Capabilities & the CoDE Program Highlights
PATH manages Digital Square, a multi-donor co-investment mechanism established by USAID with investments from 9 other donors, including the Bill & Melinda Gates Foundation, that connects 40 organizations with leading digital health experts in more than 18 countries. Through Digital Square, PATH has so far brought together 40+ partners, 20 countries where digital solutions are being deployed, and 9 unique investors, representing bilaterals, multilaterals, philanthropic foundations, and the private sector. Collaborating with stakeholders, donors, host country institutions, other public sector organizations, and/or private sector partners, Digital Square aims to accelerate the adoption, scale, and delivery of digital health innovations in low-resource settings.
Digital Square introduces an innovative approach to financing investments in digital health: transparent co-investment. This approach to investment maximizes the impact of every dollar spent on strengthening national health information systems. Through a public Open Proposal Process, developers and implementers have the opportunity to discover ways their technologies work together and create new partnerships, reducing redundancy and duplication of effort. Under Digital Square, digital health tools and technologies (called “global goods”) can be scaled and adapted to different countries and contexts. The initiative also creates digital market readiness by building capacity with governments, local technology developers, and health workers.
The Digital Square initiative cultivates a more efficient, fair, and open marketplace of digital health solutions by investing in tools and technologies with the highest potential for success and which adhere to international data exchange standards. It advances digital market readiness by growing local capacity to use, manage, and develop these tools. Additionally, it supports regional networks to encourage learning exchange and create enabling environments that will sustain investments in digital health technologies over the long term.
Digital Square is a unique convener in the digital health ecosystem, set apart by the following qualities:
- The coalition’s experience with country digital health implementations, regional networks, and technical capacity building gives it the credibility to shape the digital health marketplace.
- Through its unique open proposal and funding process, Digital Square allows for insights into the most promising tools and approaches and encourages collaboration in the development of critical digital health tools.
- The governance structure ensures that the right stakeholders review and support global goods with the highest potential and alignment to country needs.
USAID/South Africa is leveraging PATH’s Digital Square mechanism to strengthen South Africa’s HIS and data use in the public health sector. Working in close partnership with the National Department of Health, Digital Square South Africa is a four-year program to address digital health architecture, interoperability, analytics, and reporting needs to strengthen health system performance and specifically improve service provision and evaluation in HIV/AIDS and tuberculosis. Specific activities forming the focus of the first two years include: defining and implementing a provincial health data center model to scale; assessing partner management information systems and community-focused information systems; implementing a CommCare pilot for managing community health workers; supporting and strengthening expertise within the National Department of Health regarding digital health governance, strategy, and implementation; and developing a monitoring, evaluation, and reporting reference application for PEPFAR indicators.
The Data Use Partnership (DUP) is a Bill & Melinda Gates-funded, Tanzanian Government-led initiative that is improving Tanzania’s national health care system through better use of health information. DUP aims to strengthen digital health and build local capacity so that everyone – from government officials to health workers to patients – can use health information to make more informed decisions, leading to a healthier Tanzania. During the first phase of DUP, PATH worked with over 80 government and development partners to assess the country’s health information systems and support the creation of Tanzania’s Digital Health Investment Road Map. The Road Map outlines 17 strategic investment recommendations and calls for an overall investment of approximately $74 million. The government sees the Road Map as a critical component for improving the health system in Tanzania by producing better data, which will result in better health outcomes.
The second phase of DUP supports the implementation of seven of the 17 recommendations outlined in Tanzania’s Digital Health Investment Road Map. DUP’s work is unique and significant because:
- Tanzania’s Digital Health Investment Road Map is the first of its kind in the region
- The Government, as opposed to donors or other partners, leads the work
- Aims to strengthen the entire health system as opposed to focusing on just one part of the system
- Seeks to build on existing work and infrastructure, including DUP Phase 1, and the PATH-led Better Immunization Data Initiative, which is currently improving immunization data in three regions in Tanzania
- Focuses on long term impact to strengthen health system performance.
Leadership in Digital Health Technical Innovation
As a leader in the digital health and development arena, PATH works to provide recommendations on context-appropriate digital health architecture and standards adoption. PATH serves as a neutral broker, without financial ties to specific standards bodies, helping instead to advance standards that best serve specific scenarios. This enables us to give unbiased counsel on the types of standards that will best meet a specific digital health need. In some cases, PATH has worked on bringing together multiple existing systems to better unify standards. For example, PATH will be supporting Project Gemini – a collaboration between IHE and HL7 intended to increase interoperability and improve standards for immunization workflows. Moreover, PATH is represented on several domain committees of Integrating the Healthcare Enterprise (IHE) – a standards developing organization with the mission of “providing specifications, tools and services for interoperability.” Working specifically in the health sector, IHE is used primarily by healthcare providers and stakeholders to “develop, test, and implement standards based solutions to vital health information needs.”
PATH also plays an active role in the OpenHIE community, and serves on its leadership committee. PATH co-led coordination of the first annual OpenHIE community meeting in Tanzania in August 2018, where implementers came together and shared challenges and lessons learned using OpenHIE.
Through Digital Square, PATH is currently supporting a number of global goods to adopt standards; in addition to our support of advancing ISCO and FHIR through iHRIS and OpenMRS, respectively, PATH is also supporting investments in FHIR through GOFR, OpenLMIS, OpenInfoMan, and openIMIS to adopt the standard. Additional global goods that PATH is supporting include Empty Box, OpenCRVS, and OpenHIM. By investing in tools that adhere to international data exchange standards, Digital Square promotes interoperability in HIS and provide customizable solutions for countries.
Better Immunization Data Initiative
Led by PATH and funded by the Bill & Melinda Gates Foundation, the Better Immunization Data (BID) Initiative (2013-2018) aimed to empower countries to enhance immunization and overall health service delivery through improved data collection, quality, and use. PATH partnered with countries and global health stakeholders to develop and deploy a holistic and scalable approach that focuses on information system products, data management policies, and the practices of people that use them, in order to enable evidence-based decision making. These components were packaged into a replicable solution that can be easily and cost-effectively adapted by additional countries interested in using it to improve their immunization management. Through the BID Initiative, PATH also developed a high-level strategy for outreach to global development partners (multi-lateral agencies, bi-lateral agencies, foundations, regional agencies, etc.) and engaged in conversations with many of the key stakeholders. Additionally, the regional BID Learning Network (BLN) was developed as a regional peer learning community of practice, with 20 countries active from the region.
Results from BID have been impressive. In Tanzania, rollout was completed by mid-2018 in the Arusha, Tanga, Kilimanjaro and Dodoma regions, and data on more than 400,000 children were entered into the immunization registry since BID began. Tanzania has also committed Gavi funds for health system strengthening to scale up data quality and use interventions to the equivalent of ten additional regions in 2018 and then national scale in 2019. In Zambia’s Southern Province, the BID Initiative successfully introduced and quickly scaled up ZEIR, thanks to the enthusiasm of health workers across the province. Data on more than 96,000 children have been entered in ZEIR.
To improve the data use culture, PATH developed a change management approach called a “touch strategy,” where through a series of “touches,” or specific engagements with the facility, health workers were mentored in the use of an immunization registry and use of data in the registry. As a result, the percentage of nurses in Arusha able to identify and act on vaccine defaulters increased from 32% at baseline to 79% at endline.
Data For Action
At PATH, our principal assumption is that better data and regular data practice create a culture of using data for decision-making, leading to better decisions, a strengthened health system, and improved health outcomes. PATH’s focus on data use is evident in our partnerships with national programs where we work iteratively to improve existing systems and processes, and cultivate talent that produce and use health related data. We recognize that decision-making is moving from a national to subnational level in low resource settings where decision makers at the county, district, and ward level must nimbly consider many types of data streams to improve programming.
Given the diversity and complexity of the data, core principles guide PATH’s approach to strengthening data use:
Understand and optimize existing systems. In each setting, we begin with an assessment and understanding of the needs in the current state. For example, with widespread uptake of key systems and tools like the DHIS2, use of open source software such as Open Data Kit (ODK) Collect and mobile phones for surveillance and reporting, countries are using technologies that can be adapted, integrated, and optimized to improve data quality and insights. Enabling existing systems is an excellent way to improve systems and practices around data use.
Focus on building and institutionalizing capacity. PATH’s goal is to strengthen the competency and skills of our national partners to carry the work forward. It is key to identify critical capacity at the champion level in the ministries and directorates, as well as technical capacity for further development in existing surveillance, information and communication technology (ICT), HMIS, and informatics teams.
Leverage user-centered design and development methods. In order to optimize systems and develop talent and skills, we start with the requirements and developmental needs of the users. For example, in PATH’s work in malaria surveillance we apply user-centered design methods to develop use cases that drive requirements rather than restricting our thinking to specific interfaces or technologies. This approach allows us to match the right technology or process solution with the current skills and competencies of the users.