How do you strengthen a health system? This is a complex question public health experts are still trying to answer. At JSI, we know that expanding access to good health data — and getting people to use the data — is a critical piece of the puzzle.

Pakistan | 2017

In Pakistan, JSI’s was asked to strengthen the health system of Pakistan’s second-largest province, Sindh, with a focus on reproductive, maternal, newborn, and child health (RMNCH) services.

JSI worked with the government of Sindh to expand access to good data and motivate health managers and health providers to use the data to make important decisions about financing, service provision, and more.

Results were impressive: Sindh health budgets grew by 137 percent as managers learned to use data to substantiate their budget requests. Furthermore, 80 percent of Sindh’s districts were able to solve health sector challenges on their own, and the accuracy of health data improved from 64 to 79 percent in just two years.

In the photos below, we’ll “follow the data” from the collection to decision-making stages to understand how good data can truly transform — and strengthen — a health system.

Dr. Anwar Shah, a lady health worker supervisor, is collecting data from a lady health worker in Umerkot district, Sindh. This data will be uploaded to the integrated dashboard, where health managers in all districts and at the provincial level will be able to use it for planning, budgeting, and troubleshooting.

At the click of a mouse, health managers and health providers have access to the DHIS2, management information systems for vertical programs such as malaria and lady health workers, and various health sector surveys. The integrated dashboard also includes the monitoring and supervision system (M&S), which allows district and provincial managers to verify that supervisory visits are taking place, monitor areas of strengths and weaknesses, and plan for how and where to make improvements.

The HSS Component provided technical assistance and training to district and provincial teams to use the integrated dashboard for planning, budgeting, and troubleshooting. Here, Dr. Akhlaque Khan and his team from the Director General Health Services office are using the integrated dashboard to retrieve data for planning.

A lady health worker (LHW) writes health data (e.g., immunizations, illnesses, pregnant women) on the wall of a house in rural Sindh. The integrated dashboard allows users to view data on each individual LHW, including her performance, commodities she has available, and more. When the LHW data first was transferred to the online dashboard, health managers discovered that many LHWs did not have enough commodities to perform their duties. This provided agency for LHWs to advocate successfully for more funds.

After receiving technical assistance from the HSS Component, district health managers are now able to use and analyze their data (made accessible via the online integrated dashboard) to resolve 80 percent of their own district-level challenges. Open, accessible data has also generated a healthy competition among districts. Each district wants to been seen as high-performing, which further propels improvement.

The integrated dashboard allows provincial health managers (shown here are Dr. Akhlaque Khan and his team from the DGHS) to view and compare data across facilities and districts. They can also monitor supervision visits through the online monitoring and supervisory system.

The online integrated dashboard made data transparent in Sindh Province. This transparency allows actors at every level of the health system (provincial managers, district managers, health workers) to advocate for and make positive change.

The JSI-implemented Health Systems Strengthening (HSS) Component of USAID’s Maternal and Child Health Program ran from 2013 to 2017 in Pakistan.  Read the full story.

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