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Data Can Tell Stories—and Improve Health Care

My family has always valued the art of storytelling and maintaining our oral history through generations.  I remembered that as I stood in line for lunch one day at the DHIS2 & iHRIS Interoperability Academy in Monrovia, Liberia, this month, when one of the data managers from Cape Mount County remarked, “Data tell stories.” The academy was the first of its kind, the beginning of what I hope is a long story about harnessing the power of health information systems to improve the health of populations. Some background: DHIS2 is software that aggregates service delivery data, such as numbers of antenatal care visits or new users of Depo-Provera at a health facility. And iHRIS (pronounced “iris”) is a software suite that manages data about the health workforce, such as numbers and types of health workers, their qualifications, and other details that help in planning and managing a health workforce. Both systems are open source and in use throughout sub-Saharan Africa and other regions of the world. 

Looking around the room, it was fascinating to see over 90 participants working together to use the systems and their data.

Each system on its own provides valuable information for health facilities—or even entire countries—that are working to plan and manage their health workforces. But the two systems together can produce data that, when correctly analyzed, capture the on-the-ground reality of health care.

The academy in Monrovia was the first time the developers and software experts who use DHIS2 and iHRIS have come together to learn to make the two systems operate together, and practice customizing the data systems so they can speak the same “language.”

This interoperability allows users to link and move data between the two systems. The academy was also the first time participants could analyze live data from a country’s DHIS2 and iHRIS during a training to answer questions about how to improve service delivery for family planning. Looking around the room, it was fascinating to see over 90 participants working together to use the systems and their data. Participants came from all levels of the health system—there were international and national data managers, software developers, regional family planning stakeholders, and representatives from the Liberia Ministry of Health and Social Welfare.

It was beneficial to see everyone looking at data use—not just the management of information but the use of it.

The National Family Planning Strategy 2009-2014: Increasing Access to and Utilization of Family Planning Services in Liberia highlights seven strategic objectives, which were used as the backdrop of the data use sessions at the academy.  Participants used DHIS2, iHRIS, and other resources and drafted action plans for eight counties. The plans outlined activities each of these counties could do to improve family planning service delivery in-line with the strategy objectives.

“It was beneficial to see everyone looking at data use—not just the management of information but the use of it,” said Tomé Ca, Professional Officer for Health Information Systems at the West African Health Organization. “I liked to see the professionals at the county level work with the team of stakeholders to develop action plans using the data. We need to see more of this.”

Family Planning: Liberia's Story

My role at the academy was to engage and support participants to use the data to tell the story of family planning in Liberia. Together, we looked at the trends in modern contraceptive use at the county and facility levels and compared the data available in iHRIS to see what kind of health workforce information could further inform our analysis. We saw that at one facility, use of modern methods such as oral contraceptives had increased. But at the same facility, permanent methods such as vasectomies sat at zero.

Why?Was it the absence of a qualified health worker to provide vasectomy services? We asked questions like this to uncover stories through the data. Participants tapped into other data and information sources, too, such as the Liberia Demographic Health Survey, K4Health tools, and the HRH Global Resource Center. And by the end of the four-day event, we had kindled an appetite for inquiry, knowledge sharing, and data use.

Together we learned at least some of the stories the data had to tell—for example, that it’ll take behavior change communication and greater information sharing about modern contraceptive methods to increase the contraceptive prevalence rate in Liberia. And that adolescent pregnancy is a major challenge, too. The Ministry of Health and Social Welfare is now interested in comparing teenage pregnancy rates with data from DHIS2 and iHRIS to inform possible solutions.   The academy built an innovative bridge between health information system technologists and family planning service delivery decision makers. Together, we are making important inroads to using data to inform changes so that men and women have access to comprehensive and high-quality family planning and reproductive health services.

The DHIS2 and iHRIS Interoperability Academy was organized by the Ministry of Health and Social Welfare and USAID Liberia’s Rebuilding Basic Health Services Project (led by JSI),  in collaboration with the Knowledge for Health Project, IntraHealth International, and the University of Oslo.

Photos courtesy of Amanda Puckett.