Developing A Central Analytic Repository To Improve Decision Making By Stakeholders

Background The rise in data analytics has resulted in the need for data to be pooled into centralized large-scale repositories to support more organized analytics. In the health sector, housing health data in a central analytic repository makes it easier for policymakers to access and make faster, more efficient informed decisions that impact the population, especially in cases of emergencies and disease outbreaks. Our study aimed to develop a centralized health data analytics repository for Nigeria called the Multi-Source Data Analytics and Triangulation (MSDAT) platform to improve decision-making by stakeholders. Methods The MSDAT design and development was a data and user-centred process guided and informed by the perspectives and requirements of analysts and stakeholders from the Federal Ministry of Health, Nigeria. The inclusion of health indicators and data sources on the platform was based on: (1) national relevance (2) global health interest (3) availability of datasets and (4) specific requests from stakeholders. The first version of the platform was developed and iteratively revised based on stakeholder feedback. Results We developed the MSDAT for the purpose of consolidating health-related data from various data sources. It has 4 interactive sections for; (1) indicator comparison across routine and non-routine data sources (2) indicator comparison across states and local government areas (3) geopolitical zonal analysis of indicators (4) multi-indicator comparisons across states. Conclusion The MSDAT is a revolutionary platform essential to the improvement of health data quality. By transparently visualizing data and trends across multiple sources, data quality and use are brought to focus to reduce variations between different data sources over time and improve the overall understanding of key trends and progress within the health sector. Hence, the platform should be fully adopted and utilized at all levels of governance. It should also be expanded to accommodate other data sources and indicators that cut across all health system areas

Socializing accountability for improving primary healthcare: an action research program in rural Karnataka

The Alma Ata Declaration of 1978 invoked a socialising form of accountability through which communities and health workers participated in and were jointly accountable for primary healthcare. Aside from a few experiments, by the 1990s these ideals were quickly replaced by policy prescriptions based on increasing efficiency in data quality and reporting through the introduction of health information systems. More recently, there has been a revival of interest in community participation as a mechanism for improving the poor status of primary healthcare in developing countries through the constitution of village health committees. This paper documents and reflects on nine years of research on interventions aimed at improving primary healthcare accountability in rural Karnataka. Over this period, our focus has shifted from studying how computerised health information systems can strengthen conventional accountability systems to a period of extended participatory action research aimed at socialising accountability practices at village level. The findings from this study constitute vital knowledge for reforming the primary healthcare sector through different policy measures including the design of appropriate technology-based solutions

Data and Image Transfer Using Mobile Phones to Strengthen Microscopy-Based Diagnostic Services in Low and Middle Income Country Laboratories

Background: The emerging market of mobile phone technology and its use in the health sector is rapidly expanding and connecting even the most remote areas of world. Distributing diagnostic images over the mobile network for knowledge sharing, feedback or quality control is a logical innovation. Objective: To determine the feasibility of using mobile phones for capturing microscopy images and transferring these to a central database for assessment, feedback and educational purposes. Methods: A feasibility study was carried out in Uganda. Images of microscopy samples were taken using a prototype connector that could fix a variety of mobile phones to a microscope. An Information Technology (IT) platform was set up for data transfer from a mobile phone to a website, including feedback by text messaging to the end user. Results: Clear images were captured using mobile phone cameras of 2 megapixels (MP) up to 5MP. Images were sent by mobile Internet to a website where they were visualized and feedback could be provided to the sender by means of text message. Conclusion: The process of capturing microscopy images on mobile phones, relaying them to a central review website and feeding back to the sender is feasible and of potential benefit in resource poor settings. Even though the system needs furthe

eHBB: a randomised controlled trial of virtual reality or video for neonatal resuscitation refresher training in healthcare workers in resource-scarce settings

Objective To assess the impact of mobile virtual reality (VR) simulations using electronic Helping Babies Breathe (eHBB) or video for the maintenance of neonatal resuscitation skills in healthcare workers in resource-scarce settings. Design Randomised controlled trial with 6-month follow-up (2018–2020). Setting Secondary and tertiary healthcare facilities. Participants 274 nurses and midwives assigned to labour and delivery, operating room and newborn care units were recruited from 20 healthcare facilities in Nigeria and Kenya and randomised to one of three groups: VR (eHBB+digital guide), video (video+digital guide) or control (digital guide only) groups before an in-person HBB course. Intervention(s) eHBB VR simulation or neonatal resuscitation video. Main outcome(s) Healthcare worker neonatal resuscitation skills using standardised checklists in a simulated setting at 1 month, 3 months and 6 months. Results Neonatal resuscitation skills pass rates were similar among the groups at 6-month follow-up for bag-and-mask ventilation (BMV) skills check (VR 28%, video 25%, control 22%, p=0.71), objective structured clinical examination (OSCE) A (VR 76%, video 76%, control 72%, p=0.78) and OSCE B (VR 62%, video 60%, control 49%, p=0.18). Relative to the immediate postcourse assessments, there was greater retention of BMV skills at 6 months in the VR group (−15% VR, p=0.10; −21% video, p<0.01, –27% control, p=0.001). OSCE B pass rates in the VR group were numerically higher at 3 months (+4%, p=0.64) and 6 months (+3%, p=0.74) and lower in the video (−21% at 3 months, p<0.001; −14% at 6 months, p=0.066) and control groups (−7% at 3 months, p=0.43; −14% at 6 months, p=0.10). On follow-up survey, 95% (n=65) of respondents in the VR group and 98% (n=82) in the video group would use their assigned intervention again. Conclusion eHBB VR training was highly acceptable to healthcare workers in low-income to middle-income countries and may provide additional support for neonatal resuscitation skills retention compared with other digital interventions

Understanding HMIS Implementation in a Developing Country Ministry of Health Context - an Institutional Logics Perspective

Globally, health management information systems (HMIS) have been hailed as important tools for health reform (1). However, their implementation has become a major challenge for researchers and practitioners because of the significant proportion of failure of implementation efforts (2; 3). Researchers have attributed this significant failure of HMIS implementation, in part, to the complexity of meeting with and satisfying multiple (poorly understood) logics in the implementation process. This paper focuses on exploring the multiple logics, including how they may conflict and affect the HMIS implementation process. Particularly, I draw on an institutional logics perspective to analyze empirical findings from an action research project, which involved HMIS implementation in a state government Ministry of Health in (Northern) Nigeria. The analysis highlights the important HMIS institutional logics, where they conflict and how they are resolved. I argue for an expanded understanding of HMIS implementation that recognizes various institutional logics that participants bring to the implementation process, and how these are inscribed in the decision making process in ways that may be conflicting, and increasing the risk of failure. Furthermore, I propose that the resolution of conflicting logics can be conceptualized as involving deinstitutionalization, changeover resolution or dialectical resolution mechanisms. I conclude by suggesting that HMIS implementation can be improved by implementation strategies that are made based on an understanding of these conflicting logics

Understanding HMIS Implementation in a Developing Country Ministry of Health Context - an Institutional Logics Perspective

Globally, health management information systems (HMIS) have been hailed as important tools for health reform (1). However, their implementation has become a major challenge for researchers and practitioners because of the significant proportion of failure of implementation efforts (2; 3). Researchers have attributed this significant failure of HMIS implementation, in part, to the complexity of meeting with and satisfying multiple (poorly understood) logics in the implementation process. This paper focuses on exploring the multiple logics, including how they may conflict and affect the HMIS implementation process. Particularly, I draw on an institutional logics perspective to analyze empirical findings from an action research project, which involved HMIS implementation in a state government Ministry of Health in (Northern) Nigeria. The analysis highlights the important HMIS institutional logics, where they conflict and how they are resolved. I argue for an expanded understanding of HMIS implementation that recognizes various institutional logics that participants bring to the implementation process, and how these are inscribed in the decision making process in ways that may be conflicting, and increasing the risk of failure. Furthermore, I propose that the resolution of conflicting logics can be conceptualized as involving deinstitutionalization, changeover resolution or dialectical resolution mechanisms. I conclude by suggesting that HMIS implementation can be improved by implementation strategies that are made based on an understanding of these conflicting logics. Keywords: Legal and Social issues in Public Health Informatics; developing countries; health management information systems; institutional logics; institutional aspects of information systems; action research; Nigeria; Ministry of Health; change managemen