The role of governance in the design and implementation of systems-wide digital health solutions

The ultimate goal of digital health information systems is provision of information to multiple users for decision making. Information is of little value if it is not available in formats that meet the needs of multiple users − policy-makers, planners, managers, health care providers, communities, and individuals (World Health Organization, 2018). Digital health systems can only meet these expectations if supported by appropriate leadership and governance structures. It is pivotal that governance of digital health systems is integrated into broader organizational governance frameworks. A significant role for health leaders is in ensuring that the value of digital systems is fully realized by translating data into action. In the Kenyan context, there are many internal actors drawn from various government ministries and departments that influence health policies, resource allocation and oversight. All these actors rely on information from digital health systems for decision making. The departments of health confirmed that the other departments like planning and finance have challenges in understanding some of the health priorities and indicators. The USAID-Tupime Kaunti project designed and is implementing the Leadership Development and Governance (LDG) group model, whose objective is to enhance the linkage of data to action by health leaders and to ensure that digital health systems are sustained. The LDG group model is founded on the need for an integrated internal leadership structure that brings all key decision makers that have an influence on health together for evidence-based decision making. This group is tasked with increasing the scale of data utilization in policy making, budgeting and decision making. They are also responsible for strengthening structures and policies for digital health systems.

In this session, we will present and discuss how to design and deploy digital solutions that are integrated in complex ecosystems. We will showcase two country-led reforms that are incorporating digital processes in their ci¬vil registration and vital statistics (CRVS) systems. By using systems thinking methodology these countries are managing to create integrated solutions that put user perceptions and views at the centre of the design. Multiple stakeholders are engaged to ensure ownership and sustainability of these solutions. In a first introductory talk, we will present the methodology developed to incorporate an iterative user-centred approach. The approach includes the use of business process and stakeholder mapping, as well as qualitative methodologies, such as key informant interviews and participatory reflective workshops. In a second and third talk, two case studies, in Africa and Asia, will be presented in which these tools were used as part of a countrywide reform. The framework was developed to support countries in their ongoing process of strengthening their CRVS systems. The system re-engineering included the implementation of a new digital notification system for vital events and an innovative way of conducting verbal autopsies over the phone. The presenters will share the lessons learned, as well as current opportunities with these government-led reforms. The audience will engage in a wider discussion on how to incorporate such thinking in the development and scale-up of other digital health implementations.