District decision-making for health in low-income settings: a feasibility study of a data-informed platform for health in India, Nigeria and Ethiopia

Abstract

Low-resource settings often have limited use of local data for health system planning and decision-making. To promote local data use for decision-making and priority setting, we propose an adapted framework: a data-informed platform for health (DIPH) aimed at guiding coordination, bringing together key data from the public and private sectors on inputs and processes. In working to transform this framework from a concept to a health systems initiative, we undertook a series of implementation research activities including background assessment, testing and scaling up of the intervention. This first paper of four reports the feasibility of the approach in a district health systems context in five districts of India, Nigeria and Ethiopia. We selected five districts using predefined criteria and in collaboration with governments. After scoping visits, an in-depth field visit included interviews with key health stakeholders, focus group discussions with service-delivery staff and record review. For analysis, we used five dimensions of feasibility research based on the TELOS framework: technology and systems, economic, legal and political, operational and scheduling feasibility. We found no standardized process for data-based district level decision-making, and substantial obstacles in all three countries. Compared with study areas in Ethiopia and Nigeria, the health system in Uttar Pradesh is relatively amenable to the DIPH, having relative strengths in infrastructure, technological and technical expertise, and financial resources, as well as a district-level stakeholder forum. However, a key challenge is the absence of an effective legal framework for engagement with India’s extensive private health sector. While priority-setting may depend on factors beyond better use of local data, we conclude that a formative phase of intervention development and pilot-testing is warranted as a next step.

Administrators, health service providers, and consumers perspectives of functions of district health‐care systems in Oromia region, Ethiopia: A qualitative study

“…Other qualitative studies in district health‐care systems in low‐income countries explored the attitude of mothers' toward utilization of maternal health services, decision‐making process, and data platforms for decision‐making …”

“…Other qualitative studies in district health-care systems in low-income countries explored the attitude of mothers' toward utilization of maternal health services, decision-making process, and data platforms for decisionmaking. [21][22][23] According to this study, functions of district health office are creating capacity of health centers and health professionals for the provision of health care, creating access for the provision of health care, ensuring equitable access to health care, regulation of private health-care providers, disaster preparedness, and monitoring risk factors and diseases in the district. For example, they are expected to make sure that health facilities have water and electricity, motivate health professionals, provide essential drugs to health facilities, allocate health budget for the poorest, and put ambulance especially for pastoral communities.…”

Consolidating strategic information to monitor progress against the UNAIDS 90-90-90 targets: evaluating the operational feasibility of an electronic HIV testing register in Cape Town, South Africa

“…In this study, we evaluated the operational feasibility of this pilot intervention to generate an electronic HIV testing register at a local Community Health Centre (CHC) that would make available individual-level digitised testing data to inform prevention and treatment activities. In this study we adopted a de nition of operational feasibility as the ease with which the intervention is supported by the procedures and protocols within the health facility [10]. This study focussed primarily on the recreation of the HIV testing register as a test of operational feasibility and completeness of the digitisation process.…”

India and the United Kingdom—What big data health research can do for a country

“…In India, there is no government policy for personal health records to date, but as universal health care is planned and implemented, the potential is clear . Giving autonomy to localities and regions to use local and regional data in decision‐making is an important means of illustrating the value of health data research (Avan, 2016 #2444; India State‐Level Disease Burden Initiative Cancer, 2018 #2415; Newton, 2015 #2348).…”