Digitizing Community Health Information Systems: What’s next to improve health service delivery at the community level in Ethiopia?

What was the goal?

The electronic Community Health Information System (eCHIS) is a high-priority initiative, demonstrating the Ethiopian Ministry of Health’s (MOH) intentions to further use technology and data to improve service delivery starting at the community level. The eCHIS digitizes the family folder and CHIS content into a mobile platform for use by Health Extension Workers (HEW) around the country. The mobile platform and corresponding clinical, reporting, and system management tools are expected to promote access to and use of data about community service delivery within the Health Extension Program, supporting HEW responsibilities and equipping decision-makers with relevant, high-quality data to advance the health system in Ethiopia.

Where are we?

The development and implementation of the eCHIS has made significant progress over the past couple of years. The MOH has documented various iterations of requirements for the eCHIS, including overall system design and deployment architecture. Based on the new requirements and the system architecture design, a technology review was conducted and it was decided to develop the application based on a single comprehensive platform. Development of the digital family folder and the reproductive, maternal, newborn, and child health, malaria, and tuberculosis modules are complete, and the NCDs and NTDs modules will be finalized by October 2021. In addition, configuration and setup of CommCare HQ for local hosting has been done in parallel to the development of the mobile app and is implemented in over 4,000 rural health posts across six agrarian regions (Tigray, Amhara, Oromia, Sidama, Benishangul Gumuz, and SNNPR). In addition, the MOH is customizing the family folder to expand rollout to pastoralist health posts. The eCHIS customization for urban settings will continue in the next year.

What have we learned in this journey?

The actions taken to accomplish these milestones have been informative and set a pace that demonstrates the high priority of implementing a mobile tool for HEWs. While progress toward an eventual country-wide implementation has been made, core components of a comprehensive program strategy have yet to be established. These require continued exploration of the development and implementation approach and the overall programmatic goals of eCHIS. Critical rethinking areas include but are not limited to:

1. Goal-driven implementation approach with the appropriate measurement of success: Despite initial attempts to articulate a set of strategic goals, eCHIS overall programmatic goals are not still clearly defined and measurement tools and indicators have not been crafted. This requires evidence on health service delivery gaps and the anticipated effect of the eCHIS implementation. Based on the learnings from implementation so far and experiences from similar digital health projects in Ethiopia and other countries, it is important to articulate what the MOH aims to achieve with the eCHIS; why certain components of the strategy are priorities; and how each will be measured to have a foundation upon which to make decisions moving forward.
2. Road-mapping and analysis of eCHIS investment: The development of the eCHIS product and resulting implementation are based on designated milestones and roadmaps. Throughout the course of the Activity, eCHIS development and implementation plans depend partially on funding prospects and long-term intentions with the product itself, with different budget models informing implementation approaches. Long-term sustainability of the Activity is also critical. eCHIS investment planning needs to be relevant to partnerships, to demonstrate accountability, enable shared planning mechanisms, and communicate transparent expectations to all involved stakeholders.
3. Fostering partnership and collaboration among technology, programmatic, and implementation partners: It is critical for MOH to continue to build and sustain relationships with technology, programmatic, and implementation partners. Each has a critical role in bolstering capacity during various phases, as well as providing insight through collaboration and sharing experiences in similar scenarios. So far, engaging partners that are focused on software development, technology implementation, and support and maintenance has supplemented teams with expertise and provided continued training for health system staff at different levels.

Written by Netsanet A. Nigussie, Senior Director, USAID Digital Health Activity