In the post-MDG era, reaching all populations is increasingly recognized as central to achieving sustainable development. Community-based health services will gain prominence as part of countries’ efforts to address health service issues such as equity, inclusiveness, and systematic and broad coverage.
As part of these efforts, countries will have to put more attention to strengthening and mainstreaming their community-based health information systems (CHIS), which may include use of information technology. A systems approach sees technology as an integral part of a health information system, rather than seeing technology as a way around an inadequate health information system. However, the excitement around use of technology as a solution for every new initiative needs more prudence.
A CHIS not only serves the needs of health managers and policy makers, but also as a tool for community health workers, allowing them to better serve their constituencies, and can assist community members to get involved in improving and maintaining their own health. Ethiopia has implemented a family-centered community health information system that addresses both these purposes.
The Family Folder is the centerpiece of this information system where the Health Extension Worker (HEW) maintains the records of the household as well as every family member. A Tickler File System is used to organize follow-up appointments and promote continuity of care. All these are paper-based and managed manually. You can see how the local solution is helping in improving skilled services to pregnant women in the illustration below.
With this successful paper-based system well-established at community level, Ethiopia is gradually introducing technology for the HEWs to better manage the data and exchange data with the respective referral health centers.
We see similar efforts in Bangladesh where, at the community level, improved paper-based information systems are put in place and at the same time a phased introduction of electronic population registry, service registry, pregnant women registry, and death registry is taking place.
This introduction of technology at the community level is unstoppable. At the same time, confusion caused by so many innovations by technology enthusiasts that we see these days is also good because it helps in faster evolution to better systems. But, at the same time countries also need to have a conservative approach to introduce technology at the community level in a well thought out manner and at a pace that the country as a whole and the community health workers in particular can handle efficiently.
Learn more about the MEASURE Evaluation program.