Digital Decisions Made for the COVID-19 Response: Reflections and Lessons

On June 8, the USAID Country Health Information Systems and Data Use (CHISU) Project hosted a webinar titled, “Digital Decisions Made for the COVID-19 Response: Reflections and Lessons.”

Steve Ollis, Project Director, CHISU Project, moderated the webinar with panelists: 

  • Heidi Good, Deputy Director, Social Innovation and Impact, Lead, Digital Health Center of Excellence (DICE), Digital Square, PATH 
  • Dr. Karin Källander, Senior Health Adviser, Co-lead, Digital Health Center of Excellence (DICE), UNICEF 
  • Mesoud Mohammed, Assistant Director for Policy Planning and Monitoring and Evaluation, Ministry of Health of Ethiopia 
  • Dr. Anand Persaud, National Focal Point for COVID-19 Surveillance and COVID-19 Vaccine Data Management, Ministry of Health of Guyana 
  • Rajendra Prasad Poudel, COVID-19 Information Management Unit (IMU) Technical Chief, Ministry of Health and Population (MoHP) of Nepal

When COVID-19 first struck, many countries had already been moving towards greater use of digital technologies to improve their health systems performance. Suddenly, as a result of the pandemic, they had to make difficult decisions about whether they should modify existing systems, use a new system, or use one of the Global Goods being developed. They also had to weigh privacy and data use considerations. Each of these decisions would have ramifications for interoperability, governance, and data use.  
  
On the donor side, at the very beginning of the pandemic, UNICEF provided global guidance for their Country Offices and encouraged them to use best practices for leveraging digital and data solutions for COVID-19 response. Additionally, to encourage reuse of existing systems, they developed a landscape assessment of digital health technologies being used for health initiatives and other sectors in UNICEF Country Offices.

Karin noted, “To be able to use digital solutions [in the context of COVID-19], we need to follow best practices, we need to work with the global Digital Development Principles, and we need to follow national strategies … we really encouraged countries to look at what systems they already had in place first before introducing anything new.”

Similarly, one of Digital Square’s early initiatives was the development of the USAID-funded Map & Match initiative, working closely with UNICEF and others to provide a resource that allowed stakeholders to understand the existing systems available in each country and how those tools could be leveraged and expanded for COVID-19 response. 

Heidi noted, “At the start of the pandemic, this is really our big push—how do we find what’s out there, synthesize that information, share it quickly, easily, and in a digestible way, so that ministries of health and donors can then make informed decisions about how best to use those tools for mass response.”

Sharing the COVID-19 response from a country perspective, Mesoud noted that Ethiopia used DHIS2 (which had been in use since prior to the pandemic for routine health data management) and a laboratory information system (LIS), with an open platform to facilitate interaction (interoperability) between the two systems. However, the country still faced problems with this setup.  

Mesoud noted, “We have faced a lot of challenges in terms of receiving data from the DHIS2 to the LIS. There are a lot of drops even if the interoperability layer is clearly working and receiving the data and sending the confirmation [of] how many [records] are received from DHIS2.” 

In contrast to the experience of Ethiopia, Guyana did not have a digital surveillance system in place for COVID-19 and has been using a fully paper-based system—relying on staff working round the clock—since the start of the pandemic. DHIS2 was implemented in part in Guyana but was not able to be utilized for COVID-19. 

Dr. Persaud noted, “We’re currently looking at a number of options [for our COVID-19 health information system] because we’ve realized it’s fundamentally important to have a software or digital system that can cater [to our] needs and make work far easier if we have that in place.” 

In Nepal, in the early days of the pandemic, healthcare professionals relied on a combination of Excel sheets, Google Docs, Viber, Facebook Messenger, and direct phone calls to record and report COVID-19 statistics. The process was resource intensive and there were discrepancies in the data reported from multiple channels. While the Ministry of Health and other partner agencies tried to introduce Global Goods applications such as Go.Data, DHIS2, as well as apps developed/offered by the private sector, the process was not without challenges and none of these systems were successfully implemented. 

Rajendra noted, “Why [are] these [Global Goods] systems not able to work? Because we found the system is not localized as per [the] nation’s needs, and the lack of country capacity to customize the localized applications.”

In the two years since the COVID-19 pandemic started, globally, focus has shifted to vaccine service delivery and maintenance and integration of existing tools. At the country level, Ethiopia is focusing on taking a phased approach to implementing platforms and learning from implementation to further improve processes. Guyana is still primarily reliant on a paper-based system for data entry but has incorporated Excel sheets to maintain a database of vaccination and COVID-19 positive cases. After struggling to adapt some of the software Global Goods mentioned earlier, Nepal adapted and incorporated COVID-19 testing and vaccination information into an existing local system (which was used for maternal and child health tracking). 

The global and country experiences illustrate the importance of assessing what systems are already in place before implementing new ones. It is important to consider interoperability between existing and potential new systems and to continue to work to optimize this exchange of data. It is also critical that support is provided for the implementation and configuration of Global Goods, to ensure maximum utility for countries seeking to use them. Lastly, “learning by doing” and incorporating lessons learned along the process of implementation and scale-up are key. 

View the recorded webinar here.

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