How digital transformation can accelerate data use in health systems.

Introduction: We are in an era of rapid technological advance and digitalization. Countries around the world want to leverage technology to improve health outcomes by accelerating data use and increasing evidence-based decision-making to inform action in the health sector. Yet, there is no "one size fits all" approach to achieving this. To understand more, PATH and Cooper/Smith conducted a study documenting and analyzing the experiences of five African countries (Burkina Faso, Ethiopia, Malawi, South Africa, and Tanzania) that are on this digitalization journey. The goal was to examine their different approaches and develop a holistic model of digital transformation for data use that identifies what the essential components for digitalization success are and how they interact with each other. Methods: Our research had two phases: first, we analyzed documentation from the five countries to identify core components and enabling factors for successful digital transformation, as well as barriers encountered; and second, we held interviews with key informants and focus groups within the countries to fill gaps and validate findings. Findings: Our findings show that the core components of digital transformation success are highly interrelated. We found that the more successful digitalization efforts address issues that cut across components-such as stakeholder engagement, health workforce capacity, and governance structures-and consider more than just systems and tools. Specifically, we found two critical components of digital transformation that have not been addressed in previous models like the eHealth strategy building blocks developed by the World Health Organization and the International Telecommunication Union: (a) cultivating a culture of data use throughout the health sector and (b) managing the process of system-wide behavior change required to move from manual or paper-based to digital systems. Conclusion: The resulting model is based on the study's findings and is intended to inform low- and middle-income (LMIC) country governments, global policymakers (such as WHO), implementers, and funders. It provides specific, concrete, evidence-based strategies these key stakeholders can implement to improve digital transformation for data use in health systems, planning, and service delivery.

Three Waves of Data Use Among Health Workers: The Experience of the Better Immunization Data Initiative in Tanzania and Zambia.

The governments of Tanzania and Zambia identified key data-related challenges affecting immunization service delivery including identifying children due for vaccines, time-consuming data entry processes, and inadequate resources. To address these challenges, since 2014, the countries have partnered with PATH's Better Immunization Data Initiative to design and deploy a suite of data quality and use interventions. Two key aspects of the interventions were an electronic immunization registry and tools and practices to strengthen a culture of data use. As both countries deployed the interventions, 3 distinct changes in data use emerged organically. This article provides a detailed summary of these 3 phases or waves, based mostly on qualitative data or observation: (1) strengthening data collection using new data collection tools and processes and increasing efficiency of health workers; (2) improving data quality regarding accuracy and completeness; and (3) increasing use of data to take action to strengthen their work and for programmatic decision making. These waves clearly demonstrated the growing ability of health workers to move from data collectors to data analyzers who began to focus on the data quality and then the value of using the data in their day-to-day activities.

Clinical management of children with fever: a cross-sectional study of quality of care in rural Zambia.

OBJECTIVE: To evaluate current practices and standards of evaluation and treatment of childhood febrile illness in Southern Province, Zambia. METHODS: From November to December 2013, we conducted a cross-sectional survey of facilities and health workers and we observed the health workers' interactions with febrile children and their caregivers. The facility survey recorded level of staffing, health services provided by the facility, availability and adequacy of medical equipment, availability of basic drugs and supplies and availability of treatment charts and guidelines. The health worker survey assessed respondents' training, length of service, access to national guidelines and job aids for managing illnesses, and their practice and knowledge on management of neonatal and child illnesses. We also conducted exit interviews with caregivers to collect information on demographic characteristics, chief complaints, counselling and drug dispensing practices. FINDINGS: This study included 24 health facilities, 53 health workers and 161 children presenting with fever. Facilities were insufficiently staffed, stocked and equipped to adequately manage childhood fever. Children most commonly presented with upper respiratory tract infections (46%; 69), diarrhoea (31%; 27) and malaria (10%; 16). Health workers insufficiently evaluated children for danger signs, and less than half (47%; 9/19) of children with pneumonia received appropriate antibiotic treatment. Only 57% (92/161) were tested for malaria using either rapid diagnostic tests or microscopy. CONCLUSION: Various health system challenges resulted in a substantial proportion of children receiving insufficient management and treatment of febrile illness. Interventions are needed including strengthening the availability of commodities and improving diagnosis and treatment of febrile illness.

Clinical management of children with fever: a cross-sectional study of quality of care in rural Zambia

Objective:To evaluate current practices and standards of evaluation and treatment of childhood febrile illness in Southern Province, Zambia.Methods:From November to December 2013, we conducted a cross-sectional survey of facilities and health workers and we observed the health workers' interactions with febrile children and their caregivers. The facility survey recorded level of staffing, health services provided by the facility, availability and adequacy of medical equipment, availability of basic drugs and supplies and availability of treatment charts and guidelines. The health worker survey assessed respondents' training, length of service, access to national guidelines and job aids for managing illnesses, and their practice and knowledge on management of neonatal and child illnesses. We also conducted exit interviews with caregivers to collect information on demographic characteristics, chief complaints, counselling and drug dispensing practices.Findings:This study included 24 health facilities, 53 health workers and 161 children presenting with fever. Facilities were insufficiently staffed, stocked and equipped to adequately manage childhood fever. Children most commonly presented with upper respiratory tract infections (46%; 69), diarrhoea (31%; 27) and malaria (10%; 16). Health workers insufficiently evaluated children for danger signs, and less than half (47%; 9/19) of children with pneumonia received appropriate antibiotic treatment. Only 57% (92/161) were tested for malaria using either rapid diagnostic tests or microscopy.Conclusion:Various health system challenges resulted in a substantial proportion of children receiving insufficient management and treatment of febrile illness. Interventions are needed including strengthening the availability of commodities and improving diagnosis and treatment of febrile illness

A qualitative study of perceptions of a mass test and treat campaign in Southern Zambia and potential barriers to effectiveness.

BACKGROUND: A mass test and treat campaign (MTAT) using rapid diagnostic tests (RDTs) and artemether-lumefantrine (AL) was conducted in Southern Zambia in 2012 and 2013 to reduce the parasite reservoir and progress towards malaria elimination. Through this intervention, community health workers (CHWs) tested all household members with rapid diagnostic tests (RDTs) and provided treatment to those that tested positive. METHODS: A qualitative study was undertaken to understand CHW and community perceptions regarding the MTAT campaign. A total of eight focus groups and 33 in-depth and key informant interviews were conducted with CHWs, community members and health centre staff that participated in the MTAT. RESULTS: Interviews and focus groups with CHWs and community members revealed that increased knowledge of malaria prevention, the ability to reach people who live far from health centres, and the ability of the MTAT campaign to reduce the malaria burden were the greatest perceived benefits of the campaign. Conversely, the primary potential barriers to effectiveness included refusals to be tested, limited adherence to drug regimens, and inadequate commodity supply. Study respondents generally agreed that MTAT services were scalable outside of the study area but would require greater involvement from district and provincial medical staff. CONCLUSIONS: These findings highlight the importance of increased community sensitization as part of mass treatment campaigns for improving campaign coverage and acceptance. Further, they suggest that communication channels between the Ministry of Health, National Malaria Control Centre and Medical Stores Limited may need to be improved so as to ensure there is consistent supply and management of commodities. Continued capacity building of CHWs and health facility supervisors is critical for a more effective programme and sustained progress towards malaria elimination.

Health-seeking behavior for malaria among child and adult headed households in Rakai district, Uganda.

BACKGROUND: The number of orphans in Rakai district, Uganda is estimated to be 34,902 (OCBO, 2000) which translates into 28% of children under the age of 18 years. Young people who have been orphaned and as a result became heads of households must look after themselves and their siblings. These children are likely to be faced with several health problems and have to take crucial life decisions without parental/adult guidance. OBJECTIVES: This study was conducted in order to understand how child-headed households, Rakai district in Uganda recognize malaria, their health-seeking behavior when malaria is suspected and reasons for the type of behavior compared to the adult-headed households. METHODS: A comparative cross-sectional study was conducted in 300 households in Rakai district, Uganda, in which 8/23 (35%) of sub-counties and 150 child-headed households were included. The closest neighborhood adult-headed household to each child-headed household was selected for comparison. Individual interview was carried out with the respondents using semi-structure questionnaire. Key informant interview and focus group discussions were also conducted. RESULTS: The main findings were that the respondents in child-headed households had less knowledge on signs and symptoms of simple and severe malaria compared to adult heads of households. Respondents in child-headed households were less likely to seek health care from health facilities (OR=0.59, CI=0.36-0.97, p-value=0.028). There was no significant difference in the time lag before taking first action in the two types of households (OR=0.72, CI=0.42-1.22, p-value=0.194). The respondents in child-headed households were six times (OR=5.70,CI=2.75-11.91, p-value<0.001) more likely to use local herb for treatment of malaria than the adult heads households. Major reasons stated by the respondents for choosing where health care is sought included distance to source of health care, cheap or free treatment, availability of drugs, and quick services to patients. CONCLUSION: The respondents in child-headed households had less knowledge on signs and symptoms of simple and severe malaria and receive too little or late health care from health professionals compared to the adult heads of households probably due to lack of knowledge and money. Information Communication and Education programs should be designed and target the child-headed households and supply home packs.