Innovative dashboard for optimising emergency obstetric care geographical accessibility in Nigeria: Qualitative study with technocrats

Abstract

ObjectiveTo explore perspectives of public sector technocrats on the role of and considerations needed for implementing an innovative dashboard that leverages geographic information systems (GIS) in supporting optimisation of emergency obstetric care (EmOC) geographical accessibility in Nigeria. MethodsTwenty-three semi-structured interviews were conducted in person or virtually with six policymakers and 17 senior civil servants in Nigeria. Braun and Clarke's six-step approach to thematic analysis, which involved data familiarisation, initial code generation, searching for themes, reviewing themes, defining themes, and producing the report, was applied. ResultsDespite recognising the ideal of data-driven needs assessment, in reality, factors such as political pressure, persistent community advocacy, and donor funding drive decisions on siting EmOC facilities. Irregular short-term political cycles and exigencies in health systems prevent new facilities from being established or motivate a focus on facility quality over quantity. There was a strong appetite for using GIS-enabled dashboards to support planning, with enthusiasm for such technology more apparent where innovation was already part of government's philosophy. A digital dashboard that is dynamic, reflective of reality, inclusive of public and private providers, incorporates facility characteristics, and can test accessibility scenarios, was deemed particularly valuable. Its value proposition extended beyond EmOC and provider type. However, its success as a policy tool will depend on the veracity and currency of the data informing it. ConclusionsTechnocrats welcome dynamic GIS-enabled dashboards as it offers a significant step-change compared to the current practice for EmOC service planning. Value-for-money of such innovations must be considered if implemented. Public Interest SummaryPlanning and siting of emergency services used by pregnant women (EmOC) in many low-resource countries are mostly haphazard. However, there is increasing recognition that technology can refine this process. In this study, we explored perspectives of public sector technocrats in Nigeria on the role of and considerations needed for implementing an innovative digital dashboard that leverages geographic information systems in optimising EmOC geographical accessibility. We found that current planning is mainly driven by political pressure, community advocacy, and donor funding. However, there is a strong appetite in government for using GIS-enabled dashboards to inform service planning, with enthusiasm for such technology appearing to be more grounded in states where innovation was already part of the government's philosophy. Yet, concerns about data accuracy were expressed. Broadly, dashboards that are dynamic, reflective of reality, inclusive of public and private providers, incorporate facility characteristics, and can test access scenarios, were deemed particularly valuable.