of empowering health information systems

 A strong recommendation for the workshop was that ICT solutions applied to HIS should empower all stakeholders with real capacities to help them to make informed decisions. Moreover, it should improve access to information for all actors. One strategy for the development of these solutions would be to organize a hackathon that would facilitate innovations and create networks for sharing and using information and data.

We would of course like to see the organization of other events to share experiences and deepen understanding of the knowledge agenda for empowering HIS. Participants identified 5 priority areas that should be addressed to develop well-performing HIS in sub-Saharan Africa: the empowerment of the local level, the development ICT solutions that produce systemic effects, the inclusion of decentralized users’ needs during the development of ICT solutions, and cross-learning and regular knowledge updates .

National policymakers should use all these ideas and lessons to create a fresh perspective. With good leadership, they can develop a renewed vision that align all stakeholders working together towards common goals. The CoP HSD is ready to provide support to countries and to document experiences and best practices to help other countries learn, sidestep errors and better address issues that undermine the development of empowering HIS.

You can read:

• The Agenda of the workshop by clicking here

• The Final report of the workshop by clicking here.