Researching, co-creating and testing innovations in paper-based health information systems (PHISICC) to support health workers’ decision-making: protocol of a multi-country, transdisciplinary, mixed-methods research programme in three sub-Saharan countries

Xavier Bosch-Capblanch*, David O’Donnell, L. Kendall Krause, Christian Auer, Angela Oyo-Ita, Mamadou Samba, Graça Matsinhe, Abdullahi Bulama Garba, Damaris Rodríguez, Meike Zuske, Anthonia Ngozi Njepuome, Sofia Micael Mandjate Lee, Amanda Ross, Suzanne Gajewski, Artur Manuel Muloliwa, Richard B. Yapi, David W. Brown

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Health information systems are crucial to provide data for decision-making and demand for data is constantly growing. However, the link between data and decisions is not always rational or linear and the management of data ends up overloading frontline health workers, which may compromise quality of healthcare delivery. Despite limited evidence, there is an increasing push for the digitalization of health information systems, which poses enormous challenges, particularly in remote, rural settings in low- and middle-income countries. Paper-based tools will continue to be used in combination with digital solutions and this calls for efforts to make them more responsive to local needs. Paper-based Health Information Systems in Comprehensive Care (PHISICC) is a transdisciplinary, multi-country research initiative to create and test innovative paper-based health information systems in three sub-Saharan African countries. Methods/Design: The PHISICC initiative is being carried out in remote, rural settings in Côte d’Ivoire, Mozambique and Nigeria through partnership with ministries of health and research institutions. We began with research syntheses to acquire the most up-to-date knowledge on health information systems. These were coupled with fieldwork in the three countries to understand the current design, patterns and contexts of use, and healthcare worker perspectives. Frontline health workers, with designers and researchers, used co-creation methods to produce the new PHISICC tools. This suite of tools is being tested in the three countries in three cluster-randomized controlled trials. Throughout the project, we have engaged with a wide range of stakeholders and have maintained the highest scientific standards to ensure that results are relevant to the realities in the three countries. Discussion: We have deployed a comprehensive research approach to ensure the robustness and future policy uptake of findings. Besides the innovative PHISICC paper-based tools, our process is in itself innovative. Rather than emphasizing the technical dimensions of data management, we focused instead on frontline health workers’ data use and decision-making. By tackling the whole scope of primary healthcare areas rather than a subset of them, we have developed an entirely new design and visual language for a suite of tools across healthcare areas. The initiative is being tested in remote, rural areas where the most vulnerable live.

Original languageEnglish
Article number112
JournalHealth Research Policy and Systems
Volume19
Issue number1
DOIs
Publication statusPublished - Dec 2021
Externally publishedYes

Bibliographical note

Funding Information:
Members of the PHISICC Technical Advisory Group, chaired by David Brown: Blanche Anya (WHO AFRO), Abdallah Bchir (former Gavi), Marta Gacic-Dobo (WHO HQ), Richard Greff? (AIGA), Pamela Mitula (WHO AFRO), Sandy Oliver (UCL Institute) and Chris Wolf (BMGF). Research collaborators: Momade Ali, Celso Belo, Bassirou Bonfoh, Lisa Diallo, John Ferreira, Bernard Guessanbi, Caitlin Jarrett, Inza Kon?, Felix Mal?, Kouadio M?bra and Melanie Wendland. Thanks to the invaluable institutional support from the Swiss TPH: Prof. Marcel Tanner, Prof. J?rg Utzinger, Prof. Kaspar Wyss.

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • Côte d’Ivoire
  • Decision-making
  • Health information system
  • Human-centred design
  • Mozambique
  • Nigeria
  • Primary healthcare
  • Sub-Saharan Africa

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