TORs: National Junior STTA – Data Management Research Associate

Technical Support in Designing and Operationalising a Health Data Information and Decision-Making Strategic Framework in Punjab

Programme

Evidence for Health (E4H) is a Foreign, Commonwealth & Development Office (FCDO)-funded programme aimed at strengthening Pakistan's healthcare system, thereby decreasing the burden of illness and saving lives. E4H provides technical assistance (TA) to the Federal, Khyber Pakhtunkhwa (KP), and Punjab governments, and is being implemented by Palladium along with Oxford Policy Management (OPM).

Through its flexible, embedded, and demand-driven model, E4H supports the government to achieve a resilient health system that is prepared for health emergencies, responsive to the latest evidence, and delivers equitable, quality, and efficient healthcare services. Specifically, E4H delivers TA across three outputs:

Output 1: Strengthened integrated health security, with a focus on preparing and responding to health emergencies, including pandemics.

Output 2: Strengthened evidence-based decision-making to drive health sector performance and accountability.

Output 3: Improved implementation of Universal Health Coverage, with a focus on ending preventable deaths.

Backround and Problem Statement 

The Primary and Secondary Healthcare Department (P&SHD) has strived to innovate and employ sustainable technological solutions for better service delivery. The Health Information and Service Delivery Unit (HISDU) in P&SHD is the very vehicle through which the P&SHD envision its digital transformation. HISDU has some key functional units. It has a Nerve Centre responsible for developing and deploying various Web and Android applications and provides system development support to multiple sections, Units, and Programmes. There is also a facilitation centre where all applications related to administrative and legal matters are submitted, tracked, and processed. The Command-and-Control Centre is a compendium of live dashboards and surveillance systems installed in various primary and secondary healthcare facilities. It enables the Department to carry out real-time monitoring and review of various ongoing initiatives. A data collection and analysis cell also functions within HISDU to collect information from various field offices. Another key component of HISDU is the Network Operation Centre (NOC) and Data Centre, which provides storage and hosting services to various Sections and Wings of the Department. HISDU operates close to 65 modules that can be broadly clubbed under four categories – Electronic Medical Record (EMR), Health Information System (HIS) and Monitoring and Evaluation, Survey and Integrated Disease Surveillance and Response (IDSR).

Objectives 

• Enhance the existing health data infrastructure to eliminate critical gaps and inefficiencies, facilitating more effective, evidence-based decision-making processes
• Implement an integrated data governance framework that consolidates data across health Programmes, improving the coherence and impact of health initiatives. Ensure this framework is aligned with P&SHD's reform agenda and supports the strategic decision-making needs of the Department
• Strengthen the capacity of HISDU to utilise data more effectively
• Efficiently adjust programming to meet evolving health needs and target better health interventions
• Optimise resource use and improve the quality and efficiency of healthcare services
• Measure and track population health determinants, outcomes and inequalities and monitor health status in populations at greatest risk
• Provide early warning of potential public health threats
• Effectively plan and advocate for resources within and beyond the health sector
• Hold health institutions and government authorities accountable for resource use and health outcomes
• Support global monitoring
• Establish a foundation for a scalable, sustainable digital health ecosystem that can adapt to evolving health challenges and technological advancements, ensuring long-term improvement in health outcomes
• Provide health service providers and decision-makers with user-friendly digital tools that deliver real-time data and analytics, improving the speed and accuracy of health service responses and policy formulation
• Develop and implement comprehensive training Programmes and resources to enhance the departmental personnel's ability to effectively use digital health systems, aiming for widespread adoption and high user satisfaction rates.

Scope of work and methodology 

The methodology proposed in this section is non-exhaustive and provides a general overview of the minimum required depth of activities that should be undertaken for this engagement. The sequencing of inputs, activities and outputs are outlined below for simple understanding.

 1.  Situation Analysis and System Review

• Assess the functionality and integration of current Information Systems within the HISDU, IDU, and Management Information Cell at the Director-General Health office. The deep-dive analysis will explicitly focus on identifying the critical bottlenecks that hinder efficient data management and decision-making based on best regional and global practices. This step involves quantifying the extent of these gaps to create a baseline for improvement
• Review relevant case studies, such as those conducted by the Bill & Melinda Gates Foundation (BMGF), for insights into the reliability of the 65 modules operating within HISDU
• Analyse both the National Digital Health Strategy of Pakistan and any existing Digital Health Strategy in Punjab, focusing on alignment with the Punjab Health Sector Strategy regarding Health Information Systems
• Assess if there are existing coordinating and data sharing mechanisms available across diverse platforms for seamless data integration to enable a more comprehensive understanding of health trends, outcomes and facility performance
• Carry out a critical assessment of healthcare workers' capacity at health facilities to effectively use data from RHIS. The staff may need trainings for navigating RHIS and leveraging its benefits
• A quick review of the current technological capability of the department with a view to identify the most suitable digital tools and infrastructure ensuring an efficient and sustainable RHIS.
• Evaluate the current data and information management frameworks employed by the P&SHD
• Assess the infrastructure and protocols for managing different data types including images and video, to ensure they are adequately supported, securely stored, and easily accessible for decision-making purposes.

2. Stakeholder Engagement and Needs Analysis

• Map and engage a wide range of stakeholders from various sectors within the health department for their input and feedback on existing information systems and policies
• Understand the specific health information needs and realities within Punjab to tailor the strategy to local contexts
• Clarify stakeholder data requirements for informed decision-making, identifying necessary tools and processes

3. Data Quality Assessment and Infrastructure Review

• Conduct a comprehensive data quality assessment as data quality, from the development of indicators to data registration, from data collection to storage could pose a challenge for the decision makers in making evidenced-informed decision making.  
• Review how data is currently utilised across different policy areas to identify gaps in data usage
• Assess the existing technical infrastructure supporting data collection, storage, and analysis

4. Strategy Formulation

• Articulate strategic objectives based on insights from the initial analysis, stakeholder engagement, and data assessment and a link it with the Punjab Health Sector Strategy (2019 to 2028)
• Develop a detailed action plan with clear timelines, responsibilities, and resource allocations
• Establish an implementation framework, including milestones and evaluation mechanisms

5.  Capacity Building and Training

• Identify specific training needs to enhance the capabilities of staff in health information management
• Create and implement targeted trainings to address these needs

6.  Monitoring and Evaluation

• Implement monitoring and evaluation processes to track the strategy's progress and its impact on improving health information management

7. Stakeholder Communication and Reporting

• Ensure continuous communication with stakeholders about the strategy's development and progress
• Produce a comprehensive final report summarising the strategy development process, findings, and recommendations

8. Financing

• Develop a financing plan to support the strategy's implementation, identifying potential funding sources and allocating budgets across the strategy's various components
• Assess financial sustainability and explore mechanisms for long-term financial support, including partnerships with private sector and/or development partners

9. Coordination Mechanism

• Establish a robust coordination mechanism to ensure seamless collaboration among all stakeholders involved in the health information strategy. This includes forming a steering committee comprising representatives from key sectors, regular coordination meetings, and a clear communication protocol to facilitate the effective exchange of information and alignment of efforts across the strategy’s lifespan.

Phase II: Develop an Operational Plan for the Implementation of the Strategy  

1. Operational Plan for Data Use and Decision-Making for implementation of the Strategic Framework

• Holistic Data Categorisation and Integration: Systematically organise and integrate both quantitative (e.g., disease prevalence, vaccination coverage) and qualitative data (e.g., patient satisfaction, community health perceptions) to enable multifaceted health outcome analysis. This includes ensuring data complementarity and triangulation for enriched insights.
• Electronic Data and File Management: Implement state-of-the-art electronic data management and electronic file management systems to streamline data accessibility, retrieval, and secure storage. This infrastructure supports the seamless integration of data sources, facilitating comprehensive data analysis. Outline plans to establish or strengthen critical linkages between eFOAS (e-Filing and Office Automation System) and internal file management systems of P&SHD to improve data flow and integrity.
• Data Complementarity and Triangulation: Employ strategies to validate and enrich findings through data triangulation, combining various data sources and types (quantitative and qualitative) to build a robust basis for decision-making. Develop strategies for enhancing the Command-and-Control Centre's capabilities in understanding data from the national electronic media, social media, and portals for real-time monitoring and feedback
• Advanced Analytical Techniques: Apply both quantitative analyses, like statistical and predictive modelling and qualitative thematic analyses to derive actionable insights, ensuring policies and strategies are grounded in a comprehensive understanding of the health landscape
• Enhance the complaint redressal mechanism: Incorporate comprehensive feedback loops through a robust complaint management system

2. Interoperability Standards and Data Sharing

• Define standards for seamless data exchange among diverse health information systems like EMR and other HIS, ensuring effective communication and utilisation of data across platforms
• Create guidelines that balance privacy with collaborative health data use among various entities, enhancing collective health initiatives

3. Ethical Data Use and Compliance

• Formulate guidelines for ethical health data handling, emphasising patient confidentiality and individual rights protection
• Establish mechanisms for addressing and resolving data use concerns, ensuring compliance with ethical and legal standards

4. Monitoring, Evaluation, and Quality of Care Enhancement

• Construct metrics to evaluate the impact of data governance on decision-making and health service outcomes, with a focus on improving care quality
• Include KPIs for assessing the performance of health facilities using data from the Command-and-Control Centre, Surveillance Centre, and other monitoring systems to ensure continuous improvement and expand the use of KPIs for monitoring of different districts in Punjab

5. User Interface and Experience for Decision Support

• User-Centric Design for Decision Support:  Strengthen the Command-and-Control Centre, incorporating real-time visualisation, alerts, and decision support systems to facilitate strategic decisions by officials of varying expertise levels.

6.  Learning and Development 

• Offer continuing professional development (CPD) hours for completing training modules that include analysing and applying data from HISDU, motivating ongoing education. The team is expected to consider innovative and outside-of-the-box solutions that consider the limited resources and budgetary constriants however. This could include solutions like collaborations with accredited universities and colleges to incorporate health data analytics as short term certification programmes that enrollees will have to finance themselves, or through loans from the Department. This assumes that certifications will be tied to greater career prospects however. HISDU may also be explore introducing internship programmes where students can contribute to HISDU-related projects while earning course credits for their own academic programmes.
• Provide certifications that recognise skill development in handling and interpreting HISDU data, enhancing professional portfolios.
• Use case-based real-world data sets and scenarios from HISDU to enhance problem-solving and decision-making skills.
• Incorporate peer learning to offer diverse perspectives and enhance collaborative problem-solving with HISDU data.
• Utilise interactive simulations that replicate real-life challenges in data management using HISDU data.
• Complement with guided case studies involving HISDU data to deepen understanding of complex data nuances and practical application.
• Establish forums and mentorship programmes where health managers can share experiences, solutions, and learnings related explicitly to the use of HISDU data

7. Resource mobilisation

• Mobilise resources within HISDU to develop a prototype of their EMR system, ensuring it aligns with EPIC, the most commonly used EMR system in the United States. Consider using internship programmes where students from accredited universities can contribute to HISDU-related projects while earning course credits.
• Engage in hackathons such as those organised by health technology forums, such as Harvard's recent one, to demonstrate the utility and maturity of HISDU’s EMR system and showcase its features and capabilities to a broader tech and health community.
• Initiate training programmes to help other provinces, such as Khyber Pakhtunkhwa (KP), Sindh, and Balochistan, develop units similar to HISDU, enhancing nationwide health data management systems. This may include introducing knowledge exchange programmes between provinces, where best practices and learnings are shared through virtual workshops, reducing the need for travel and accommodation expenses.
• Continue to mature HISDU’s data systems to explore potential commercial opportunities, evaluating if the systems can be marketed and sold as robust health data management solutions.
• Generate interest among donors and development partners in investing in the technology enhancement of HISDU, highlighting its potential impact on health data management and patient care outcomes. This can be done by organising virtual donor conferences to present the value proposition of investing in HISDU technology enhancements.

Phase III: Regularly convene a coordination mechanism

In phase III of the TA, our team is expected to implement an efficient, actionable and easily monitorable roadmap approach with specific checkpoints. The plan should sequence the activities, key milestones, and expected outcomes. This approach enables the P&SHD to visualise the phased progression towards a fully operational and effective data governance system.

Checkpoint 1: (July-August)

• Establish a governance mechanism or a steering committee comprising senior stakeholders from the Health Department. This committee will provide strategic direction, oversight, and resource allocation for the data governance framework.
• Assign clear, outcome-oriented roles and decision-making authorities to committee members. Each role should be directly linked to specific performance metrics, ensuring accountability for progress and resolution of strategic issues.
• Form a TWG with specialists in health informatics, data management, IT infrastructure, legal and ethical standards. The TWG will be responsible for the day-to-day operational management of the data governance framework, including technical support, user training, and compliance monitoring.

Checkpoint 2: (August-November)

• Detail the responsibilities, such as system maintenance, user support, data quality assurance, and compliance with data protection regulations. Establish regular review cycles to assess performance.
• Specify the HR needed to operationalise the governance framework effectively. This includes identifying new roles and responsibilities and estimating the number of personnel required across different functions such as system administration, data management, technical support, and user training
• Develop detailed costing for HR, ongoing system maintenance, user support services, and training Programmes. This analysis should provide a holistic view of the financial resources needed for the framework's sustainable operation.

Checkpoint 3: (November-January)

• Develop comprehensive SOPs covering all aspects of the data governance framework, including data collection, storage, processing, and sharing
• Update existing regulations and policies to align with the national digital health strategy and international best practices in health data governance
• Establish a mechanism and assign responsibilities to periodically review and update regulations and policies to ensure compliance with changing legal standards and technological advancements
• Develop   trainings for data system users working on the operational aspects of the data governance framework, regulatory compliance, and ethical use of health data  and data validation point for the TWG and steering committee members

Implement a mechanism for monitoring the performance of the data governance framework against established KPIs and user feedback. This includes routine audits of data quality, user satisfaction surveys, and system usability assessments.

Timeline and LOE 

Requirement

Technical expertise

• Proficiency in collecting, validating, and managing data to ensure accuracy and reliability for monitoring and evaluation purposes.
• Sound Understanding of relevant performance indicators that align with program objectives and outcomes.
• Ability to conduct quantitative and qualitative data analysis using statistical tools and methods to derive insights.
• Capability to prepare clear and concise reports and visually represent data to communicate findings effectively
• Familiarity with frameworks and methodologies to track progress, assess impact, and identify areas for improvement

Competencies

• Capacity to develop clear and measurable indicators aligned with program goals and objectives and monitor program progress against them
• Ability to implement and adhere to established monitoring and evaluation frameworks
• Able to assist in establishing data-driven insights to support evidence-based decision-making.
• Ability to visualise data findings through graphs, charts, and other visual aids for effective communication.

Deliverables/KPIs

• Support the team in developing a succinct report that analyses the current governance structures, data systems, information system key challenges, key performance indicators, and approaches for roadmap development, and information flows within the P^SHD
• Support the development of a roadmap that should delineate strategies, resource allocation, technical support, and other necessary measures to ensure the sustainable implementation of this roadmap.
• Support the National Health System Expert develop health data governance mechanism to harmonise the efforts of different information systems at the district, and provincial levels.
• Support the team in developing regulations and guidelines that govern the functioning and linkages for the information at different levels regarding data collection, sharing, and utilisation.
• Support the team in facilitating the convening of the first meeting of the data governance mechanism and jointly develop meeting agenda and analytical presentation format, oversee the meeting proceedings and acquire approvals across various platforms.
• Support the team in writing reports, developing visuals for data illustration, interpreting graphs/charts, and maintaining project documentation.