10 Lessons for Stronger Health Information Systems in Ebola-Affected West Africa

AmandaBy Amanda Puckett

The need for stronger health information systems and disease surveillance has always been an issue in West Africa, but for me and others in global public health, Ebola forced the issue. The ongoing outbreak—marked early by a lack of information on transmission and case notification, and severely disrupted health services—has shed light on grave weaknesses in the health systems in Guinea, Sierra Leone, and Liberia.
These weaknesses contributed to the spread of the disease and the loss of more than 11,100 lives.

They also brought together the international community in Accra, Ghana, last month for the Annual Joint Meeting of National Health Information Systems and of Integrated Disease Surveillance and Response Managers with Technical and Financial Partners. I was honored to be invited to participate and to engage with so many global stakeholders.
During May 18–21, participants from around the world came together to develop a consensus for action to improve health information systems in West Africa as the region continues to overcome and eventually recovers from the epidemic. These systems ensure that the right information goes to the right users at the right time, and form the backbone of any health system.

In Accra, 10 main points came to light:

1. It’s not just about the technology—it’s about deploying technology responsibly.
Believe it or not, the technology is the easy part. Engaging the many stakeholders to agree on processes, policies, and data sharing—even within different levels of government—is the larger challenge. Officials must make decisions to responsibly deploy systems that support the needs of their countries.

2. There is great value in face-to-face engagement.
You can only accomplish so much with email, webinars, and Skype calls. Taking the time to meet for several consecutive days facilitates discussion and problem-solving that doesn’t occur virtually. When thoughtfully planned, meetings like the one in Accra are worth the time and expense.

3. Governance, leadership, and ownership are key.
Before determining indicators, partners, or even applications, local governments must prioritize leadership and good governance for health information systems. Some recommendations included elevating the authority of health information systems within government, calling for governments to establish national coordination entities, and developing a health information systems policy and strategy. And of course, ministries of health must be in the driver’s seat.

4. Users must be the center of technology design and implementation.
Designers of systems, applications, and platforms, must engage their users. By bringing users on at the beginning of technology development—not when the technology is ready to be implemented—designers can be sure the approach will meet users’ needs and align with their systems and infrastructure.

5. Implement what is meaningful.
Technology can be driven by donors or by partners. But governments should only implement technology that is meaningful to them and will help advance their health agendas, not just what is available.

6. Real time doesn’t mean real fast.
There has been a lot of buzz about real-time data. Countries need data as fast as they can use it for action, and that may not mean instantaneously.

7. Partnership will take us far.
It takes transparency and committed partnership to support health information systems. This work is not easy and requires expertise and support from many different disciplines. My favorite quote from the meeting was an African Proverb: “If you want to go quickly, go alone. If you want to go far, go together.”

8. Investments in infrastructure pay off.
No matter how robust the electronic platform or well-designed the mobile application, it will not work in a setting that lacks a supportive infrastructure. Mobile network coverage, cable for internet, and equipment and hardware are necessary for running digital health technologies. Investments should be made here early—not when you realize your program won’t work because of poor infrastructure.

9. Users of technology and data can benefit from training.
Using data and building technology are not innate in some settings. Consider building the capacity of your technology and data users, specifically in data analytics and use.
10. This is a process with a committed community.
Meaningful improvements to West Africa’s health information systems will not happen overnight. This is a process that involves many stakeholders.
Accra was unique—a rare and valuable opportunity to bring the right people together at a critical time. This is not a moment for complacency—we must work together now to improve health information systems.

A follow-up event at Wilton Park in Sussex, England, next month will allow stakeholders to come together again to build on the discussions and plans made in Accra. With a focus on mobile technology and health systems, the Wilton Park agenda will host private-sector stakeholders, senior-level ministry of health officials from West Africa, and international partners to foster ongoing collaboration and plan scalable, sustainable solutions.

I’m preparing for this event now, and I’m excited to see concrete next steps for improving West Africa’s health information systems.

(Re)Building Health Systems in West Africa: what role for ICT and mobile technologies?

(Re)Building Health Systems in West Africa: what role for ICT and mobile technologies?

Lesley-Anne Long
mPowering Frontline Health Workers

Dykki Settle
Open Source for Global Health

The Ebola epidemic has brought the weak state of health services and systems in West Africa into the spotlight. It is broadly understood that stronger health systems would not only have minimized the impact of Ebola in West Africa, they would have also proven more resilient in the crisis. Even with the 11,000 deaths1 directly attributable to Ebola, countless more resulted from closed health facilities and health workers either unable or unwilling (understandably) to maintain their posts in the three countries.

Ebola is just one highly publicized example of the devastating impact weak health systems have for the health of populations. As the post-2015 agenda takes shape, low and middle income countries are emphasizing the need for stronger health systems and the critical importance of skilled and connected frontline health workers within these systems.

Figure 1: Global focus on the need for stronger health systems 2

In West Africa, the focus is now shifting from the immediate response to Ebola to long-term approaches that will strengthen routine systems and offer sustainable capacity and resilience for health.

To effectively recover from the chaos of Ebola and prevent future disease outbreaks from becoming as threatening, West African governments and development partners are making plans to invest more deeply in health systems. These investments will

support countries to address a disease burden that is shifting rapidly in unpredictable ways. Moreover, they are finding new opportunities to join forces in order to expedite interoperable health information systems (HIS) and strengthen institutional capacity of Ministries of Health in the area of HIS governance, leadership and management.

Two upcoming events in May and June, 2015 will bring governments and partners together to focus on these priorities, building a global harmonization and coordination agenda that transcend traditional national and organizational boundaries.

The first event in Accra, Ghana will be a four-day technical workshop on strengthening leadership, governance and systems for disease surveillance and data sharing using information and communication technologies. The second event, at Wilton Park in West Sussex, England, will build on the Accra discussions – participants will explore how ICT solutions created in response to the crisis can be effectively integrated into broader national ecosystems that meet future health needs of populations over the coming decade and beyond.

The harmonization and coordination agenda therefore frames the discussions at both meetings. This creates an opportunity for what are currently multiple and siloed solutions—including mobile technologies—to converge into whole-system solutions. By bringing together policy-makers, medical, telecom, biotech, implementation research, and donor communities, these two events begin the conversations that will guide and support strong digital health systems in West Africa and beyond.

1 As of May 6, 2015 from http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html
2 http://bit.ly/1dVNHQL

This blog is the first in a series, linked to the themes of the Accra and Wilton Park events. Over the next six weeks, thought leaders and experts will share their insights with the global community, focusing on topics such as HIS interoperability, frontline health worker training and support, best uses of data and long term collaboration.