Catalyzing Change: Scaling up an Information Use Culture across Ethiopia’s Health System

Since 2017, the Ethiopia Data Use Partnership (DUP) has been an active partner in the implementation of the Ministry of Health’s (MOH) Information Revolution (IR), a national strategic initiative to transform collection, management, and use of health information to ensure evidence-based action. Led by JSI, DUP began shortly after the IR was launched, enabling it to contribute to the critical groundwork. Since then, DUP has supported the operationalization of health information system (HIS) strategies and led efforts to reinvigorate health data collection and use, strengthening processes and practices from strategy formulation to performance monitoring and evaluation at all levels of the country’s health system.

In 2019, aiming to set a precedence in effective and responsive IR implementation, DUP, MOH, and regional health bureaus (RHBs), embraced a ‘learning by doing’ ethos and established learning, or demonstration, sites in eight districts and five hospitals across different regions. The sites served as a testing ground for implementation innovations, while also receiving intensive tailored support.

Learning site selection was based on a consultative and cooperative process. DUP and MOH developed criteria and standard operating procedures and RHBs selected the districts and hospitals. With the goal of promoting an evidence-based decision-making culture across target sites, the team provided need-based training, supportive supervision, mentoring, routine data quality assessments, experience sharing review meetings, among other support. Throughout the engagement, DUP documented and disseminated the sites’ best practices to scale up across the country.

Inside the learning blocks

DUP’s interventions at the learning sites were multifaceted. In addition to providing digital health tools to improve data systems, the team strengthened health worker and manager data use capacity through training, mentoring, and hands-on job support. Learning sites also received information communication technology resources such as computers, tablets, modems, and USBs.

In designing and operationalizing the learning strategy, DUP and MOH intended to demonstrate implementation standards that underpin the creation of IR model sites. These are sites where information is available and accessible for use. This intensive support has done exactly that— it’s resulted in impressive performance that led to the creation of demonstration sites, so others can replicate these best practices,” says Wubshet Denboba, DUP project director.

The investment returns are significant. Learning site facilities overhauled their manual, paper-based data collection systems and now employ electronic and online information management tools. This has strengthened a culture of data use that continues to grow with improved data quality and decision-making.

This shift in technology and behavior is down largely due to the unreserved and close follow up from DUP. Thanks to the cultural improvement across the whole system, health workforce started acknowledging and using information—a practice that has significantly enhanced our service quality,” says Mokenin Eshete, head of Aleltu District Health Office, a learning district in Oromia Region.

Examples of the learning sites’ value abound. The Lera Primary Healthcare Unit in the West Azernet Berbere district of the Southern Nations, Nationalities and Peoples (SNNP) Region increased its IR implementation score from 63% in 2019 to 97% in June 2022. Performance reviews indicate that facilities including Tiyo in Oromia, Shebel Berenta in Amhara, and Damot Weyde in SNNP have also improved their processes for evidence-based decision-making with their IR implementation score markedly increased from baseline.

Scaling up lessons

A primary intention of the learning sites, as the name implies, is to help other facilities learn from and replicate effective data use processes in their own contexts. With DUP’s support, RHBs organized various HIS performance review platforms upon which learning sites could share their experiences testing interventions and the lessons that emerged. DUP and the RHBs also arranged several rounds of site visits for staff of other health institutions to meet learning site staff, observe their data practices, and hear about their progress and outcomes.

With their significant improvements in data quality and use, the learning sites have a highly receptive audience. At a regional dissemination workshop, most RHBs pledged to replicate best practices in one woreda at least annually—starting scale up efforts sooner than planned. Some RHBs committed to expanding learning site lessons to the zonal level.

Throughout the learning site approach, DUP ensured that partnership, collaboration, and government ownership remained central tenants. Because of this, the sites have institutionalized an information-sensitive culture and data practice at various levels of the health system. Moreover, aligning activities with the MOH helped build workforce capacities and skills in data across the health structure. In effect, these strategic decisions sparked the growing commitment to impart learning site experiences and lessons to health institutions across the country, allowing DUP’s contributions to take hold and ensure the sustainability of what has been accomplished.

Photos: Benti Ejeta