District Decision-Making for Health in Low-Income Settings: A Feasibility Study of A Data-Informed Platform for Health in India, Nigeria, and Ethiopia

Session: District Decision-Making for Health in Low- and Middle-Income Countries: Assessing the Feasibility of a Data-Informed Platform for Health through Multi-Country Studies

Presenter: Bilal Avan, IDEAS Project, London School of Hygiene & Tropical Medicine

Background: The potential of health-information systems for MNCH planning and decision-making at district level remains unrealised in developing-country settings. Lack of sound infrastructure, robust technology and a culture of evidence-based decision-making are the key challenges, as discussed in the preceding abstracts. A data-informed platform for health (DIPH) is proposed as a promising way forward for guiding district-level stakeholders, and coordinating data-based decisions that could influence MNCH. This study describes implementation research assessing the feasibility of establishing a DIPH in district health systems in Ethiopia, India and Nigeria.

Methods: A cross-sectional, descriptive feasibility assessment for implementing a DIPH was conducted in Ethiopia, India and Nigeria, using mixed qualitative methods to triangulate findings. Assessment was primarily at district level – the lowest administrative unit of health-system management with potential to make independent decisions about health-service delivery. The study was based on the five dimensions of the TELOS framework: Technology and Systems, Economic, Legal and Political, Operational, and Scheduling Feasibility.

Results: India’s health system was found to be most amenable to a DIPH, due to stronger infrastructure, better technological and technical expertise, availability of financial resources, and an existing district-level forum for stakeholders. However, a challenge for India – in contrast with Ethiopia – is the absence of an effective legal framework for engaging with the extensive private health sector. Improving Northeast Nigeria’s damaged health infrastructure takes precedence over initiatives like a DIPH in the short term. Lacking across all three geographical contexts are standardised decision-making processes for data-based decision-making at district level.

Conclusion: Based on the TELOS framework’s five feasibility criteria, India is most eligible for a DIPH, followed by Ethiopia. However, health systems stakeholders in all three country settings agreed on the potential value of a DIPH to enhance the use of local data in collaborative, effective decision-making for MNCH services.