Transforming Rural Health Workers' Jobs through Digitization

Effective use of digital information and communication technologies is poised now to change the way rural health workers work and to offer them an increased level of efficiency. In Bangladesh, a pilot program has begun transforming the rural health workers’ jobs and the accuracy of the data they gather.

By Professor Abul Kalam Azad, Assistant Director General and Director, Management Information Systems (MIS) of the Directorate General of Health Services, Ministry of Health and Family Welfare

Dhaka Tribune PageDHAKA, Bangladesh—Effective use of digital information and communication technologies is poised now to change the way rural health workers work and to offer them an increased level of efficiency. In Bangladesh, a pilot program has begun transforming the rural health workers’ jobs and the accuracy of the data they gather.  

The program employs digital tablets to gather the data that tell the story of individuals, their health issues and concerns, and the services delivered to them. It begins with a registration of the population. A household with four to five members can be registered by a rural health worker in about 10 to 12 minutes, enabling health workers to collect data from about 50 to 60 people each day, with each person identifiable by a health identification number.  

The speed and accuracy possible through digitization matter greatly for the health information system in Bangladesh, where, as in most countries, the granular data gathered at the household level is the basis for aggregated data on health issues, services needed, and service gaps across the country. The initial data gathered by rural health workers, and also in health facilities, is called the routine health information system (RHIS) and the data they contain are the workhorses of health information-gathering. They offer a healthcare provider the most granular data about a patient and are fed upward through the system to provide data on health issues and trends to decision makers at the top. Think of it as a long supply chain.

That kind of information is important as the world is focused on increasing its use of evidence to underpin decisions made about health: emerging diseases and sudden virulent outbreaks, service delivery, health commodity supply, equity in access to services and services rendered, achieving an AIDS-free generation, and ending preventable child, maternal, -non-communicable disease-related and other deaths. To achieve these goals, the world needs data. And to get data, the world will need to rely upon those workhorses: routine health information systems.

This need is the genesis for efforts across the globe and in Bangladesh to improve RHIS, to make the data it collects more robust, and to ensure that the data are useful and are used for decision making. A population registration system (PRS) is considered to be the foundation of the RHIS and as Bangladesh digitizes this process, it is moving strongly toward a complete PRS through the new pilot program, called RHIS Initiatives. The RHIS Initiatives has four implementing partners working under USAID in the two districts of Tangail and Habiganj: MEASURE Evaluation, icddr,b, MaMoni HSS, and SIAPS. Two departments under the Ministry of Health and Family Welfare of the Bangladesh government provide healthcare at this level: the Directorate General of Health Services and the Directorate General of Family Planning, whose community workers provide health services chiefly through home visits. Once fully implemented, PRS will contribute to full civil registration and vital statistics coverage, which records events such as births, deaths and cause of deaths, and is essential for sound health care planning, for which the Government of Bangladesh has undertaken a comprehensive approach by engaging multiple ministries and agencies.

The digitized PRS also changes the amount and quality of evidence available at the top. The system validates initial data and also collects background meta data, such as geographic coordinates and administrative data that are useful for decision makers and are available in near-real time for improved decision making.

Real-time information, redundancies to enable work offline when connectivity is down, hand-held platforms that are portable for rural health workers are converging in Bangladesh with RHIS Initiatives to increase and improve data that, in turn, can help to improve lives.

The RHIS Initiatives is one of several health data and eHealth programs of the Ministry of Health and Family Welfare of Bangladesh which can be viewed at www.dghs.gov.bd.

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A new video, premiered at the Health Data Collaborative meeting in Dhaka, Bangladesh on April 27, tells the story of the RHIS Initiatives’ introduction of mobile data collection for population registries conducted in rural areas. See the USAID-supported MEASURE Evaluation website at www.measureevaluation.org or the project’s video page at https://vimeo.com/158974120.

This article was first published in the Dhaka Tribune on April 25, 2016, and is reprinted with permission from the author.  

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