Abstract
Many low- and middle-income countries have pluralistic health systems where private for-profit and not-for-profit sectors complement the public sector: data shared across sectors can provide information for local decision-making. The third article in a series of four on district decision-making for health in low-income settings, this study shows the untapped potential of existing data through documenting the nature and type of data collected by the public and private health systems, data flow and sharing, use and inter-sectoral linkages in India and Ethiopia. In two districts in each country, semi-structured interviews were conducted with administrators and data managers to understand the type of data maintained and linkages with other sectors in terms of data sharing, flow and use. We created a database of all data elements maintained at district level, categorized by form and according to the six World Health Organization health system blocks. We used content analysis to capture the type of data available for different health system levels. Data flow in the public health sectors of both counties is sequential, formal and systematic. Although multiple sources of data exist outside the public health system, there is little formal sharing of data between sectors. Though not fully operational, Ethiopia has better developed formal structures for data sharing than India. In the private and public sectors, health data in both countries are collected in all six health system categories, with greatest focus on service delivery data and limited focus on supplies, health workforce, governance and contextual information. In the Indian private sector, there is a better balance than in the public sector of data across the six categories. In both India and Ethiopia the majority of data collected relate to maternal and child health. Both countries have huge potential for increased use of health data to guide district decision-making.
Highlights
Good quality data from all relevant sources at district level play a major role in health system strengthening
The third article in a series of four on district decision-making for health in low-income settings, this study shows the untapped potential of existing data through documenting the nature and type of data collected by the public and private health systems, data flow and sharing, use and inter-sectoral linkages in India and Ethiopia
In India and Ethiopia, both the public and private sectors play a major role in providing health service delivery, and health data are generated from multiple sources at district level
Summary
Good quality data from all relevant sources at district level play a major role in health system strengthening. According to the World Health Organization (WHO), attributes of health systems include health services, workforce, supplies, financing, governance and health information (WHO 2007). Out of these six building blocks, data from health information systems can help in planning for health workforce, commodities and infrastructure needed to deliver services that improve health outcomes (WHO 2008). Within the public system there are multiple sectors other than health departments that deliver health services Coordination between these sectors can save time and improve quality and cost efficiency, leading to improved health outcomes (Gragnolati et al 2005; Nutley 2012; Pelletier et al 2012; Prasad et al 2013)
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