Partnering for a Cultural Transformation in Information Use: Reflections on DUP’s Journey in Strengthening Ethiopia’s Health Information System

By Wubshet Denboba, Project Director, DUP/JSI

In February, after six years of working with the Ministry of Health (MOH), regional health bureaus (RHBs), universities, and partners to implement the MOH’s Information Revolution (IR), the Ethiopia Data Use Partnership (DUP) concluded its first phase of implementation. To mark the end of this chapter, on February 22 and 23, DUP hosted a dissemination workshop and exhibition that culminated with a closeout celebration and reception in Addis Ababa.

The event drew dignitaries including the minister and the state minister from the MOH and representatives from the Ministry of Education, RHBs, universities, UN agencies, and partners. It was an opportunity to reflect on DUP’s considerable contributions to the sector and share best practices with local and global stakeholders. As project director, I was fortunate to be able to host and confer with attendees, who noted how well the event was organized and, more importantly, appreciated our significant work to improve the country’s health information system (HIS) performance.

With funds from the Bill & Melinda Gates Foundation and a supplemental grant from the Doris Duke Charitable Foundation, DUP supported multiple HIS activities that advanced individual and institutional capacities to generate and use high-quality health data for decision-making, improving health outcomes at all levels. DUP played a pivotal role to transform information use by digitizing key HIS priorities such as DHIS2 and developing and implementing essential HIS governance structures and standards. DUP provided tailored support and piloted several data quality and use innovations, including a non-monetary incentive mechanism, in learning health institutions that share best practices with sites across the country to replicate. Furthermore, DUP supported evidence generation, translation, and use to improve health program implementation. Our implementation research—a relatively recent area of study in which researchers and implementers collect and apply lessons— with local universities yielded a body of evidence for the development of various strategic initiatives.

What equally interested event participants was DUP’s implementation approach, which is grounded in innovation and inclusivity to establish consensus and collaboration among stakeholders, maximizing HIS investments. The following principles create our core ethos that guided our conduct and work:

• Alignment: We aligned support with government priorities by embedding activities and resources within MOH structures and plans. In addition, we advocated for and support partners to adopt this modality to promote country ownership and sustainability. Instead of duplicating efforts and prescribing foreign or new initiatives, we built on government priorities by providing strategic thought leadership and technical expertise.
• Partnership: In essence and practice, DUP is an effective HIS platform for partnership and collaboration to realize IR objectives across the country’s health system. Through the coordination of partners, DUP supported the strategy and standardization of HIS implementation to enhance quality of care, while reducing the duplication of efforts and waste of resources. DUP’s role in coordinating partners to implement MOH’s Capacity Building and Mentorship Program, which involves higher academic institutions in HIS implementation, exemplifies this principle.
• Comprehensiveness: DUP’s comprehensiveness emanates from supporting implementation across the three IR pillars: data use culture transformation, digitization of key HIS tools, and HIS governance. Our involvement in and support for the development of national strategic documents and guidelines and their implementation at the local level allowed us to influence activities at each step of the way. It also provided an effective response mechanism as we could send timely feedback on implementation to all government structures and quickly fill gaps.
• Sustainability: Sustainability has been core to DUP’s engagement. We worked hard to institutionalize a culture of information use and digitize health data tools across the health system. We ensured future sustainability by building local capacities of RHBs, universities, district health offices, and facilities through trainings, job aids, and supportive supervision. To ensure availability of skilled human resources in HIS, we sponsored master’s and PhD students and developed the IT Internship Program, recruiting and deploying about 170 new graduates in health informatics and related specialties. Furthermore, DUP played a significant role mainstreaming and elevating digital health to a nationally prominent position where it can reap the full benefits of technological advancements in health care.

All engagements are based on these principles, which has earned us the respect and trust of the MOH to coordinate HIS resource mobilization and develop innovative solutions such as the Digital Health Innovation and Learning Center, a dedicated learning and workspace hub where digital solutions are conceived, designed, tested, and implemented. At the closeout event, H.E. Dr. Dereje Dugumas, state minister of the MOH, called DUP a “driving force behind Ethiopia’s IR operations,” a testimony to our overall commitment and visible impact in IR implementation. At the end of this first phase, we celebrate what DUP has achieved and the ongoing effect of these accomplishments. Our work over the last six years will lay the ground work for future efforts and continue to improve the use of high-quality data across the country.