Improving Primary Health Care Data use to inform decisions

According to the MoH reports and the Surveillance gaps assessment supported by CHAI in September 2020, through BMGF funding, the fragmented or lack of centralized standardized data system has posed a challenge in measuring the Primary Health Care System Performance in Eswatini. Currently the data systems in Eswatini are unable to provide dashboards data visualization at primary health care facilities making it difficult measure the performance of PHC and prompt decision making at PHC.  The Primary Health Care still experience huge data quality gaps in data collection, visualizations and use for decision making. This proposal seeks to strengthen data systems and data use in primary care to enable tracking of services delivered, performance and reach of standard indicators. 

Eswatini uses the Client Management Information System (CMIS) as the standard Electronic Health Records (EHR) system for all diseases at the point of care in health facilities, with current coverage in 80% of all public facilities. The Government of Eswatini through funding support from USAID have made great investments in scaling up CMIS throughout the country, however not all indicators for various diseases are included and dashboards yet to be incorporated. Our solution would be creation of automated dashboards using the MoH’s existing preferred visualization tool (DHIS2) to allow health facility staff to easily view interactive charts, graphs, tables, and maps for routine decision making. DHIS2 does not require a high level of connectivity or bandwidth and its designed for use in low medium level income countries.

Automated dashboards will enable health care workers in primary care facilities quick access to their data to monitor disease trends, patient care and outcomes to strengthen service delivery within their catchment areas.  Patients from the facility catchment area will receive improved care e.g. a diabetes client will be easily tracked over a period of time showing if treatment and/or lifestyle counselling are having an impact.  

CHAI is a global health organization committed to saving lives and reducing the burden of disease in low- and middle-income countries (LMICs) around the world. Further, we aim to strengthen government and indigenous private health systems so that progressively our participation in areas where we work can be phased out and the impact of our work will sustain. CHAI is working to ensure that technology is used effectively to catalyze government health goals. We work with governments, developers, donors, and end users (health care providers, health systems managers, and patients) to design, develop, scale, and institutionalize fit-for-purpose digital products. CHAI Eswatini started operations in 2004 with a consortium Memorandum of Understanding with the Ministry of Health to increase access to more affordable commodities for HIV/AIDS which initiated mutually agreed upon technical assistance. We officially registered in Eswatini as a non-profit in 2008 and provide technical support to the Ministry of Health.

 

In 2020, with CHAI support, the electronic logistics management information system (ELMIS) was piloted by the Ministry of Health (MoH) to enhance efficiency and provide increased operational visibility for health commodities in three (3) health facilities – Pigg’s Peak Hospital, Dvokolwako Health Centre and Lobamba Clinic. The project integrated the Central Warehouse Management Information System to the eLMIS and successfully integrate the Client Management Information System (CMIS) to the eLMIS for patient data processing and the development of a report and Analytics module.  Current planning for scale-up of the eLMIS to 22 additional facilities.

 

CHAI is currently also providing support for the pilot of PROMPTS: A digital health platform connecting mothers with lifesaving advice. Almost a third of maternal deaths are cause by delays in care-seeking. We operate a digital health platform that connects mothers with lifesaving advice and referral to care. This service is completely free to the user. We keep costs low by using tools such as an AI-based triage system to help answer mothers’ questions. By using AI and Helpdesk agents, we are are able to meet mothers’ needs quickly and effectively, resulting in more successful maternal outcomes, and safe mothers and babies. 

There is currently no funding support to build data dashboards for use at primary care facilities that currently use CMS.  We believe that providing facility level data to health care workers will enable them to optimize the performance of their primary care services. 

The CMIS was developed and deployed after extensive engagement with stakeholders from national to community level.  Inclusion of automated dashboards was a recommendation from the various engagements as it allows for decentralization of data use from national to facility level and is the fastest way to solve the current existing information gap in primary care facilities for performance optimization. 

First year:

Impact goal: Improved decision-making for patient flow and care in primary care facilities in the pilot

Next 5 years:

Impact goal: Informed decision-making to optimize performance in primary care facilities in the pilot

Impact goal: Improved measurement of quality service delivery in primary care facilities in the pilot

Outputs Outcomes ·         Functional interactive dashboards for visualization from CMIS ·         Good quality patient data with interactive dashboards from pilot facilities ·         Primary care facility management using data from dashboards to inform planning and decision making ·         Data used to inform decision-making for improved patient flow, care, and performance of the facility

We will be using DHIS2 which utilizes the Java frameworks

Healthcare workers in primary care facilities collect the data.  

• Appreciating the life experiences every stakeholder brings to the success of the work
• Embracing the rich and varied cultures of our stakeholders and team members
• Acknowledging that diversity promotes creativity, innovation, and awareness; and
• Fostering a culture where all stakeholders and team members are encouraged to reach their professional and personal goals.