By: Yasmin Hussain Al-Haboubi

LSHTM MSc Global Mental Health Student

Population Service International (PSI) carries out their health interventions much like a fortune 500 company would go about their business. Whilst this may seem counterintuitive to the compassionate nature of health, it is an approach that works well.

“Compassion without knowledge is ineffective”; Frederik Weisskopf’s 1998 quote still stands today, despite our methods of knowledge appraisal having jolted significantly over the past 10 years.

On 1 February, Christina Luissiana connected via skype to LSHTM. Her clear, engaging talk took the room through PSI’s approach to the use of routine data to evaluate health interventions. PSI were early adopters of the latest health informatic system. The District Health Information Software (DHIS2) is an open source, multi-platform system created by the University of Oslo that enables governments and NGO’s to collect and analyse health intervention data. It is provided without a licensing fee, meaning 47 countries currently use it as their main health management system. PSI’s ‘data to action’ approach aims to inform Ministries of Health of the appropriate policy recommendations based on real time data. Christina presented a Malaria Case Surveillance case study from the Greater Mekong Subregion, where a visually clear and user-friendly app has been developed to track malaria cases in non-public health facilities.

Once notified of a potential malaria case, the data collector responds (smartphone in hand) to the health centre. The app collects seven items of patient information; age, sex, malaria test result, if they had received treatment, travel history, occupation (at risk occupations were noted) and phone number. Once the data is generated and uploaded to DHIS2 dashboard, it serves two purposes:

1. Mapping malaria cases and helping identify ‘hot spots’. In the Greater Mekong Subregion the highest number of potential cases have been found close to the borders. From such geographic mapping, governments have the possibility to make informed decisions about the supply and distribution of anti-malarial drugs. This acts as a potentially cost-effective measure to LMIC Health Ministries. This has yet to be monitored fully but could be a good scope for future research.
2. Generation of information in real time can be used to identify emerging outbreaks.

This proves a key feature of DHIS2, there is a balance between customisation and standardisation. The interoperability of the app means it can overlay other platforms and software systems, particularly systems that link back to each Ministry of Health.

The rapidity of the data analytics means that there is scope for DHIS2 to be used in humanitarian emergencies and disease epidemics. PSI do not do so themselves, however Christina pointed to the use of DHIS2 in Madagascar, in fighting seasonal epidemics of the plague (bubonic, septacemic and pneumonic). According to WHO, 95% of those in contact with the plague, as identified by DHIS2, were provided with antibiotics.

Following the presentation there was a lively debate surrounding DHIS2 use ranging from the pragmatic to the ethical.

Logistically, in LMIC the reality remains that remote and rural areas will often have problems with both mobile connectivity and electricity. Both being paramount to the collection of raw data. To address this the University of Oslo’s web architects and configurators created a platform wherein the app can be used offline in low connectivity areas, and when reconnected will upload the information to the platform. And if all else fails, pen and paper have served people well for generations.

However, there were questions raised by the audience surrounding how PSI works to ensure ownership of data for the Ministries themselves. This was proven much harder to answer than the logistic questions.

It was suggested that potentially Ministries of Health need to be persuaded to want to use data. Public sector workers in LMIC’s are already overburdened, so they may not want to engage in data visualisations, as this is another layer to their already heavy workload. To combat this, and make health intervention data engaging and interesting, PSI have taken lessons from social media – #majorkey. In the dashboard, people can have conversations about the data, they can also ‘tag’ others. This capacity building tactic has seen slow but certain progress in data engagement and interest.

PSI are working to push data out of their DHIS2 systems, to national health systems. This brings the country back into focus, rather than PSI itself. The contextual framework of the nation’s health system should always be taken into account. Action looks different in different settings, and evidence-based healthcare should reflect this.

Blog reports on the Centre for Evaluation’s Student Seminar, Delivering evidence-based health interventions. Population Services International’s (PSI) unique approach to development, on 1st February 2018.