Digital health information systems are maturing to reflect realities on the ground

By Christina Villella, MPH

I am sure many of you have been in the same boat, spending months developing a tool to help improve health information systems in low- and middle-income countries. You know the field is saturated with new ideas, so you want to make sure your tool is grounded in expert knowledge and experience. To achieve that, you travel to several countries to listen to both compliments and critiques.

You find that even as this tool is still under development, a few individuals in ministries of health ask you, “When will it be ready?” And that pleases you because—if you’re like me as an international development professional, the greatest satisfaction is when you discover your tool is likely to meet a real need, as opposed to just being the product of your own thinking.

As the tool I recently helped develop, the Health Information Systems Interoperability Maturity Toolkit, is now being piloted in several countries, I have been reflecting on developments in digital health in low- and middle-income countries that predate this effort. As we identified details for the toolkit, we noticed that the literature and published frameworks focused chiefly on technology. However, as we talked with stakeholders in Kenya and Ghana, we heard talk about governance, financing, human resources, and capacity—and how critical they are to strong interoperable information systems. 

Therefore, we settled on three areas of focus: leadership and governance, human resources, and, yes, technology. This selection reflects technical input from the project I work on, MEASURE Evaluation, and trends in digital health over the last few years.

We can see those trends through the lens of the Global Digital Health Forum. In 2015, it was a smaller meeting called the Global mHealth Summit, focused on integrating mobile technology into global health. Even then, some experts were advising we expand beyond mobile technology and go “back” to computers, because mobile technology would not be the only digital solution for health.

In 2016, the meeting became the Global Digital Health Forum, and focused on a wider array of digital health topics, such as how governments need to coordinate digital investments, how to overcome fragmented systems, user-centered design, partnerships, interoperability, and the increasing numbers of digital tools—mobile and otherwise—making inroads into this space.

This past year, my favorite presentations were those where representatives from governments shared how they planned to implement digital health in their countries. It was clear that governments are in the driver’s seat now more than ever, which is important not only for sustainability of digital investments, but also to grow local human resources.

Reflecting on this trajectory, it seems digital health has matured significantly. Yet, work remains. I suggest these areas for future focus:

• Capacity—Not just human capacity for technology but skills to lead and govern. Program managers and government officials need to understand how to manage these systems. One way that MEASURE Evaluation has responded is developing a course in health informatics for health information systems professionals in low- and middle-income countries.
• Interoperability—The word gets tossed around a lot, but how often is it happening? We need to be intentional in identifying which systems should be interoperable and why. What data should we triangulate to provide meaningful information for decision makers?
• Responsible data practices—This has been a hot topic at several conferences. With so many opportunities to collect and transmit data (block chain, interoperability, mobile data collection, etc.), we need to put safeguards in place and be certain this is happening at the country level. MEASURE Evaluation recently published a guide for low- and middle-income countries to assess data security, privacy, and confidentiality for mHealth.

With our focus on these key structures, the field will move closer to its goal of sustainable, usable, and trustworthy systems that meet the needs of health workers and other decision makers around the world.

Christina Villella is a senior technical officer in health informatics and works on the USAID-funded MEASURE Evaluation project.          

Republished with permission from Science Speaks.