Thinking Beyond Technology: Governance of Digital Health Systems

The global health community is finally realizing that technology is only one piece of a digital health system. Aligning people and processes are just as important, especially given the role that both play in facilitating the uptake of new technology and promoting sustainability.

Through USAID’s flagship Maternal and Child Survival Program, we are aligning people and processes in Tanzania to develop and deploy a health information mediator (HIM). The HIM will improve interoperability between existing information systems and enable electronic data sharing between multiple systems. This will permit frontline healthcare workers and health management teams to utilize data from multiple sources for improved decision-making.

Over the past three years, JSI has established and collaborated with the Tanzania Ministry of Health (MOH) technical working group (TWG) to review other information systems in the health sector that can eventually exchange information through the HIM. Within the TWG, there are different task teams based on the type of system: for example, a team for Electronic Medical Records and a team for logistics information systems. The TWG allows for better communication among relevant actors in Tanzania’s health information system, making it easier to achieve interoperability.

In addition, we also work with the Project Management Office (PMO), a unit that supports the MOH by providing a holistic view of all information systems in the country with the end goal of achieving better harmonization of systems. This coordination between people and units is essential to workflow optimization.

We’ve also identified other elements of governance that should be incorporated when implementing digital health systems. These include the following:

• Consider existing systems. Ensure that your digital health system is compatible with and not duplicative of these systems. This is important for sharing data and guaranteeing sustainability.
• Establish and implement clear policies and guidelines for the technology. These guidelines should be developed during the planning phase and involve key MOH stakeholders, implementing partners and donors,  and any users affected by the system.
• Build capacity and identify resources. Do the officials supporting the system have the required technical skills and funding? If not, make sure there are trainings in place to build their capacity. These trainings should focus on system maintenance and upgrades and occur as the system is being built and when it is deployed.
• Explore financing options for future expansions. It’s important to think beyond the current use cases of the system and about ways to expand. What happens if upgrades or further customization is needed? One possibility is to leverage existing funding mechanisms targeted to improve particular systems to ensure those use cases are added to the HIM.

Building solid governance structures ensures that technology is not developed and deployed in a silo. Engaging relevant stakeholders, and implementing relevant policies, will ultimately make it easier for countries to take ownership of new technology systems and scale up. We hope that JSI’s success implementing the HIM in Tanzania can serve as a model of the effective governance structures needed for the development of future digital health systems.

Written by Ssanyu Nyinondi and Caitlin Viccora