BUILDING CONSENSUS ON CHIS's. - Community Health Impact Coalition

DELPHI STUDY

COALITION RESEARCH.

Community Health Information Systems (CHISs) are being increasingly used by health workers, including community health workers. They’re used across a range of discrete healthcare interventions, such as tracking maternal and health outcomes, monitoring infectious disease outbreaks and facilitating follow-ups for disease management.

CHISs are “complex interventions” and can play an important role in health systems strengthening. When used correctly, CHISs could improve healthcare coverage by quality, speed and equity of access. But there are no clear guidelines on how these tools should be designed or used with other digital platforms. So these tools cannot reach their potential and few make it past the pilot phase or reach scale, resulting in fragmented care.

At the Coalition, guided by a commitment to expanding ideas of what is possible in community health and overcoming institutional obstacles, we set out to address this. We conducted a Delphi study drawing upon the views of experts from four World Health Organization regions, including the African, Americas, South-East Asia and European Regions. Next we established a consensus on key features and interoperability priorities for CHISs.

Contributors included Community Health Impact Coalition, Medic and Dimagi.

NOTHING ABOUT CHWS, WITHOUT CHWS.

During the research we conducted five rounds of surveys, where experts rated the importance of different CHIS features and interoperability use cases. As a Coalition made up of thousands of CHWs and aligned healthcare organizations, we acknowledge that for too long, discussions about CHWs have been happening without CHWs. It’s time for a change. So, we also engaged CHWs in focus group discussions to provide practical insights and validate the findings from the expert panel.

CURRENT CHALLENGES.

CHISs today are expected to be feature-rich, to support a range of user roles in community health systems, and to be highly adaptable to local contextual requirements. But there are challenges in their use.

Fragmentation and Inconsistency: CHISs often lack standardization, leading to fragmented health data and inconsistent service delivery. Different regions and health systems may implement CHISs with varying features and capabilities, resulting in inefficiencies.
Limited Interoperability: Many CHISs are not designed to integrate seamlessly with other health information systems, such as health management information systems (HMIS) and electronic medical records (EMR). This limitation hampers the flow of information and coordination of care.
Resource Constraints: Community health programs, particularly in the hardest to reach communities, may face challenges in implementing and maintaining CHISs. Limited financial and technical resources can affect the scalability and sustainability of these systems.
Data Security and Privacy Concerns: Ensuring the security and privacy of health data is a significant concern. It is vital CHISs comply with data protection regulations and implement robust security measures to protect patient information.
User-Friendliness: CHISs need to be user-friendly to be effective. Complex and non-intuitive interfaces can hinder the adoption and efficient use of these systems by CHWs.

A woman standing in front of a house while holding a tab

Last Mile Health

KEY FINDINGS & NEXT STEPS

POTENTIAL FOR IMPROVED CARE.

The study found that 77% of WHO-classified digital health interventions are vital for CHISs. Prioritized features include case management, care coordination, data collection, user-friendly interfaces, real-time data access, and mobile compatibility.

We also found that integration with HMIS, electronic medical records (EMR) and other digital health platforms is crucial for enhancing data exchange, patient tracking, and decision-making processes.

CHISs should also be adaptable to various local contexts and scalable to meet increasing demands. Systems must support different user roles, including CHWs, supervisors, and program managers.

The evidence is clear we need feature-rich, interoperable CHISs that support diverse user roles and enhance community healthcare delivery. This could lead to:

better health outcomes by ensuring CHWs have access to accurate and timely information, enabling them to deliver more effective care;
informed decision-making, at all levels of the health system, supported by comprehensive data analysis;
resource optimisation, reduced redundancy and improved efficiency in health service delivery.

Or in short, future CHIS interoperability efforts are expected to strengthen community health systems in ways that measurably improve care. But for this to be a reality, CHWs must be included in decision-making processes central to CHIS design, implementation, and evaluation..

Read the full study in BMJ Global Health

HELP US SHARE THE RESEARCH