The 30 practitioners from 13 countries across Latin America, Africa and Asia who gathered in Hanoi, Vietnam this September convened in the pursuit of a shared goal: achieving universal health coverage for their country’s citizens through strengthening their primary health care systems.
Primary health care (PHC) is foundational to creating health systems in which all citizens—regardless of their economic standing—have access to high quality and affordable health care services.
Throughout the journey of developing a comprehensive PHC system, however, many countries face similar challenges in measuring PHC system performance–and know that it’s difficult to improve what you can’t measure. Gaps in difficult-to-measure service delivery areas such as quality of care, the fragmentation of data sources across disease areas or health programs, and data quality issues limit countries’ ability to gain a comprehensive view of PHC. Countries also face obstacles in making sure that data are not just collected, but are used routinely and effectively to prioritize areas for improvement, identify practical solutions, and monitor progress.
The representatives from national health agencies and monitoring and evaluation departments came together for the fourth in-person workshop of the Primary Health Care (PHC) Measurement for Improvement collaborative to address measurement challenges as part of a cross-country learning group under the JLN’s Primary Health Care Initiative. Held in partnership with the Primary Health Care Performance Initiative, the workshop was generously hosted by the Vietnamese Health Strategy and Policy Institute and included partners from Ariadne Labs, the Bill & Melinda Gates Foundation, PATH, Results for Development, and the World Bank Group.
The collaborative addresses measurement and data challenges in primary health care systems by developing practical tools and approaches that can support country policymakers, health system managers and frontline providers to more effectively use data to improve PHC. To achieve this goal, the group is collectively developing a toolkit that will provide guidance and a set of functional tools to help countries identify and fill measurement gaps and formulate strategies to ensure that primary health care data are routinely used for improvement throughout the system.
During the Vietnam workshop, participants and facilitators collaborated closely to produce content for the toolkit, drawing from the expertise of the implementers around the room. Throughout the discussions, practitioners articulated five key insights on measurement and data use:
To drive improvement, data must be translated into information and knowledge that supports decision-making and action. Successful implementation of the data to improvement pathway requires countries to build the systems for data collection, the individual capacities to give and receive data, and a culture that builds demand and value for data use.
Though challenging, this often requires countries to put things in reverse: rather than starting with pre-existing data, practitioners should start with the decisions that need to be made at different levels of the primary health care system and work backwards to the data (and systems, capacities, and culture) that are needed to support them.
The technical part is the easy part – the challenge is often human. For example, when establishing a data warehouse—an electronic system that links data sources to store and access large quantities of data—countries need to go beyond thinking about interoperability of data sources or different technology platforms. Often the most pressing challenges relate to the people who will use the warehouse, from their technical skills to resistance to the introduction of new technologies into existing processes. The overarching advice? Keep it simple—don’t scare people away with too much complexity or technology.
When it comes to effective data analysis and visualization, it’s important to understand what motivates your audience. It’s not just about knowing the key stakeholders and selecting the right data they need to make decisions. For truly effective communication, a data producer must consider the full profile of that stakeholder—are they motivated by passion or costs? Do they want to hear numbers or stories? By delving into the details, data managers can ensure that they present data in useful and impactful ways that will drive action.
Even when you have the right information, decision-making isn’t just dependent on data. There are many other factors that impact decision-making, from politics and the media, to budgets and available resources, and it’s up to implementers to find practical ways that measurement can influence these processes.
With so many competing factors, it’s important to build a culture of and demand for data, so that data use for decision-making becomes institutionalized throughout the system. This is easier said than done: it requires important components that take time and commitment to build, from inspiring leadership, to the right enabling environment, to mechanisms for accountability and transparency at all levels. A critical step involves establishing a safe space where performance results can be shared without a punitive response.
When it comes to change, you can never say you’ve arrived – you must keep monitoring and improving. The data to improvement pathway isn’t just a series of steps, but a continuous cycle that involves routine measurement and iterative improvement. As countries continue to strengthen the way they measure PHC performance, comparative benchmarking—using global indicator sets like the PHC Vital Signs—can be helpful to track progress and share results, while peer learning supports countries to discuss strengths and weaknesses, exchange experiences, and share improvement strategies.
So, what’s next for the PHC Measurement for Improvement collaborative? Over the coming months, the group will continue to work together to finalize the Primary Health Care Measurement for Improvement Toolkit, which will be available for country use by early 2018.
But the action won’t stop at the collaborative level. During the workshop, each country team created an action plan to strengthen PHC measurement in their respective countries and committed to take steps toward implementing this plan at home. With more and better data, countries will have the information they need to drive efforts to improve primary health care along the path to achieving universal health coverage.