A responsive and reliable health information system is pivotal to accelerating universal health coverage—particularly, during a health emergency. Health information systems provide a platform to monitor the delivery of essential health services, and a means to make informed decisions. With disaggregated health data, it is possible to plan initiatives that reduce health inequities, at all levels of care. Although vital, health information systems in many countries are fragmented, unstandardized, and unresponsive—particularly in low-resource settings. Fragmented health information systems are usually a result of health programs operating in silos and not sharing vital data. Donor agencies can exacerbate the problem with their own reporting formats and demands for data, and by funding the development of program-specific systems.

The Health Information System of Lao PDR was similarly challenged. Each health program operated their own information system, supported by development partners. Impacted by a lack of standardization, poor data security, and high costs associated with developing and maintaining multiple systems—the country’s health information system needed an overhaul. WHO’s Country Office (WCO) recognized the need to address these challenges. In 2013, WCO initiated the process of building an integrated health information system in Lao PDR. Over the past eight years, WCO has supported the Ministry of Health (MoH) to build and operate an integrated health information system on DHIS2 (a free modular web-based, open source software package). Today, Lao PDR can boast of a robust, integrated health information system that was built from the ground up. Among other factors, WCO’s strategy to (1) secure government ownership early on in the process, and (2) bring all development partners to the table, ensured the success of this initiative.

1. Securing government buy-in and ownership: WCO secured early buy-in from the MoH, building strong political commitment, and across Ministry programs. The Country Office team attained government support and ownership through sustained advocacy efforts, multiple rounds of discussion, promoting a bottom up approach in information system design and capacity building initiatives. Cognizant that ownership needed to trickle down to all levels of the health sector, WCO made concerted efforts to empower end users to be part of the design of information systems and to build national capacity to use the health information system efficiently, and with ease. WCO team members supported DHIS2 academies and local training sessions, and even brought in international experts to conduct training programs. Through these capacity building efforts, all players in the health sector acquired experience in data entry and generating information for action. WCO’s multi-year strengthening process thus ensured ownership and better utilization of the health information system, at all levels in the health sector.

2. Bringing all development partners to the table: To address the issue of multiple, and oftentimes conflicting, donor data requirements—WCO worked to channel contributions from multiple development partners towards building and sustaining the health information system. WCO leveraged existing convening platforms such as sector working groups and informal development partner meetings to facilitate discussions and build agreement among multiple players. Mindful that sustaining an integrated health information system requires significant investments, WCO advocated for long-term support from these development partners. WCO’s efforts paid off, and key funders contributed significantly towards Lao PDR’s national health information system. GAVI continues to contribute to a strong information system for the Expanded Program on Immunization, Gates Foundation through PSI funds the development of an effective Emergency Operations Centre system, the Global Fund supported systems for the TB, HIV and Malaria control programs and more recently with World Bank to track and monitor Disbursement Linked Indicators, European Commission supports the strengthening of Nutrition Information Systems and Asian Development Bank collaborates closely with WCO in developing a digital health enterprise architecture which will serve as the basis for a five-year e-health strategic plan in Lao PDR. These contributions were considerable, not only in terms of building the health information system, but also in terms of sustaining it for years to come.

Testing Waters during COVID-19

Strategic investments in building and sustaining a robust health information system supported Lao PDR’s preparedness for and response to COVID-19. The country’s responsive and agile health information system easily adapted to information demands during the COVID-19 response—and delivered great value for money. Investments in capacity building paid off, and trained health care workers are efficiently able to monitor and track essential health service indicators using the national health information system. This allows decision makers to easily perceive health trends and make informed evidence-based decisions in response to COVID-19. Thus, previous efforts to build and strengthen the health information system has ensured better coordination, pooling of resources and enhanced transparency—in turn building donor trust and thereby increasing resources for health strengthening. WCO’s efforts in the region significantly enhanced progress towards GPW13 indicators, particularly towards accelerating universal health coverage and better protection during health emergencies through integrated health information systems.

Photo caption: A health worker in Lao PDR enters COVID-19 health resources tracking data on a tablet PC.

Photo credit: WHO