Strengthening Health- Applying Research Evidence (SHARE)

‘Alone we can do so little, but together we can do so much’ - Professor Dr. Abul Kalam Azad, Director General of Health Services rightly quoted in his inauguration speech during International Conference on ‘Data for Decision (D4D) in Health’. Bangladesh has become a bright example of such togetherness for strengthening health information system. This extraordinary partnership has resulted remarkable progress in relation to health data generation which has already drawn global attention.  ‘Measurement and Accountability for Results in Health’ Summit at World Bank Headquarters in June 2015 was the first step in developing a health data collaborative partnership between members of the global health community. South Africa and Bangladesh were co-sponsoring countries of that summit convened by the USAID, WHO and World Bank Group. This articulated a shared responsibility for creating framework of measurement and accountability in health sector.  Afterwards, Conference on Measurement and Accountability for Health in the Asia Pacific and AeHIN 4th General Meeting of October 2015 in Indonesia focused on investment planning and implementation of scalable and sustainable M&E systems, health information systems, and e-Health solutions.  It was decided there that Bangladesh would host the first Regional Conference on Measurement and Accountability in April 2016 and it was organized successfully. Within just one year, Directorate General of Health Services (DGHS) organized this ‘D4D in Health’ Conference during 1-3 April, 2017 in Dhaka with the support from European Union, SHARE project of icddr,b, UNICEF, UNFPA, WHO, Vital Strategies of Bloomberg Philanthropies, Measure Evaluation, USAID funded SIAPS program, Access to Information Programme and HISP Bangladesh.

Development is a collaborative process. D4D conference created defining moments for Bangladesh to apply enduring experience and knowledge of national and global partners in strengthening health information. This collaborative journey started in 2009 when an integrated approach was initiated for developing a well-functioning health information system. With GIZ support, Ministry of health and Family Welfare (MoHFW) developed a central electronic data repository for national health data, using DHIS2 (a free and Open Source health information system developed by University of Oslo) with the aim to bridge the gap by bringing together the data from various systems. With support from different development partners like European Union, icddr,b, GIZ, UNICEF, and DFID, DGHS is conducting capacity building training on DHIS2 use for the health managers, IT focal persons and statisticians in all divisions. This helps them to increase skills on data analysis, interpretation and creating their own dashboards in DHIS2 with charts, pivot tables and GIS maps resulting in enhancing data informed decision making in health sector. These capacity building initiatives were reflected in D4D Conference. Data management in family planning programme was also addressed in the Conference showcasing how Family Planning Department uses logistics data to manage distribution of contraceptives at service delivery points and for procurement or forecasting demands. With USAID support, Ministry has improved decentralized decision making in reducing stock-out for any family planning method, increased availability of modern contraceptives which are contributing to reduce unintended pregnancies and prevent maternal deaths.  

D4D Conference showcased how MoHFW invested on developing key systems such as Human Resource Information System - to manage human resources delivering health service,  ‘Shastho batayon’ - Health call center to get free medical consultation from Doctor and integrated media monitoring tool which organizes all health news published in national media. Open display of health data and development of monthly on-line Local Health Bulletin for each health facility are also significant initiatives of DGHS. A central health information dashboard has been created and lodged in DGHS website, where anyone can view current status of health system without username and password. This dashboard is helping health managers to monitor different indicators from routine health data. Decision makers are now able to view the distribution of heath workforce and reallocate resources based on evidence. Technical session of the conference focused on importance of routine health information system, shared global experience on combining information from routine and non-routine data for management of health services, addressed challenges on use of routine health information and how to improve use of data for decisions at local, district and national levels. Mobile SMS complaint and suggestion is another example of innovation in citizen driven accountability system for improving health services initiated by DGHS. Quality Improvement Secretariat and health managers are directly involved to improve service quality based on this SMS driven system. Technical session also showed how DGHS is promoting best practices with WHO support in health care management based on DHIS2 data as reported by health facilities, onsite monitoring, physical assessment of facilities and patient satisfaction survey. This is expected to improve accountability among health manager and enhance responsiveness, create a culture of good performance, and transparency. Vital insights from the technical sessions of conference were:

• Necessity to change mindset and practice, particularly for senior health mangers

• Continuity of capacity development activities on health data use in upcoming sector plan

• Data quality is a combination of technology, people, processes & tools; and it requires creating a culture for data use through system strengthening approach

• Inadequate ICT infrastructure, lack of incentive or motivational factor, lack of integration or interoperability of existing softwares, weak feedback mechanism and data governance have been identified as obstacles.

Sharing knowledge products in marketplace and interaction among national and international experts created value added learning opportunity for the participants. International participants from 15 countries including USA, UK, France, Spain, India, Sri Lanka, Congo, Lao PDR, Netherlands, Germany, Myanmar, Haiti, and Norway attended the conference and visited management information system of DGHS, its local health bulletin and national data centre and participated in interaction with district and upazila level health managers through video conference as part of their regular monitoring system with DGHS. International participants also visited Government Employee hospital of the capital and Kaliganj Upazila Health Complex of Gazipur district to see individual patient’s records under hospital automation process through Open MRS software, birth and death registration through vital registration system.

For icddr,b and other development partners, organizing  D4D Conference led by DGHS created scope to highlight the global and regional progress to date in strengthening health information system, showcase e-health innovations through marketplace, present the country status on ensuring access to information and data visualization. The conference successfully brought together government officials, development partners, leaders from the private sector, academicians, researchers, civil society, media and other national and international stakeholders. Bangladesh still has to go a long way for integrating health data culture in health policy making as emphasized in D4D Conference. This country needs to invest more in strengthening data sources and capacities. More alignment with stakeholders is needed for supporting country health information systems towards accountable and effective health services in line with Sustainable Development Goals. Bangladesh has several important landmarks in attaining the Millennium Development Goals especially in reducing maternal and child mortality. With this spirit of progress, D4D Conference necessitated for designing health programmes based on accurate health data, shedding more urgency on health information research, implementing more evidence-informed programmes, and incorporating innovative and best practices in health policies.