Revolution: eHealth/mHealth Solutions for Improved Data

By Brittany Iskarpatyoti, MPH, MEASURE Evaluation

LIVERPOOL, ENGLAND—Liverpool locals, The Beatles once sang:

“You say you want a revolution. Well, you know, we all want to change the world.”

Here at the Health Systems Research conference in Liverpool, we’re talking about different kinds of revolutions: data and technology revolutions. The former took root in response to the 2015 Millennium Development Goals to “draw on existing and new sources of data to fully integrate statistics into decision making; promote open access to, and use of, data; and ensure increased support for statistical systems” (UN High Level Panel Report).

For many working in development and health, this goal has been tied to a technological revolution happening in low- and middle-income countries, driving investment in digital eHealth and mHealth initiatives. In this year’s opening plenary, The Right Honorable Alistair Burt, Member of Parliament (UK), reflected on the digital landscape, saying, “Digital technology has the potential to change how services and information are delivered.”

And, as The Beatles continued just a few lines later: “You say you got a real solution. Well, you know, we’d all love to see the plan.”

To wit, MEASURE Evaluation and iccdr,b joined forces at the conference this week to discuss how digital plans play out, citing progress made using digital technology to collect population and health services data far from Liverpool in rural Bangladesh. Essentially taking the promise of the digital health revolution and putting it to the test.

Community health workers (CHWs) in Bangladesh are trained and provided digital tablets for collecting patient and household data to sync to an electronic management information system (eMIS). Tablets can operate offline but link to the cloud when connectivity is available. The system automates data collection at the community and facility levels and can produce real-time visualizations (e.g., charts and graphs) for rapid decision making.

In a survey of CHW users and supervisors, both groups said the tablets and eMIS were easy to learn and use. The burden of reporting has dramatically reduced—going from more than 20 paper registers in a facility to the single electronic system. Accuracy has increased as less time is needed to complete reporting. Additionally, the use of improved unique client identifiers has reduced duplications and missed entries and allowed providers to track the continuum of care from multiple facilities.

Some challenges and concerns remain. To increase uptake, eMIS systems were developed to digitize what already exists. Paper registers may not include certain information or indicators because they have been excluded—due to assumptions made or to reduce reporting burden. For example, sex is often left off family planning paper registers, as it is assumed most clients are female. But if sex is omitted from the eMIS, then information on male participation in family planning will continue to be overlooked. eMIS technology makes for efficient collection, but if it simply mirrors paper data collection, we will have missed a true revolution that can change how we collect data plus improve the type of data we collect. And all will go nowhere if we cannot ensure continued support for training and technology.

And, as one session participant commented, “We are concerned so much about the sustainability of these electronic systems, but we’re focusing on the wrong issue. What I see is that paper systems are the ones that aren’t sustainable!”

He’s right. While we need more evidence on the cost benefit of digitizing health information systems, one thing is already clear: the data and technology “revolution” isn’t coming. It’s here.

And, do we want to change the world?

MEASURE Evaluation, iccdr,b, USAID/Bangladesh, and MaMoni HSS staff after the eHealth/my health session at HSR 2018