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Part II- Achieving Universal Health Coverage: The Role of Routine Health Information


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As countries continue to invest and make strides toward achieving the SDGs and universal health coverage, strong routine health information systems (RHIS) are fundamental to the effort. Well-functioning RHIS provide a wealth of data on a country’s health system, including service delivery, availability of a trained workforce, and reach of interventions, that can be harnessed to identify gaps and support evidence-based decision making. Yet, while many low-to-middle income (LMIC) countries have established a national RHIS structure, there are existing challenges related to the availability, analysis, and use of the data that have yet to be addressed.

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Part II- Achieving Universal Health Coverage: The Role of Routine Health Information

  1. 1. Use of Community Health Data for Shared Accountability Tariq Azim, MBBS, DM MEASURE Evaluation John Snow, Inc.
  2. 2. Shared Accountability: Cases • Disease epidemics: sharing responsibilities and working in tandem o Liberia Ebola crisis  There was widespread noncompliance with government- imposed cremation to prevent viral spread.  Traditional and religious leaders influenced the development of World Health Organization guidelines on safe burials with dignity, which became government policy at the end of 2014.
  3. 3. Shared Accountability: Cases • Community-based maternal death surveillance o Accra, Ghana  A modified survey system of community-based reproductive age mortality using six questions was implemented in the Bosomtwa district of Accra o Malawi  Community-linked maternal death review: Communities and health facility staff worked in partnership to investigate and respond to maternal deaths occurring in communities and at health facilities
  4. 4. Shared Accountability: Cases • Community-based tuberculosis directly observed treatment, short course (TB-DOTS): accountability on both sides o Mozambique  Clients choose their DOTS with support from the local volunteers, known as padrinhos  Example of community taking responsibility for supervising TB-DOTS  Padrinhos make themselves accountable to the larger community regarding adherence to DOTS by the clients of TB services.
  5. 5. Community Ownership & Accountability • Ownership requires: o Taking responsibility o With that comes accountability • Accountability: o Committing to decisions and/or actions and holding oneself answerable for those actions and their consequences • Shared Accountability o Both the community & the health system (public and/or private) are accountable for:  Sharing health and related information  Taking actions to improve/maintain health  Publicly reporting and answering questions about those decisions and/or actions 5
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  7. 7. Qualitative Monitoring of “Accountability Forum” Performance 7 Legend: Green = desired performance Yellow = acceptable performance Red = unfavorable situation Health System Shared Information Took Actions Community Shared Information Box 1: Both the health system and the community shared information Box 2: Community provided information; health system acted on it (health system’s responsiveness) Took Actions Box 3: Health system shared information; community acted on (community engagement in taking action) Box 4: No information was shared, but both the health system and community acted on their own
  8. 8. Quantitative Monitoring of Accountability Forum Performance 8
  9. 9. Basic Principles: Community Health Data Use for Shared Accountability • The community takes the leadership role in running the accountability forum/meeting • Use an existing meeting structure at the community level • The community and the health system both share health and related data/information o Health status, service coverage, disease occurrences, service availability, maternal & infant deaths • Mutually decide on the health priorities and voluntarily commit to taking responsibility for addressing health priorities • Promote transparency and open sharing of data while ensuring privacy and security 9
  10. 10. Electronic tool for CHWs to - ensure continuity of care - improve service delivery management and quality MEASURE Evaluation eMIS Bangladesh
  11. 11. Digital solutions for the health workforce • Routine health information system through eMIS: an information and communications technology (ICT) initiative supported by USAID to automate the business processes of CHWs working in the public sector • Comprehensive, interlinked (between community and facility) solutions • eRegisters (mobile apps) allow CHWs to collect population and health service data (offline and online options) • Web-based application for users at different layers o Aggregated data are available to supervisors, managers • Automated reporting at national and other levels (linking eMIS to DHIS2) • Implementation period: 2015─ongoing o All systems developed in-house using open source software • After successful piloting, tools are being scaled up in other areas
  12. 12. eMIS Architecture
  13. 13. eMIS: A New Dimension to Bangladesh Health Systems • This video explains how eRegisters used in the facilities or communities are contributing to the better service delivery by the community health workers (CHWs) in Bangladesh working under the DGHS and DGFP. The eRegisters have been developed under the eMIS Initiatives. • bangladesh-health-systems •
  14. 14. eMIS: A New Dimension to Bangladesh Health Systems
  15. 15. Scale-up scenario Census Population: 17.08 million Registered: 6.27 million
  16. 16. Data collected by CHWs • Population data o Personal identifiers o Geographic identifiers o Household characteristics o Socioeconomic variables o Maternal, newborn death data • Service data o Maternal and child health, adolescent health, reproductive health, immunization • Commodities • Administrative o Performance- related o Metadata o Geographic positioning system data o Generated during encounters with the clients • Collected during household visits or during transactions at first-line facilities o Registered people are given health identity cards (HIDs) • Coverage: Universal in the catchment areas
  17. 17. Use of innovative mHealth supervision tools to enhance monitoring of community health workers • CHW work plan review, approval, and monitoring progress • CHW data verification • Preparation and submission of their own work plan • Reporting, notification
  18. 18. CHW work-plan review approval & progress monitoring
  19. 19. Monitoring performance
  20. 20. Use of information – Challenges we faced  Political will  Collaboration across stakeholders  Choice of technology  Harnessing in-country capacity  Facts matter  Apprehension about accountability
  21. 21. Use of information - Global experience Share your story or experience on gradual introduction of use of information for decision making This forum is now open for participants to share their own story
  22. 22. This presentation was produced with the support of the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID-OAA-L-14-00004. MEASURE Evaluation is implemented by the Carolina Population Center, University of North Carolina at Chapel Hill in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. Views expressed are not necessarily those of USAID or the United States government.