July 2023: Digitizing Community Health Information Systems
Issue 2, July 2023
This month’s Digital Health Research Roundup is focused on the digitization of community-based health information systems, or CBIS. We’ve invited Remy Mwamba, an expert in health information systems at UNICEF, to provide his thoughts on the importance of community health, community data, and how digitization can play a role in strengthening CBIS.There's lots to explore, including studies that demonstrate the importance of:
- collecting and leveraging community-level data
- optimizing surveillance and reporting systems
- -- and more!
Guest Editor's Remarks:
The Astana global conference has emphasized the importance of building sustainable primary health care (PHC), which includes effective and high quality community-based care and prioritizes disease prevention and health promotion as the cornerstone of universal health coverage. On the other hand, the World Health Assembly resolution WHA72.3 encouraged the generation of a more substantial evidence base for the impact of CHW programs. Investing in community data and information systems is therefore critical to generating more evidence so that community health contributions to improving population health outcomes and strengthening PHC can be well understood and documented.
Increasing access to technologies and digitalization can enable effective and efficient care at the community level. It can accelerate timely data use for decision-making at point-of-care by community health workers through decision-support tools during interactions with supervisors, periodic review meetings, or enable patient follow-up and referrals. The WHO recommendations on digital health interventions for health system strengthening highlighted select areas where digital technologies, accessible at a minimum via mobile devices, have some evidence to address health systems’ needs.
A key challenge, though, is to ensure that technology doesn’t widen inequities but instead helps to reach the most vulnerable with quality health services. Implementing digital technologies at the community level should be guided by a thorough assessment of the digitally enabled environment; understanding of systems bottlenecks and must account for change management and measures that ensure sustainability.
Optimizing health systems with Community-Based Health Information Systems
CGDHI key takeaways and comments on the research articles hand-picked by our guest editor:
CBIS Works To Improve Data Collection – and works better with support
Biemba et al, A Mobile-Based Community Health Management Information System for Community Health Workers and Their Supervisors in 2 Districts of Zambia, Global Health: Science and Practice, 2017
Summary & Takeaways:
The article outlines the implementation of a Community Health Management Information System (C-HMIS) mobile platform (DHIS2 adaptation) in Zambia amongst 40 CHWs and 20 CHW supervisors. The C-HMIS addresses the need for real-time, community-based health information exchange between CHWs, CHW supervisors, and district/central-level staff. CHWs used feature phones to submit comprehensive data on iCCM cases, medical supplies, and referrals, originally collected on paper forms. C-HMIS also facilitated feedback and automated reminders for mentorship sessions between health center staff and CHWs, and improved access to real-time community-level health data for district/central-level staff. Findings demonstrated the feasibility of employing a mobile platform to generate real-time community-level health information in Zambia - but primarily for data collection and reporting and less for data analysis/visualization.
Comment from the Center for Global Digital Health Innovation:
Use of a digital CBIS was seen to ease CHW reporting and access to community-level data amongst this small sample. Mobile network connectivity (and offline capabilities), need for continuous technical support, health facility staffing shortages impacted use of the platform - underscoring the need for a strong enabling environment to support CHWs in collecting and leveraging community-level data.
Digital Malaria Case-Based Reporting tool can optimize surveillance and reporting systems
W.H. Oo et al, A mobile phone application for malaria case-based reporting to advance malaria surveillance in Myanmar: a mixed methods evaluation, Malaria Journal, 2021
Summary & Takeaways:
The article explores the effectiveness and implementation challenges of a digital CBIS, the Malaria Case-Based Reporting (MCBR), in Myanmar on malaria case reporting compared to the existing paper-based reporting (PBR) system. The 41,040 cases reported through MCBR showed significant improvements to speed and accuracy in data reporting, with 63% of MCBR users transmitting rapid diagnostic test outcomes within 24 hours, compared to 0% of PBR users. CHWs expressed high satisfaction with MCBR, highlighting improved efficiency and data quality. While the implementation of MCBR provided valuable insights for malaria surveillance, challenges related to connectivity, data synchronization, and e-literacy skills were identified.
Comment from the Center for Global Digital Health Innovation:
Despite technical and operational challenges, MCBR showed potential for optimizing malaria reporting systems. To fully leverage its benefits, improvements in internet connectivity, data synchronization, and training programs are crucial. MCBR provides valuable findings that can be utilized to improve application-based reporting systems for malaria monitoring and surveillance. The strong acceptability of the MCBR by the community malaria volunteers and its preference over PBR indicate the potential of digital CBIS to facilitate more timely and accurate data reporting in the community.
CBIS Success: a collaborative, locally-embedded digital approach supports data collection and training of HEWs
Mengesha et al, Can mHealth improve timeliness and quality of health data collected and used by health extension workers in rural Southern Ethiopia?, Journal of Public Health, 2018
Summary & Takeaways:
This study focused on the impact of a digital CBIS, developed in collaboration with Ethiopian MOH, on data use, community health services, and the overall experience from Health Extension Workers (HEWs). Phones were given to one pair of HEWs per clinic outpost to compare the impact of digital vs existing paper-based data collection and reporting. 62 HEWs registered a total of 8,833 clients on the digital CBIS. HEWs were also provided with additional training, supportive supervision, and regular meetings to discuss the intervention. Findings reported improvements in HEW skill acquisition, service delivery, data quality, and patient follow-up. Further, the digital CBIS utilized was open-source and used open-standards which can facilitate data flow into the existing HMIS.
Comment from the Center for Global Digital Health Innovation:
This study demonstrated the importance of engaging, training, and supporting key stakeholders - including HEWs - in the development and use of the CBIS. However, various challenges related to training, connectivity issues, power failures in rural areas, and workload were identified. This CBIS only focused on two of 16 health packages HEWs are responsible for; digitization can facilitate improved integration of services but may cause challenges with double burden of reporting (especially if there are both paper and digital systems) for HEWs, data integration between disparate systems, among others.
Including SmartVA is a smart move for collecting verbal autopsies digitally
Hazard et al, Automated verbal autopsy: from research to routine use in civil registration and vital statistics systems,BMC Medicine, 2020
Summary & Takeaways:
The article discusses the implementation and effectiveness of SmartVA, a digital application focused on automated verbal autopsy that has been implemented in four countries: Myanmar, Papua New Guinea, Bangladesh, and the Philippines. The study demonstrated SmartVA’s feasibility and acceptability for generating COD. Training and evaluation of trained COD interviewers using SmartVA was found to improve data quality.
Comment from the Center for Global Digital Health Innovation:
In countries where there are inadequate CRVS systems, use of the digitized SmartVA facilitated collection of reliable community-level COD and improved data quality. SmartVA can increase and improve the evidence base around community-level and previously unregistered deaths.
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meet the guest editor
Remy Mwamba is a public health professional with over 15 years of experience. He currently serves at UNICEF as a Health Specialist, focusing on health management information systems and community health. He has previously worked with two USAID-funded projects in immunization, maternal, newborn, and child health. Remy has been actively engaged with the Health Data Collaborative (co-chairing the Community Data working group) to support the alignment of partners’ efforts to strengthen the community health information system. He also focuses on strengthening linkages between the health and CRVS systems. Remy Mwamba graduated in Public Health; he holds a master’s degree in science and is pursuing a Ph.D. in Epidemiology.