Challenges for Health Indicators in Developing Countries: Misconceptions and Lack of Population Data

Asah, Flora Nah; Nielsen, Petter; Sæbø, Johan Ivar

doi:10.1007/978-3-319-59111-7_48

Cited by 6 publications

(11 citation statements)

References 20 publications

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“…Frequent health worker error in classifying health conditions during documentation as well as post hoc recording was also described, resulting in inaccurate estimates of the prevalence of the condition in the population, and thus discouraging the use of the data (Cibulskis and Hiawalyer, 2002; Mosse and Sahay, 2003). Furthermore, an other study reported falsification of data when there was a lack of supervision or feedback provided to lower level healthcare workers (Asah et al, 2017).…”

Section: Resultsmentioning

confidence: 99%

Understanding the challenges associated with the use of data from routine health information systems in low- and middle-income countries: A systematic review

Hoxha

Hung

Irwin

et al. 2020

HIM J

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Background: Routine health information systems (RHISs) are crucial to informing decision-making at all levels of the health system. However, the use of RHIS data in low- and middle-income countries (LMICs) is limited due to concerns regarding quality, accuracy, timeliness, completeness and representativeness. Objective: This study systematically reviewed technical, behavioural and organisational/environmental challenges that hinder the use of RHIS data in LMICs and strategies implemented to overcome these challenges. Method: Four electronic databases were searched for studies describing challenges associated with the use of RHIS data and/or strategies implemented to circumvent these challenges in LMICs. Identified articles were screened against inclusion and exclusion criteria by two independent reviewers. Results: Sixty studies met the inclusion criteria and were included in this review, 55 of which described challenges in using RHIS data and 20 of which focused on strategies to address these challenges. Identified challenges and strategies were organised by their technical, behavioural and organisational/environmental determinants and by the core steps of the data process. Organisational/environmental challenges were the most commonly reported barriers to data use, while technical challenges were the most commonly addressed with strategies. Conclusion: Despite the known benefits of RHIS data for health system strengthening, numerous challenges continue to impede their use in practice. Implications: Additional research is needed to identify effective strategies for addressing the determinants of RHIS use, particularly given the disconnect identified between the type of challenge most commonly described in the literature and the type of challenge most commonly targeted for interventions.

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Section: Resultsmentioning

confidence: 99%

Understanding the challenges associated with the use of data from routine health information systems in low- and middle-income countries: A systematic review

Hoxha

Hung

Irwin

et al. 2020

HIM J

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“…Often the people who entered the data were not the same people who generated the products -in some cases it was the sstatisticians or 'IT' that were assigned to tabulate the data and share the generated summary reports with district and divisional health managers (32,37) and in other cases there was the perception or culture that it was not the facility staff that were the key players in terms of using the data for decision making: 'the use of data in decision making is generally limited at national and sub national levels' (50) and 'district managers are not involved in decision-making as this is the responsibility of those at the central level' (31). However, Asah et al (31) note that nurses claimed that they used data to inform planning, but there was confusion over what constituted an indicator. Ogega (42) notes that whereas district staff were conversant with DHIS2 and the creation of dashboards and graphs, facility staff needed to ask district staff to produce reports as they had limited access to DHIS2…”

Section: Processmentioning

confidence: 99%

“…With respect to planning very little detail was given on how the DHIS2 informed the plans -in most documents there were simple statements made about DHIS2 data informing plans and in one case excerpts from the plan were presented (31). However, no further detail on how action plans were previously used or not used or how they planned to be implemented were included.…”

Section: Purposementioning

confidence: 99%

“…Though clinical trials and other evidence for clinical decision making and delivery of health care are important sources a more inclusive and sophisticated view of evidence has emerged (for example 56, 57-59) with the term evidence-'informed' practice becoming more used than evidence-'based' practice (60, 61). We can question whether the concept of 'data use' is best suited to what we have de ned as 'data use' in this review or whether we should be promoting evidence informed action taking and decision making and adopting different language to describe this.Another debate arose in the work of Asah et al(31) over who is expected to make decisions. In their case of Cameroon Asah et al note(31) that decisions are not expected to be made at the level below district and thus facility level users of the system have only permission to input data.…”

mentioning

confidence: 99%

“…We can question whether the concept of 'data use' is best suited to what we have de ned as 'data use' in this review or whether we should be promoting evidence informed action taking and decision making and adopting different language to describe this.Another debate arose in the work of Asah et al(31) over who is expected to make decisions. In their case of Cameroon Asah et al note(31) that decisions are not expected to be made at the level below district and thus facility level users of the system have only permission to input data. Thus requests for information are made via the district o ce due to lack of access but also due to lack of expectations that data will be used in practice for decision-making or action.…”

mentioning

confidence: 99%

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Routine Use of DHIS2 Data: A Scoping Review

Byrne

Sæbø

2021

Preprint

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BACKGROUND:In terms of health service planning and delivery the use of information at different levels in the health system is vital, from influencing policy, to program action, and to evidence informed practices. However, having good data or access to good data does not necessarily imply data use. For information to be used relevant data needs to be collected, processed and analysed in an accessible format. The problem of little or no data use is widespread and has been evident for decades.The DHIS2 software platform supports routine health management for an estimated 2.4 billion people and is used in over 70 countries. DHIS2 is by far the largest and most widespread software for this purpose and adopts a holistic socio-technical approach to development and implementation. With this approach and the rapid and extensive scaling of DHIS2 we questioned whether this has been matched with the increased scaling of improved information use. To date there has been no rigorous review of the documentation on how DHIS2 data is routinely being used for action and decision-making. This scoping review addresses this gap. METHODS:The five stage approach of Arksey and O’Malley and progressed by Levac et al., was followed. Three databases (PubMed, Web of Science and Embase) were searched, along with relevant conferences and postgraduate thesis. In total approx. 300 documents were reviewed with 18 documents being fully reviewed. RESULTS:Overall DHIS2 data is being used but there are few detailed descriptions of this in peer reviewed or grey literature. We find that there is commonly a centralised versus decentralised pattern of use in terms of access to data and reporting data up in the system, and that the different conceptualisations of data use and how data use is conceptualised is not made explicit. CONCLUSIONS:We conclude with some suggestions on the way forward, namely: the need to document in more detail and share how data is being used, investigating how data was created and who uses the data, designing systems based on work practices and exploring and promoting forums in which we can have ‘conversations’ around data.

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Regular measurement is essential but insufficient to improve quality of healthcare

Agweyu

Hill²,

Diaz

et al. 2023

BMJ

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Quality of CareRegular measurement is essential but insufficient to improve quality of healthcare Ambrose Agweyu and colleagues argue that large scale improvements in quality of healthcare require strong change management as well as health information systems that can provide continuous and rapid feedback E vidence on the detrimental effect of low quality health systems on preventable mortality worldwide has accelerated investments in large scale healthcare improvement. 1 Regular measurement of quality of care is a core principle of quality improvement programmes that has been promoted in some low resourced settings as the primary means to improve quality of healthcare-that is, the degree to which health services for individuals and populations are effective, safe, and people centred. 2 Advances in information technology over the past decades, along with a growing demand for accountability and regular measurement of quality of care, have resulted in a proliferation of indicators, tools, and approaches to measuring the performance of health systems. 3 4 Routine health information systems (RHIS) that capture high quality data to facilitate regular use of data to monitor realtime trends in healthcare processes and outcomes are essential.Regular measurement, however, will not improve healthcare on its own. Measurement must be coupled with specific actions to improve care, including change management processes to achieve and sustain large scale healthcare improvements. This realignment requires an appreciation of the challenges associated with the current model in healthcare, especially in low resource settings. Unlocking potential of routine health information systemsHigh quality health information on which to base decisions is needed by patients and their communities, healthcare providers and managers, insurers and other payers, governments, and international development agencies. Since health information systems in many settings with high mortality have been developed, to some extent, to facilitate the aggregation of information at subnational, national, and global levels to fulfil reporting requirements, they are often not fully used to improve health service management and quality at the local level. Faced with the challenge of satisfying the diverse information needs of different consumers, health systems often struggle with data generation, collation, analysis, and reporting, let alone using these data to establish or monitor quality improvement efforts.Health information systems in countries across all income levels fall short of their potential to contribute to improving health system performance because of three interrelated factors: technical limitations, including poorly structured data collection tools, limited interoperability, and inadequate investment in maintenance, support, and data privacy [5][6][7] ; behavioural factors, such as poor motivation to generate high quality data 8 9 ; and organisational determinants often arising from weak governance and resource constraints resulting in understaffing...

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Challenges for Health Indicators in Developing Countries: Misconceptions and Lack of Population Data

Cited by 6 publications

References 20 publications

Understanding the challenges associated with the use of data from routine health information systems in low- and middle-income countries: A systematic review

Understanding the challenges associated with the use of data from routine health information systems in low- and middle-income countries: A systematic review

Routine Use of DHIS2 Data: A Scoping Review

Regular measurement is essential but insufficient to improve quality of healthcare

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