ICTworks

Routine Health Information Systems (RHIS) are facility-based and ideally community-based systems that can form the main data source for daily planning and management of quality healthcare services at the local level. Most of the data are gathered through routine health facility activity, including individual health records, records of services delivered, and records of health resources.

Routine health information systems systems can increase the efficiency of:

• Coverage and quality of health interventions
• Disease surveillance
• Commodity security
• Human resource management
• Financial management
• Integrated management of health interventions

However, few health data ecosystems have strong locally-managed routine health information systems. Often at the local level, data is collected for the sole use of regional or national decision makers. This results in data being fragmented into program-specific information systems and overall poor data quality with much duplication and waste.

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Worse, because local actors are not involved in decision making, and may not even see the results of their data collection, local health information system resources are underutilized and there is an absence of data culture use where data use could have the greatest impact.

How to Create a Culture of Data Use in Health Systems?

The Routine Health Information Network (RHINO) has developed a multi-step process to build a culture of data use at the district and sub-district levels. They utilize:

• Human-centered design to create information systems for users at all system levels
• A culture of accountability at the community level
• Innovative electronic tools for data management by the community

Through these three processes, countries can use strong routine health information systems to invest and make strides toward achieving the SDGs and universal health coverage. Well-functioning RHIS provide a wealth of data to community healthcare stakeholders on their local health system, including service delivery, availability of a trained workforce, and reach of interventions.

1. Human Centered Design to Create a Culture of Data Use

RHINO suggests that informatics practitioners start by establishing a “culture of information” – the capacity and control to promote values and beliefs among members of an organization for collection, analysis and use of information to accomplish its goals and mission.

The culture of information can start with human-centered design (HCD) to accommodate the needs of the users at all health system levels by involving users in designing routine health information system.

For example, informatics practitioners can develop innovation groups of end-users (policy level, district level, delivery of care level) to think through how data should be utilized at every level.

2. Creating a Culture of Accountability at the Community Level

Critically, data use will only happen when there is a culture of accountability that holds health systems mangers responsible for health outcomes at all levels of the healthcare ecosystem. Through the HCD process, the health system stakeholders should develop routine health information systems with:

• An enabling environment with a decentralized organizational structure
• Robust data feedback loops throughout the health system
• Clear roles and responsibilities around decision making
• No-blame environment that promotes transparency
• Encouragement and incentives to motivate behavioral change
• Mutual accountability and shared ownership within the health system, and between the health system and the community

3. Innovative Digital Tools for Community Data Management

Once there is a culture of accountability, then innovative digital tools can be utilized to bring a culture of data use into the daily lives of the community healthcare stakeholders. For example, a routine health information system could:

• Publish district level indicators through media
• Use RHIS data to solve community healthcare issues
• Allocate resources based on RHIS indicators
• Disseminate RHIS information success stories
• Use RHIS information for annual performance appraisals

Most of all, senior health information managers can model behavior by institutionalizing their use of RHIS information in every aspect of their work, especially their communication with community healthcare system stakeholders.

Implementing Routine Health Information Systems

Of course, there are challenges in creating a culture of information and data use. Cultural change is a social and behavior change intervention. It is not solved by shiny, flashy technology, but through working with community members over time.

Informatics practitioners need to work with donors and other stakeholders to ensure everyone has the same expectations and patience to wait for RHIS capacity building to improve data analysis, problem solving, and advocacy skills of district and facility staff. When they do, RHINO found the results to be heartwarming and impressive:

“Two years ago, we were the least performing [Ethiopian] woreda in the zone. The training we received on how to use our performance data to make decisions and take action was an eye opener. We knew very little about using our own data to identify our own gaps and propose solutions. Now, we are completely data-driven. Soro Woreda health office has witnessed a growing interest in use of performance data for decision making, making it a cliché in the hearts and minds of health workers and managers in the woreda.” Abenezer Bekele, Head of Soro Woreda HO, Ethiopia.

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