District decision-making for health in low-income settings: a feasibility study of a data-informed platform for health in India, Nigeria and Ethiopia.

Joanna Schellenberg,Nasir Umar,Deepthi Wickremasinghe,Bilal Iqbal Avan,Della Berhanu

doi:10.1093/heapol/czw082

Joanna Schellenberg, Nasir Umar + Show 3 more

Open Access

https://doi.org/10.1093/heapol/czw082

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Abstract

Low-resource settings often have limited use of local data for health system planning and decision-making. To promote local data use for decision-making and priority setting, we propose an adapted framework: a data-informed platform for health (DIPH) aimed at guiding coordination, bringing together key data from the public and private sectors on inputs and processes. In working to transform this framework from a concept to a health systems initiative, we undertook a series of implementation research activities including background assessment, testing and scaling up of the intervention. This first paper of four reports the feasibility of the approach in a district health systems context in five districts of India, Nigeria and Ethiopia. We selected five districts using predefined criteria and in collaboration with governments. After scoping visits, an in-depth field visit included interviews with key health stakeholders, focus group discussions with service-delivery staff and record review. For analysis, we used five dimensions of feasibility research based on the TELOS framework: technology and systems, economic, legal and political, operational and scheduling feasibility. We found no standardized process for data-based district level decision-making, and substantial obstacles in all three countries. Compared with study areas in Ethiopia and Nigeria, the health system in Uttar Pradesh is relatively amenable to the DIPH, having relative strengths in infrastructure, technological and technical expertise, and financial resources, as well as a district-level stakeholder forum. However, a key challenge is the absence of an effective legal framework for engagement with India’s extensive private health sector. While priority-setting may depend on factors beyond better use of local data, we conclude that a formative phase of intervention development and pilot-testing is warranted as a next step.

Highlights

Low-resource settings often make only limited use of local data for health-system planning and decision-making (Simba and Mwangu 2004)
To promote the use of local data for decision-making and priority setting we propose an adapted framework known as a data-informed platform for health (DIPH)
We report the feasibility of establishing a DIPH in the context of district health systems in India, Nigeria and Ethiopia, using five dimensions: technology and systems, economic, legal and political, operational and scheduling feasibility

Summary

Introduction

Low-resource settings often make only limited use of local data for health-system planning and decision-making (Simba and Mwangu 2004). There have been several attempts to bring private- and public-sector data together for better decisionmaking (Bryce et al 2005, 2011; Asante and Zwi 2007; Victora et al 2011), including the National Evaluation Platform (Johns Hopkins Bloomberg School of Public Health 2016). This framework guides data-coordination for evaluation and policy-making, bringing together data from the public and private sectors that could influence maternal and newborn health. Implemented at the district level, this approach could improve service planning and co-ordination, but would rely on local health departments and other service providers having ownership of assured data-sharing mechanisms

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