The Transformation from Data-Dismissive Attitudes to Data-Driven Practices at a Primary Health Care Unit in Ethiopia

On October 29, 2022, Jamel Ahmed, head of Lera Primary Health Care Unit (PHCU) in the West Azernet Berbere District of the Southern Nations, Nationalities and Peoples’ (SNNP) Region of Ethiopia, welcomed visitors with a wide smile. Regional health information system (HIS) workers from 11 zonal health departments and seven special districts were visiting to share experiences of the PHCU, which has six health posts (HPs) reporting to it. Recently, the facility has become a popular learning hub at which regional HIS workers learn how to implement the Ministry of Health’s (MOH) Information Revolution (IR) strategy.

The Process of Change

Before becoming an intervention site for the Ethiopia Data Use Partnership (DUP), a collaborative initiative between the MOH and JSI, in 2019, Lera PHCU struggled with a culture of poor data quality and use. A 2019 assessment revealed that it had suboptimal HIS and monitoring and evaluation (M&E) infrastructure and arbitrary decision-making practices, which led to poor service delivery. The PHCU scored 63 of a100 in its implementation of the IR—a national strategic directive to transform management and use of health information to ensure evidence-based actions. The score indicated that the health facility was unable to perform the minimum requirement for information use due to lack of proper implementation skills, functioning M&E structures, and information technology infrastructures.

The DUP team supported HIS strengthening in the facility. First, it ensured that staff understood its major intervention activities, which included digitizing HIS tools, assuring data quality, and improving data use culture. Then it trained almost 50 staff from Lera and its six HPs on IR implementation, district health information software-2; data analytics and visualization; health management information systems (HMIS); and community health information system.

Next, DUP’s team focused on identifying and ending processes and behaviors that prevented data-driven decisions. Revitalizing the performance monitoring teams (PMTs)—comprising health workers who review performance, identify gaps, and develop and implement corrective actions—was a top priority. Beyond reinstating the PMT at the management level, DUP helped establish and operationalize PMTs at the case-team level, the lowest and smallest unit within Lera’s organizational structure. DUP provided supportive supervision to monitor health worker progress and mentoring to improve data recording and documentation practices. As a way to sustain the results and outcomes achieved from the activities, intervention efforts also focused on infusing a cultural change in staff data practices from indifference to evidence-based.

In addition to building staff capacity, DUP supplied Lera PHCU with information communication technology equipment that included computers, tablets, and data visualization tools. DUP also refurbished two standard cardroom shelves and reorganized the medical records unit room to ensure access and ability to track patient data. “DUP-led support has made all the difference. It has improved skill and knowledge to implement health information-transformation initiatives. Similarly, material supports in the form of computers, tablets, shelves, and others provided the resources to translate acquired knowledge to actions,” said Jemal.

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