Strengthening Community Health Service Delivery through Data Visualization

Posted July 12, 2023

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bC1zaGFyZS0tMDkyIC50Yi1zb2NpYWwtc2hhcmVfX3BpbnRlcmVzdF9fc2hhcmUtYnV0dG9ue2N1cnNvcjpwb2ludGVyO2Rpc3BsYXk6aW5saW5lLWJsb2NrO2JhY2tncm91bmQtc2l6ZTpjb250YWluO2JhY2tncm91bmQtY29sb3I6I2NiMjEyODt9LnRiLXNvY2lhbC1zaGFyZS0tMDkyIC50Yi1zb2NpYWwtc2hhcmVfX3RlbGVncmFtX19zaGFyZS1idXR0b257Y3Vyc29yOnBvaW50ZXI7ZGlzcGxheTppbmxpbmUtYmxvY2s7YmFja2dyb3VuZC1zaXplOmNvbnRhaW47YmFja2dyb3VuZC1jb2xvcjojMzdhZWUyO30udGItc29jaWFsLXNoYXJlLS0wOTIgLnRiLXNvY2lhbC1zaGFyZV9fcmVkZGl0X19zaGFyZS1idXR0b257Y3Vyc29yOnBvaW50ZXI7ZGlzcGxheTppbmxpbmUtYmxvY2s7YmFja2dyb3VuZC1zaXplOmNvbnRhaW47YmFja2dyb3VuZC1jb2xvcjojNWY5OWNmO30udGItc29jaWFsLXNoYXJlLS0wOTIgLnRiLXNvY2lhbC1zaGFyZV9fdmliZXJfX3NoYXJlLWJ1dHRvbntjdXJzb3I6cG9pbnRlcjtkaXNwbGF5OmlubGluZS1ibG9jaztiYWNrZ3JvdW5kLXNpemU6Y29udGFpbjtiYWNrZ3JvdW5kLWNvbG9yOiM3YzUyOWU7fS50Yi1zb2NpYWwtc2hhcmUtLTA5MiAudGItc29jaWFsLXNoYXJlX19lbWFpbF9fc2hhcmUtYnV0dG9ue2N1cnNvcjpwb2ludGVyO2Rpc3BsYXk6aW5saW5lLWJsb2NrO2JhY2tncm91bmQtc2l6ZTpjb250YWluO2JhY2tncm91bmQtY29sb3I6IzdmN2Y3Zjt9LnRiLXNvY2lhbC1zaGFyZS0tcm91bmQgLlNvY2lhbE1lZGlhU2hhcmVCdXR0b257Ym9yZGVyLXJhZGl1czo1MCV9LnRiLXNvY2lhbC1zaGFyZV9fZXhjZXJwdHtkaXNwbGF5Om5vbmV9LnRiLXNvY2lhbC1zaGFyZSAuU29jaWFsTWVkaWFTaGFyZUJ1dHRvbi0tZGlzYWJsZWR7b3BhY2l0eTowLjY1fSB9IA==

By: Edin D. Issak, Senior M&E Specialist, PSI; Kingsley Chukwumalu, Chief of Party & Health Services & Quality Improvement Advisor, PSI; Antony Mwirii, Business Intelligence Consultant; Dr. Adisalam Abdullahi, Federal Government Somalia; and Abdinasir Gedi, Federal Government Somalia

In Somalia, nomadic, rural populations and women living in conflict zones are disproportionately affected by the lack of access to quality health services. To better serve these populations, the Federal Government of Somalia (FGS) and stakeholders in the health sector wanted to better understand community health needs.

That’s why, since 2021, Population Services International (PSI) has supported the Federal Government of Somalia (FGS) and its members states to digitize, transmit, and visualize its community service delivery data in a resource limited fragile context.

But first, some context:

Somalia’s national Female Health Worker program currently employs 753 Female Health Workers (FHWs) and 59 Female Health Supervisors (FHSs) with support from the World Bank Cost and Reform Financing Project (RCRF).
In alignment with Somalia’s Community Health Strategy, Somalia’s Female Health Worker program is implemented in collaboration between the Federal Government of Somalia and Federal Member States (Galmudug, Puntland, Hirshabelle, Southwest State, and Jubbaland).
With PSI support as the government’s Health Technical Partner (HTP) over the last two years, the FHW training curriculum was updated and a community health information system that includes data collection and reporting has been rolled out. Currently, 132,000 households receive primary health services from FHWs.

What challenges did we face? What solutions did we emplace? We explain, below.

I. Paper-based tracking

Challenge: The use of paper-based registers and forms to track health service delivery data in rural Somalia by the Female Health Workers (FHWs) program caused barriers to sharing this data with any other members of the health system, from linked health facilities, district health offices all the way to the FMS and FGS.

Paper-based data collection was cumbersome and inefficient; data collected was not readily available for analysis and decision making; monitoring of FHWs’ performance was limited. Many Female Health Workers (FHWs) and Supervisors in Somalia work in fragile and active-conflict districts that are rural and have semi-nomadic dispersed populations. Collecting and interpreting data on clients served is essential for country level decision making.

Solution: PSI supported the Federal Government of Somalia (FGS), who temporarily approved the adoption of a digital intervention ODK (Open Data Kit) for data collection, to digitize FHW data collection. Forms needed by FHWs were translated to ODK and downloaded onto FHWs’ phones to use during routine home visits. Data collection and submission improved drastically and the volume of FHW data uploaded to ODK daily basis increased.

II. Visualizing data

Challenge: How do we now visualize the massive amounts of data collected to be useful and inform decision making?

Solution: PSI worked with the FGS and FMS to use Power BI to visualize real-time data reporting from ODK by the FHWs. PSI supported the government to develop a Data-to-Action framework for program indicators identified by the Federal Ministry of Health (FGS-MOH), Federal Member State Ministry of Health (FMS-MOH), and Female Health supervisors (FHSs) needs at each level of the health system. Somalia’s Female Health Worker Power BI dashboard uses real-time data to monitor the FHW program, supports decision making and supportive supervision. The dashboard is used to track performance and health indicators at a district level, program managers at state level are able to directly identify individual FHW performance from the dashboard and provide feedback.

III. Measuring impact

Challenge: How can visualized data be used to improve community health?

Solution: PSI and the Federal Government of Somalia partnered together to overcome a challenging environmental context and successfully implement a digital health intervention. In consultation with all stakeholders (Federal Ministry of Health, FGS-MOH, Federal Member State Ministry of Health (FMS-MOH), and Female Health supervisors (FHSs)), an agreement on sets of key program performance indicators and targets was reached. These indicators include:

Number of Household registered by the FHWs
Number of registered households visited by FHWs during the month
Number of Pregnant Women referred for ANC services among other KPIs.

Following the setup of the dashboard, PSI trained all program data users including FHSs in all the states on the use of the Power BI dashboard for regular program monitoring, reporting and decision making.

The dashboard is currently being used in the following ways:

Providing the government and program implementation team with the opportunity to access program data visualized in real-time, facilitating program discussion, and timely decision.
Monitor each FHW’s performance through a section of the dashboard (Figure 2) that captures important parameters such as number of days worked, and type of activities conducted.
FHWs reporting and use of the digital tool to collect and report data have improved through hands-on, data driven support provided by the program team on routinely.

“The dashboard is essential in ensuring that the program data is visualized by all users in real time and is used to make data driven decision” Abdinasir Gedi, Data Analyst, Federal Government State

Going forward

In-line with the government’s plan to transition the FHW program reporting from ODK to DHIS2, PSI will continue to provide technical support to ensure a seamless transition process to government ownership.
There is continued advocacy by the FGS on the use of the dashboard at all levels (FGS, FMS, FHS) for reporting and decision making,
The government will prioritize the digitization of the remaining FHW program paper-based M&E tools. These include the Referral Slips, Supervision Forms, and others. These forms will also be linked to the existing Power BI dashboard for continued visualization.