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10 Lessons for Stronger Health Information Systems in Ebola-Affected West Africa

The need for stronger health information systems and disease surveillance has always been an issue in West Africa, but for me and others in global public health, Ebola forced the issue.The ongoing outbreak—marked early by a lack of information on transmission and case notification, and severely disrupted health services—has shed light on grave weaknesses in the health systems in Guinea, Sierra Leone, and Liberia.These weaknesses contributed to the spread of the disease and the loss of more than 11,100 lives.

Believe it or not, the technology is the easy part.

They also brought together the international community in Accra, Ghana, last month for the Annual Joint Meeting of National Health Information Systems and of Integrated Disease Surveillance and Response Managers with Technical and Financial Partners. I was honored to be invited to participate and to engage with so many global stakeholders.During May 18–21, participants from around the world came together to develop a consensus for action to improve health information systems in West Africa as the region continues to overcome and eventually recovers from the epidemic. These systems ensure that the right information goes to the right users at the right time, and form the backbone of any health system.In Accra, 10 main points came to light:

1. It’s not just about the technology—it’s about deploying technology responsibly.

Believe it or not, the technology is the easy part. Engaging the many stakeholders to agree on processes, policies, and data sharing—even within different levels of government—is the larger challenge. Officials must make decisions to responsibly deploy systems that support the needs of their countries.

2. There is great value in face-to-face engagement.

You can only accomplish so much with email, webinars, and Skype calls. Taking the time to meet for several consecutive days facilitates discussion and problem-solving that doesn’t occur virtually. When thoughtfully planned, meetings like the one in Accra are worth the time and expense.

3. Governance, leadership, and ownership are key.

Before determining indicators, partners, or even applications, local governments must prioritize leadership and good governance for health information systems. Some recommendations included elevating the authority of health information systems within government, calling for governments to establish national coordination entities, and developing a health information systems policy and strategy. And of course, ministries of health must be in the driver’s seat.

4. Users must be the center of technology design and implementation.

Designers of systems, applications, and platforms, must engage their users. By bringing users on at the beginning of technology development—not when the technology is ready to be implemented—designers can be sure the approach will meet users’ needs and align with their systems and infrastructure.

Governments should only implement technology that is meaningful to them.

5. Implement what is meaningful.

Technology can be driven by donors or by partners. But governments should only implement technology that is meaningful to them and will help advance their health agendas, not just what is available.

6. Real time doesn’t mean real fast.

There has been a lot of buzz about real-time data. Countries need data as fast as they can use it for action, and that may not mean instantaneously.

7. Partnership will take us far.

It takes transparency and committed partnership to support health information systems. This work is not easy and requires expertise and support from many different disciplines. My favorite quote from the meeting was an African Proverb: “If you want to go quickly, go alone. If you want to go far, go together.”

8. Investments in infrastructure pay off.

No matter how robust the electronic platform or well-designed the mobile application, it will not work in a setting that lacks a supportive infrastructure. Mobile network coverage, cable for internet, and equipment and hardware are necessary for running digital health technologies. Investments should be made here early—not when you realize your program won’t work because of poor infrastructure.

9. Users of technology and data can benefit from training.

Using data and building technology are not innate in some settings. Consider building the capacity of your technology and data users, specifically in data analytics and use.

10. This is a process with a committed community.

Meaningful improvements to West Africa’s health information systems will not happen overnight. This is a process that involves many stakeholders.Accra was unique—a rare and valuable opportunity to bring the right people together at a critical time. This is not a moment for complacency—we must work together now to improve health information systems.A follow-up event at Wilton Park in Sussex, England, next month will allow stakeholders to come together again to build on the discussions and plans made in Accra. With a focus on mobile technology and health systems, the Wilton Park agenda will host private-sector stakeholders, senior-level ministry of health officials from West Africa, and international partners to foster ongoing collaboration and plan scalable, sustainable solutions.I’m preparing for this event now, and I’m excited to see concrete next steps for improving West Africa’s health information systems.Photos courtesy of Amanda Puckett.