In low-resource settings the use of local data for health system planning and decision-making is often limited: many health managers are poorly equipped for data-driven decision-making. The District Health Information Software (DHIS2); is a transformative development, including routine data from all public health facilities, and leading to better data collection, validation, storage, analysis, and communication, albeit with a focus on service delivery. These improvements have exposed a long-neglected issue of how to use district-level data for problem-solving, and how to foster a data-sharing culture and collaborative action-planning among health-stakeholders.
Building on ten years of collaborative research in Nigeria, India, and Ethiopia, led by our team, we co-created the Data Informed Platform for Health (DIPH) intervention in Ethiopia and supported implementation in 12 districts of North Shewa zone over a 21-month period.
Using a cluster-randomised design, we conducted an evaluation of the effect of the DIPH intervention on health information system performance and data-driven decision-making in all 24 districts of North Shewa zone, Ethiopia, between October 2020 and June 2022.
Developing the Data Informed Platform for Health strategy
The DIPH aims to enable district-level managers to make structured decisions, using elements of quality decision-making: defining problems using a health-system framework; reviewing all available data and evidence; considering alternative options for health-service solutions; value-based prioritisation; and a consultative process to develop a feasible action plan, commit to it, and follow up. The strategy has three main elements:
- Identifying and convening stakeholders in a virtual platform to deliberate on issues. Membership of this virtual platform was flexible according to the nature and needs of the problem in focus.
- Organising stakeholder meetings in five-step cycles (see Figure above): Assess, Engage, Define, Plan, and Follow-up. These five steps together comprise one cycle and, in practice, took about four months to complete. Each cycle looked at a specific health theme identified in the early stages of the cycle itself.
- A digital interface so that all involved could regularly review data and check on progress.
We developed a package of job aids and guidelines for district health officers and staff in administrative and managerial roles, which included a training handbook, structured forms, and a digital interface.
‘When I compare the time before DIPH came and now … every decision is data-driven. We conduct a close follow-up until what we have planned is achieved. This is what I call change.’
District M&E officer
In the context of DHIS2, the Data Informed Platform for Health strategy can improve district-level data use and structured decision-making in Ethiopia.
All Supporting Local Decision-Making related outputs can be found under Resources by selecting that theme from Research Areas.