Mr. Gizachew Gishu is head of the Hawella health center, one of the four health centers in the Hawella district of the Sidama region in Ethiopia. During his tenure at the health center, he grappled with how poor data quality and its use negatively impacted the provision of services. “In the health center, there was lack of an effective process and practice of managing health information. Poor data recording and sharing practices resulted in information loss which mostly led to ill-informed actions.”
Mr. Gishu’s reflection mirrors the challenges that woredas, or districts, across the country face—despite the critical importance of data. In 2015, in recognition of how routine health information can advance national efforts to deliver quality and universal healthcare and contribute to the country’s progress toward achieving the 2030 agenda of the SDGs, the Ministry of Health (MOH) launched the Health Sector Transformation Plan (HSTP), a five-year initiative with four transformational agendas.
Mr. Gishu, Hawella Health Center Head, showing a renovated cardroom after the intervention
The Information Revolution (IR), one of the four agendas, seeks to create a culture of information use at all levels of the health sector; digitize priority health interventions; and strengthen governance of the health information system. Over the past several years, the MOH has partnered with regional health bureaus and local universities to support woredas implement IR initiatives in the Capacity Building and Mentorship Program (CBMP). While the MOH designed CBMP, its implementation is primarily led by six local universities as it aims to improve the generation, sharing, and use of quality data to ensure evidence-based decision-making, in addition to fostering strong multi-sector collaboration between academic institutions and service providers
In Sidama, Hawassa University, jointly with the Ethiopia Data Use Partnership (DUP) led by JSI Research & Training Institute, Inc., Sidama regional health bureau, and the MOH, has been supporting CBMP implementation in the Shebedino and Hawella districts since December 2018. In the two districts, there are 12 health facilities and two district health offices. The baseline assessment indicated that 60% of the facilities lacked any kind of appropriate process and practice to produce and use quality data, while 34%, despite having monitoring and evaluation infrastructure in place, did not adequately use it. Only 6% of the health facilities and offices were able to use improved quality data. It was a compelling gap that required swift and urgent intervention attention.
Throughout the intervention Hawassa University provided capacity building activities, including a training on data quality and use improvements. It also focused on supporting the district health offices and facilities to produce quality data through operationalizing nonfunctioning electronic health tools, such as DHIS2, a digital platform that the MOH rolled out across the country in January 2018 to improve the generation, use, and sharing of high quality data from all health institutions across Ethiopia.
Ilfinesh Juge, Cardroom Worker, registering a Hawella Health Center Visitor
A year into the intervention, a performance review indicated that most health facilities in the two districts had made strides in laying down the very foundation to producing and using data-- setting-up a functioning M&E system. However, a significant number of health facilities were still underperforming and falling behind. Convening and training grassroots level implementers to execute activities did not yield desired results, so Hawassa University began to rethink its support mechanism. The university shifted to an innovative and practical approach that provided focused and tailored support to each health facility, customized to their specific context and needs, and documented and shared the lessons learned to assist other districts facing similar challenges. This approach created an opportunity for the university to closely work with facilities on all aspects of transforming its health information management, including down to the renovation of facility rooms, cardrooms, and waiting rooms.
“This means, which we call practice-based learning approach, enabled facilities and units to effectively remove the barriers that hindered quality health data production. Additionally, this focused intervention created a demonstration site where others visit for experience sharing. Visitors usually return home with ‘we too can do it’ attitude,” says Mr. Keneni Gutema, PhD, the university’s program coordinator.
Mrs. Wusen Giro, Gebre Kiristos Health Center, discussion the progress
In July 2021, 100% of the health facilities and district offices in the Shebedino and Hawella districts achieved becoming models in collecting, consuming, and communicating quality health data. More importantly, all of the health facilities and offices are currently able to share their data using one or more of the MOH’s digital health tools. The change moved beyond improving the data quality in the two districts -- across all levels of the health system, a culture shift, where health staff began to seek, review, and use data to make programmatic and budgeting decisions, become the norm.
The use of quality data directly translated to improved health service deliveries. For example, at Hewalla health center, one of the facilities, skilled birth attendance (SBA) has reached 84% in July 2021. “The improvement in all priority areas made our health center the preferred destination by the community. Similarly, all other service have shown substantial improvement thanks to the support from the university and DUP,” says Mrs. Wuse Giro, head of Gebre Kiristos Health Center in Shebedino district.
Through a rigorous evaluation, the regional health bureau and the MOH verified and officially accredited the districts as models in implementing initiatives that enhance quality data management and use practices. Following this verification, Hawassa University inaugurated the two districts as models on 27th of August 2021 in an elaborate ceremony.
The collaboration in Shebedino and Hawella districts among the country’s academic and health sector actors is just one microcosm of a nationwide movement that is a piece of a greater global effort to ultimately achieve better health and nutrition outcomes. Ethiopia’s experience demonstrates the need for strong partnerships across sectors, models to learn from and be inspired by, and innovative approaches that contribute to accomplishing the greater global goals while accommodating the local context.
About the Author
Benti Ejeta, Senior Learning and Knowledge Management Specialist, (DUP)/JSI