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Dykki Settle leads IntraHealth International and the IntraHealth-led CapacityPlus project’s efforts in health worker informatics, bringing a health worker-centered approach to the availability and use of high-quality information.
Data, data, data—they’re the fuel that powers any robust national health care system. They can propel a country toward the Shangri-La of universal health coverage—or they can hold one back. IntraHealth’s Dykki Settle answers five questions about how the right information in the right hands could pave the way to health care for all.
How exactly can information and data help countries to achieve universal health coverage?
Data and information systems are critical. You need them in order to know how big the problem is and how to go about fixing it. Right now, many governments don't have a good sense of who in their countries has access to health care and who doesn't. The best way to find out is to measure the population’s access to trained, skilled health workers. So you need to know: Where are the people who still need access to care? What are their health needs? How rural and remote are these populations and how far are they from health services?Then you need data about the health workers. Where are they? What are their skills? Are they all licensed and qualified to provide care? What geographic areas do they cover? With good, strong data like these, you can see exactly how far your country’s health sector is from the ideal of universal health coverage. And you have to know that gap—or the size of the problem—before you can effectively fix it.
How can health worker registries help?
In every country, there are many different sources that generate data about health workers—there are the ministries of health and other national ministries, of course, but there are also for-profit providers, faith-based organizations, nonprofits, nongovernmental organizations, military health care providers, and even prison-based health care providers. There are also professional associations, boards, and councils that maintain data on specific cadres—nurses, doctors, pharmacists, midwives, and so on. But none of them has a complete picture of the workforce. Everybody's got their own piece of the puzzle.
A health workforce registry aggregates data from all of these different information sources, identifies conflicts in the data, and helps to build a high-quality, comprehensive information resource on the health workforce. Only with that big picture can you really see your true denominator of the health workforce and how that measures against your target of total universal health coverage. But that big picture is difficult to create.
Why is it so difficult to collect and maintain the data a country needs to see that big picture of its health workforce?
The first challenge is stakeholder leadership—getting everyone to agree to combine the datasets that will build the registry. The next challenge is a lack of ICT (or information and communication technology) professionals who can maintain the necessary technologies. And overshadowing both of those is a third challenge: a lack of a culture of data use. Many officials aren’t used to using this kind of information, and therefore don’t value it. Also, many times, certain stakeholders will silo their information—they’re not incentivized to share it or they feel threatened by the idea of sharing it. And once everyone does agree to share and you can compare disparate datasets, you have to be prepared to deal with what emerges. For example, say we have data from a nursing council that insists there are X nurses working in the public sector. But the public sector data say there are actually Y nurses. Who's right? How do we resolve these issues? Another common challenge is that providers who work in the public sector during the day often moonlight within the private sector at night. Maybe that's something the private sector is okay with, but the public sector may not be. In cases like these, the data can threaten people's livelihoods. As you can see, it gets really complicated really fast.
Of all the ways iHRIS helps to address these problems, how does it make the greatest impact?
Through local innovations. iHRIS is simple, easy-to-use, open source software that we developed to help health-sector leaders track, manage, and plan their health workforces. It’s now being used to track over 675,000 health worker records worldwide. And thanks to its open-source approach, local individuals and organizations are starting to take on ownership of iHRIS and adapt it in ways we never anticipated.
In Tanzania, for example, it’s been adapted to track not only health workers but also parasocial workers. And the University of Dar es Salaam in Tanzania has even adapted iHRIS to track their institutional assets, such as furniture and computers. It has nothing to do with health worker data, but the fact that iHRIS provided a platform that they could easily adapt means that the tool has value far above and beyond anything we set out to do. These innovations are going to be the key to making iHRIS sustainable. If there was a team that independently saw enough value in iHRIS to adapt it to meet their needs, that means they see enough value in it to encourage and contribute to its ongoing success. And when somebody down the line has another similar need, they’ll know someone they can reach out to and say, for example, “Hey, we'd really like to track employee benefits better and differently than we are now. You were able to adapt this into an asset tracker, surely you can add a benefits module for us."
And so we’re starting to see this web of interconnectivity and support that's no longer dependent on any single global organization or global funder. It’s very exciting.
What’s an example of a country using iHRIS to change its health sector?
Zanzibar is now using data from WISN (or Workload Indicators of Staffing Needs, a World Health Organization tool) in conjunction with data from iHRIS to increase the size of its health workforce. WISN is a tool for determining your staffing need and iHRIS is tool for determining what staff you have—literally, your target versus your gap.
For the past three years in Zanzibar, the Ministry of Health has had funds for just 30 new health workers per year. But Zanzibar’s officials looked at this new data and said, "Wow, according to this, we need a heck of a lot more than 30 per year. We need over 300 a year." And so the Deputy Minister of Health was able to meet with the President of Zanzibar and show that the health sector needed more funds to provide the health services Zanzibar’s people need.
Thanks to the data—and to IntraHealth’s Tanzania Human Resource Capacity Project for supporting and championing this kind of work—Zanzibar’s health workforce has increased by over 27% in the last few years, and it will continue to grow. As other countries grow their own systems and sharing agreements, they will experience similar success.
This is a huge victory. Because you can have everything else in the world—medicines, facilities, supplies—but without health workers, your people are not going to get care.
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