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Open Access 01-12-2021 | Tuberculosis | Research

Key informant perspectives on the challenges and opportunities for using routine health data for decision-making in Senegal

Authors: Pierre Muhoza, Haneefa Saleem, Adama Faye, Ibrahima Gaye, Roger Tine, Abdoulaye Diaw, Alioune Gueye, Almamy Malick Kante, Andrea Ruff, Melissa A. Marx

Published in: BMC Health Services Research | Issue 1/2021

Abstract

Background

Increasing the performance of routine health information systems (RHIS) is an important policy priority both globally and in Senegal. As RHIS data become increasingly important in driving decision-making in Senegal, it is imperative to understand the factors that determine their use.

Methods

Semi-structured interviews were conducted with 18 high- and mid-level key informants active in the malaria, tuberculosis and HIV programmatic areas in Senegal. Key informants were employed in the relevant divisions of the Senegal Ministry of Health or nongovernmental / civil society organizations. We asked respondents questions related to the flow, quality and use of RHIS data in their organizations. A framework approach was used to analyze the qualitative data.

Results

Although the respondents worked at the strategic levels of their respective organizations, they consistently indicated that data quality and data use issues began at the operational level of the health system before the data made its way to the central level. We classify the main identified barriers and facilitators to the use of routine data into six categories and attempt to describe their interrelated nature. We find that data quality is a central and direct determinant of RHIS data use. We report that a number of upstream factors in the Senegal context interact to influence the quality of routine data produced. We identify the sociopolitical, financial and system design determinants of RHIS data collection, dissemination and use. We also discuss the organizational and infrastructural factors that influence the use of RHIS data.

Conclusions

We recommend specific prescriptive actions with potential to improve RHIS performance in Senegal, the quality of the data produced and their use. These actions include addressing sociopolitical factors that often interrupt RHIS functioning in Senegal, supporting and motivating staff that maintain RHIS data systems as well as ensuring RHIS data completeness and representativeness. We argue for improved coordination between the various stakeholders in order to streamline RHIS data processes and improve transparency. Finally, we recommend the promotion of a sustained culture of data quality assessment and use.

AbouZahr C, Boerma T. Health information systems: the foundations of public health. Bull World Health Organ. 2005;83(8):578–83 doi: /S0042-96862005000800010.PubMedPubMedCentral

Pappaioanou M, Malison M, Wilkins K, Otto B, Goodman RA, Churchill RE, et al. Strengthening capacity in developing countries for evidence-based public health: the data for decision-making project. Soc Sci Med. 2003;57(10):1925–37. https://doi.org/10.1016/S0277-9536(03)00058-3.CrossRefPubMed

Walshe K, Rundall TG. Evidence-based management: from theory to practice in health care. Milbank Q. 2001;79(3):429–57, IV-V. https://doi.org/10.1111/1468-0009.00214.CrossRefPubMedPubMedCentral

Wilkins K, Nsubuga P, Mendlein J, Mercer D, Pappaioanou M. The data for decision making project: assessment of surveillance systems in developing countries to improve access to public health information. Public Health. 2008;122(9):914–22. https://doi.org/10.1016/j.puhe.2007.11.002.CrossRefPubMed

Andermann A, Pang T, Newton JN, Davis A, Panisset U. Evidence for Health II: Overcoming barriers to using evidence in policy and practice. Health Res Policy Syst. 2016;14:17.CrossRefPubMedPubMedCentral

Ikmari L, Adewuyi AA, Akinlo A. Decision maker perceptions in Kenya and Nigeria: an assessment of data use constraints. Chapel Hill: MEASURE Evaluation; 2007.

Harrison T, Nutley T. A review of constraints to using data for decision making: recommendations to inform the design of interventions. Chapel Hill: MEASURE Evaluation; 2010.

Nutley T, Reynolds HW. Improving the use of health data for health system strengthening. Glob Health Action. 2013;6:20001.CrossRefPubMed

Uneke CJ, Sombie I, Keita N, Lokossou V, Johnson E, Ongolo-Zogo P. Improving maternal and child health policymaking processes in Nigeria: an assessment of policymakers’ needs, barriers and facilitators of evidence-informed policymaking. Health Res Policy Syst. 2017;15(1):48.CrossRefPubMedPubMedCentral

10.

Qazi MS, Ali M. Health management information System utilization in Pakistan: challenges, pitfalls and the way forward. Bioscience Trends. 2011;5(6):245–54. https://doi.org/10.5582/bst.2011.v5.6.245.CrossRefPubMed

11.

Kumar M, Gotz D, Nutley T, Smith JB. Research gaps in routine health information system design barriers to data quality and use in low- and middle-income countries: a literature review. Int J Health Plann Manag. 2018;33(1):e1–9. https://doi.org/10.1002/hpm.2447.CrossRef

12.

Jones L, Champalle C, Chesterman S, Cramer L, Crane TA. Constraining and enabling factors to using long-term climate information in decision-making. Climate Policy. 2017;17(5):551–72.CrossRef

13.

Naude CE, Zani B, Ongolo-Zogo P, et al. Research evidence and policy: qualitative study in selected provinces in South Africa and Cameroon. Implement Sci. 2015;10:126.CrossRefPubMedPubMedCentral

14.

Barasa EW, Cleary S, English M, Molyneux S. The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study. BMC Health Serv Res. 2016;16(1):536.CrossRefPubMedPubMedCentral

15.

Allen W, Ouedraogo A, McCullough L. Health information needs in West Africa: results of a survey on the role of the West Africa health organization (WAHO). Bobo-Dioulasso: West Africa Health Organization; 2010.

16.

Sylla AH, Robinson ET, Raney L, Seck K. Qualitative study of health information needs, flow, and use in Senegal. J Health Commun. 2012;17(Suppl 2):46–63. https://doi.org/10.1080/10810730.2012.666624.CrossRefPubMed

17.

Hane F. Production des statistiques sanitaires au Sénégal : entre enjeux politiques et jeux d’acteurs. Santé Publique. 2017;29(6):879–86. https://doi.org/10.3917/spub.176.0879.CrossRefPubMed

18.

Diouf O, Gueye-Gaye A, Sarr M, et al. Evaluation of Senegal’s prevention of mother to child transmission of HIV (PMTCT) program data for HIV surveillance. BMC Infect Dis. 2018;18(1):588.CrossRefPubMedPubMedCentral

19.

Dumont A, Gueye M, Sow A, Diop I, Konate MK, Dambé P, et al. Using routine information system data to assess maternal and perinatal care services in Mali and Senegal (QUARITE trial). Revue d'epidemiologie et de sante publique. 2012;60(6):489–96. https://doi.org/10.1016/j.respe.2012.05.005.CrossRefPubMed

20.

Krug C, Cavallaro FL, Wong KLM, Gasparrini A, Faye A, Lynch CA. Evaluation of Senegal supply chain intervention on contraceptive stockouts using routine stock data. Plos One. 2020;15(8):e0236659. https://doi.org/10.1371/journal.pone.0236659.CrossRefPubMedPubMedCentral

21.

Faye S, Cico A, Gueye AB, et al. Scaling up malaria intervention “packages” in Senegal: using cost effectiveness data for improving allocative efficiency and programmatic decision-making. Malar J. 2018;17(1):159.CrossRefPubMedPubMedCentral

22.

Global Fund. Building Resilient and Sustainable Systems for Health (RSSH) Information Note. 2019. https://www.theglobalfund.org/media/4759/core_resilientsustainablesystemsforhealth_infonote_en.pdf. Accessed 14 Sept 2019.

23.

Conseil National de Lutte contre le Sida (CNLS). Plan Stratégique National de Lutte Contre le Sida 2018-2022. https://www.cnls-senegal.org/wp-content/uploads/2018/07/PSN-2018-2022.pdf. Accessed 16 Sept 2019.

24.

Programme National De Lutte Contre Le Paludisme. Plan Strategique National De Lutte Contre Le Paludisme Au Senegal 2016–2020. Dakar: Programme National De Lutte Contre Le Paludisme; 2016.

25.

District Health Information System. District Health Information System (Version 2) Overview. https://www.dhis2.org/overview. Accessed 17 June 2021.

26.

Programme National De Lutte Contre La Tuberculose. Plan Strategique De Lutte Contre La Tuberculose Au Senegal 2018-2022. 2017. http://www.pntsenegal.com/wp-content/uploads/2019/08/Plan-strat%C3%A9gique-PNT-2018-2022.pdf. Accessed 16 Sept 2019.

27.

Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893–907. https://doi.org/10.1007/s11135-017-0574-8.CrossRefPubMed

28.

MEASURE Evaluation. Tools for Data Demand and Use in the Health Sector. 2013. https://www.measureevaluation.org/resources/publications/ms-11-46.html. Accessed 13 Apr 2020.

29.

Akhlaq A, McKinstry B, Muhammad KB, Sheikh A. Barriers and facilitators to health information exchange in low- and middle-income country settings: a systematic review. Health Policy Plan. 2016;31(9):1310–25. https://doi.org/10.1093/heapol/czw056.CrossRefPubMed

30.

MEASURE Evaluation. Barriers to Use of Health Data in Low- and Middle- Income Countries: A Review of the Literature. 2018. https://www.measureevaluation.org/resources/publications/wp-18-211. Accessed 31 Aug 2019.

31.

Aqil A, Lippeveld T, Hozumi D. PRISM framework: a paradigm shift for designing, strengthening and evaluating routine health information systems. Health Policy Plan. 2009;24(3):217–28. https://doi.org/10.1093/heapol/czp010.CrossRefPubMedPubMedCentral

32.

Humphries S, Stafinski T, Mumtaz Z, Menon D. Barriers and facilitators to evidence-use in program management: a systematic review of the literature. BMC Health Serv Res. 2014;14:171.CrossRefPubMedPubMedCentral

33.

World Health Organization. Data Quality Review Module 1: Framework and metrics 2017.

34.

Russo G, Xu L, McIsaac M, Matsika-Claquin MD, Dhillon I, McPake B, et al. Health workers’ strikes in low-income countries: the available evidence. Bull World Health Organ. 2019;97(7):460–467H. https://doi.org/10.2471/BLT.18.225755.CrossRefPubMedPubMedCentral

35.

Clarke M. Strikes in the health care industry. J Health Hum Resour Adm. 1981;4(2):167–80.PubMed

36.

Thompson SL, Salmon JW. Strikes by physicians: a historical perspective toward an ethical evaluation. Int J Health Serv. 2006;36(2):331–54. https://doi.org/10.2190/B5CX-UX69-45LY-2D6D.CrossRefPubMed

37.

Tichenor M. Data performativity, performing health work: malaria and labor in Senegal. Med Anthropol. 2017;36(5):436–48. https://doi.org/10.1080/01459740.2017.1316722.CrossRefPubMed

38.

Tichenor M, Adams V. 4. The Power of Data. Global Malaria Governance and the Senegalese Data Retention Strike. Metrics. 2016;4(4):105–24.

39.

PMI. President’s Malaria Initiative: Senegal Malaria Operational Plan FY 2016. Washington DC: PMI; 2015.

40.

Justin Tine SF, Nakhimovsky S, Hatt L. Universal Health Coverage Measurement in a Lower-Middle-Income Context: A Senegalese Case Study. Bethesda: Health Finance & Governance Project, Abt Associates Inc; 2014.

41.

Irimu G, Ogero M, Mbevi G, Kariuki C, Gathara D, Akech S, et al. Tackling health professionals’ strikes: an essential part of health system strengthening in Kenya. BMJ Glob Health. 2018;3(6):e001136. https://doi.org/10.1136/bmjgh-2018-001136.CrossRefPubMedPubMedCentral

42.

Salama P, McIsaac M, Campbell J. Health workers’ strikes: a plea for multisectoral action. Bull World Health Organ. 2019;97(7):443–443A. https://doi.org/10.2471/BLT.19.238279.CrossRefPubMedPubMedCentral

43.

PMI. President’s Malaria Initiative: Senegal Malaria Operational Plan FY 2018. Washington DC: PMI; 2017.

44.

PMI. Health Systems Strengthening. https://www.pmi.gov/how-we-work/cross-cutting-technical-areas/health-systems-strengthening. Accessed 17 June 2021.

45.

Mphatswe W, Mate KS, Bennett B, et al. Improving public health information: a data quality intervention in KwaZulu-Natal, South Africa. Bull World Health Organ. 2012;90(3):176–82.CrossRefPubMed

46.

Edwards LJ, Moisés A, Nzaramba M, Cassimo A, Silva L, Mauricio J, et al. Implementation of a health management mentoring program: year-1 evaluation of its impact on health system strengthening in Zambézia Province, Mozambique. Int J Health Policy Manag. 2015;4(6):353–61. https://doi.org/10.15171/ijhpm.2015.58.CrossRefPubMedPubMedCentral

47.

Workneh G, Scherzer L, Kirk B, Draper HR, Anabwani G, Wanless RS, et al. Evaluation of the effectiveness of an outreach clinical mentoring programme in support of paediatric HIV care scale-up in Botswana. AIDS Care. 2013;25(1):11–9. https://doi.org/10.1080/09540121.2012.674096.CrossRefPubMed

48.

Lemma S, Janson A, Persson L-Å, Wickremasinghe D, Källestål C. Improving quality and use of routine health information system data in low- and middle-income countries: a scoping review. PLoS One. 2020;15(10):e0239683. https://doi.org/10.1371/journal.pone.0239683.CrossRefPubMedPubMedCentral

49.

Mpofu M, Semo B-W, Grignon J, et al. Strengthening monitoring and evaluation (M&E) and building sustainable health information systems in resource limited countries: lessons learned from an M&E task-shifting initiative in Botswana. BMC Public Health. 2014;14(1):1032.CrossRefPubMedPubMedCentral

50.

Amani PJ, Ngowi R, Dratler S. Development of human resources for health in Tanzania: A case study of the MSc in Health Monitoring and Evaluation Program at Mzumbe University. East Afr J Appl Health Monit Eval. 2017;1(1):2–8.

51.

Foreit K, Moreland S, LaFond A. Data demand and information use in the health sector: conceptual framework. Chapel Hill: MEASURE Evaluation, Carolina Population Center; 2006. p. 1–17.

52.

Brunner B, Barnes J, Carmona A, et al. Senegal private health sector assessment: selected health products and services. 2016.

53.

Bettina B, Barnes J, Carmona A, et al. Evaluation du secteur prive de la sante au senegal a travers quelques exemples d'offres de produits et de prestations de services. Bethesda: Abt Associates; 2016.

54.

Githinji S, Oyando R, Malinga J, Ejersa W, Soti D, Rono J, et al. Completeness of malaria indicator data reporting via the district health information software 2 in Kenya, 2011–2015. Malar J. 2017;16(1):344. https://doi.org/10.1186/s12936-017-1973-y.CrossRefPubMedPubMedCentral

55.

Maina JK, Macharia PM, Ouma PO, Snow RW, Okiro EA. Coverage of routine reporting on malaria parasitological testing in Kenya, 2015–2016. Global Health Action. 2017;10(1):1413266.CrossRefPubMedPubMedCentral

56.

Lippeveld T. Routine health facility and community information systems: creating an information use culture: Global Health: Science and Practice; 2017.

57.

Wagenaar BH, Sherr K, Fernandes Q, Wagenaar AC. Using routine health information systems for well-designed health evaluations in low- and middle-income countries. Health Policy Plan. 2016;31(1):129–35. https://doi.org/10.1093/heapol/czv029.CrossRefPubMed

58.

Cothran D. Senegal’s community-based health System model: structure, strategies, and learning; 2019.

59.

Nabyonga-Orem J, Tumusiime P, Nyoni J, Kwamie A. Harmonisation and standardisation of health sector and programme reviews and evaluations–how can they better inform health policy dialogue? Health Res Policy Syst. 2016;14(1):87. https://doi.org/10.1186/s12961-016-0161-9.CrossRefPubMedPubMedCentral

60.

Global Fund. Backing civil society to end the AIDS, tuberculosis and malaria epidemics. Geneva: Global Fund; 2019.

61.

Coutinho A, Roxo U, Epino H, Muganzi A, Dorward E, Pick B. The expanding role of civil society in the global HIV/AIDS response: what has the President's emergency program for AIDS Relief's role been? JAIDS. 2012;60(Supplement 3):S152–7. https://doi.org/10.1097/QAI.0b013e31825d0383.CrossRefPubMed

62.

Rice B, Boulle A, Baral S, Egger M, Mee P, Fearon E, et al. Strengthening routine data systems to track the HIV epidemic and guide the response in sub-Saharan Africa. JMIR Public Health Surveill. 2018;4(2):e36. https://doi.org/10.2196/publichealth.9344.CrossRefPubMedPubMedCentral

63.

Petersen M, Yiannoutsos CT, Justice A, Egger M. Observational research on NCDs in HIV-positive populations: conceptual and methodological considerations. J Acquired Immune Defic Syndr. 2014;67(0 1):S8.CrossRef

64.

World Health Organization. Consolidated guidelines on person-centred HIV patient monitoring and case surveillance. 2017.

65.

Wickremasinghe D, Hashmi IE, Schellenberg J, Avan BI. District decision-making for health in low-income settings: a systematic literature review. Health Policy Plan. 2016;31(suppl_2):ii12–24.CrossRefPubMedPubMedCentral

66.

Bhattacharyya S, Berhanu D, Taddesse N, et al. District decision-making for health in low-income settings: a case study of the potential of public and private sector data in India and Ethiopia. Health Policy Plan. 2016;31(suppl_2):ii25–34.CrossRefPubMedPubMedCentral

67.

Sebuliba I, Lindan C, Baryamutuma R, et al. Improving the ability of districts in Uganda to monitor their HIV programs. East Afr J Appl Health Monit Eval. 2018;2018(2):1–8.

68.

Streeck W, Rueschemeyer D. Usable theory: analytical tools for social and political research. Arch Euro Sociol. 2011;52(3):556–60. https://doi.org/10.1017/S0003975611000373.CrossRef

69.

Colyvas JA, Powell WW. Roads to institutionalization: the remaking of boundaries between public and private science. Res Organ Behav. 2006;27:305–53. https://doi.org/10.1016/S0191-3085(06)27008-4.CrossRef

Title: Key informant perspectives on the challenges and opportunities for using routine health data for decision-making in Senegal
Authors: Pierre Muhoza
Haneefa Saleem
Adama Faye
Ibrahima Gaye
Roger Tine
Abdoulaye Diaw
Alioune Gueye
Almamy Malick Kante
Andrea Ruff
Melissa A. Marx
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Tuberculosis
Malaria
Tuberculosis
Human Immunodeficiency Virus
Acquired Immune Deficiency Syndrome
Published in: BMC Health Services Research / Issue 1/2021
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-021-06610-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Key informant perspectives on the challenges and opportunities for using routine health data for decision-making in Senegal

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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