Strengthening Health Systems Through Digital Transformation

26 May Strengthening Health Systems Through Digital Transformation

Stuardo Herrera is the informatics technical advisor at Palladium, an HRH2030 program partner. 

Recently, USAID launched the Health System Strengthening (HSS) Vision, which made me reflect on the role of data as an enabler of the vision. Particularly, data is an essential driver for strengthening the health workforce, contributing to the resiliency and sustainability of the system. The vision proposes to focus USAID and stakeholders’ efforts on three goals: equity, quality, and resource optimization for health systems strengthening. We have all heard the quote, “you can’t improve what you don’t measure.” In this case, we could say that you can’t strengthen what you don’t measure. To optimize resources and ultimately achieve health systems equity and quality, health systems need to have quality health workforce data that can be used to measure and support action on health systems’ most pressing  challenges.

I was lucky to be part of the HRH2030 Indonesia team, whose work has been recently recognized by USAID as one of five winners of the 2020 Awards for Digital Development (“The Digis”). Working with USAID Indonesia, our support to Indonesia’s Ministry of Health started in 2018 with a simple yet powerful question: What areas of the SI-SDMK, Indonesia’s Human Resource Information System (HRIS), needed to be strengthened to improve HRH data availability and use? Ultimately, the MOH wanted to have better data to address some of their key resource optimization challenges. They wanted to have a well-trained, high-performing national health workforce, with the appropriate HRH skills mix and effective distribution, to ensure that the population’s needs could be met.

After using the HRIS assessment framework (HAF), a tool developed by USAID and PEPFAR to assess HRIS in several functionality and capacity areas, we found that SI-SDMK was strong in its technology infrastructure, decentralization, sustainable financing, and staffing capabilities. However, there was still work to be done in data completeness. The vision of the BPPSDMK, the Directorate General of Human Resources for Health, Ministry of Health, was to have a complete, end-to-end view of their health workforce, from production to deployment. We knew that with Indonesia’s specific context – 265 million people, with 1.2 million health workers scattered across more than 17,000 islands – the challenge wasn’t going to be easy. We needed to take a systemic and sustainable approach framed within a digital transformation strategy. In general terms, digital transformation means reinventing how we work using technology and data as a critical enabler to produce better and faster outcomes. It requires a change in mindset to understand that we are not working on digital initiatives in international development anymore but that we are doing development in a digital age. Here are five lessons we learned in our journey to achieving digital transformation at HRH2030:

1. Take an ecosystems approach: A critical factor of digital transformation is to think not about how an isolated technology will be implemented but how stakeholders, information systems (new ones or pre-existing ones), and enabling environments will work together to achieve outcomes. In Indonesia, like in many other parts of the world, HRH data is scattered throughout many data sources managed by different stakeholders, both outside and within the MOH, creating islands of information and making it impossible to build a complete picture of the health workforce. This required a change in mindset in which BPPSDMK took charge of collecting and managing a portion of the HRH data and having a coordinating role among the stakeholders that produce and manage data. Instead of strengthening an information system, we needed to build bridges to interconnect all the different islands of technology solutions and stakeholders.
2. Promote an open architecture, open-source and open standards strategy: As health systems digitize and an increasing amount of data on the health workforce is available, health systems need to have a technology architecture capable of easily integrating new data sources, independently of the technology used to generate it. This leads to complete information about the health workforce and its challenges and a more flexible and resilient human resources digital ecosystem. In Indonesia, this was possible by implementing open source global goods such as OpenHIM to create interoperability and DHIS2 for data warehousing capabilities. Also, the use of open standards, such as HL7 FHIR, was vital to ensure all digital systems “speak” in the same language.
3. Establish information systems governance: Just as technical interoperability is necessary, “people interoperability” is also crucial. Thanks to governance, the different actors involved in the HRH data ecosystem are taken into account, promoting data sharing, accountability, and sustainability.
4. Promote a data use culture that considers all stakeholders’ information needs: With the right tools and processes, we can have vast amounts of HRH data, but at the end of the day, what matters is how these data are used to make decisions that will improve the health system’s capacity and resource optimization and ultimately, support health workers for improved quality of care. The HRH2030 Indonesia team works with the BPPSDMK to build data use skills and generate constant feedback loops with the facility, provincial, district, and national users to understand their information needs, adapt the strategy, and provide meaningful data to them.
5. People should be at the center of the strategy: The last, but in my opinion, most important lesson is that people’s needs and motivations should drive the strategy. First, we need a deep understanding the challenges and context of health workers. From Indonesia, we learned that working hand in hand with the MOH team, creating a community of practice around data use, providing capacity building, and meeting users where they are along the journey to self-reliance is critical for sustainability. Adhering to this basic principle has ensured that even when the HRH2030 activity finishes, the Indonesia MOH can respond to their own needs.

Through this focused approach, Indonesia’s MOH now has a game-changing analytics platform that helps stakeholders at all levels make HRH planning decisions that will ultimately strengthen the Indonesian health system. They are building their path to digital transformation.

Photo: Stakeholders in Indonesia’s human resource information system, SI-SKMK, in Maros District, South Sulawisi, during a health workforce data integration and use workshop in April 2021.