Didar Ali, Technical Advisor – Monitoring, Evaluation, Research and Learning

I was pleased to attend the three-day Indo-Pacific Digital Health Users Forum in Fiji last week, where I learned about the increased use of technology in the health sector, the Pacific context and the challenges and opportunities around improving health outcomes in this part of the world. 

As someone with a Monitoring, Evaluation and Learning (MEL) background, I was inspired by the innovative technologies exhibited at the Forum and how they are simplifying and facilitating the data management process, particularly in the health sector. Compared to many other sectors I have worked in – from education, civil society, agriculture and food security to economic growth, financial inclusion, women’s empowerment, and governance – data-informed decision making seems more prevalent in the health sector. This is largely because service delivery and overall functionality depend on it. As a result, systems and mechanisms which improve the quality and accessibility of data to health personnel, administrators, practitioners, and communities tend to be better resourced.

That said, challenges persist. During the Forum it became clear that in many Pacific countries, there is limited capacity to apply improved data-related technologies for healthcare services. E-health strategies either do not exist or are outdated. Much of the investment is donor-dependent, raising questions about long-term sustainability. For example, Beyond Essential Systems (Tamanu, Tupaia) and Msupply are implemented in some Pacific countries, but there is still some way to go before they will be managed, implemented, and financed independently.

This is where monitoring, evaluation, and learning (MEL) comes in. DFAT and other development partners can support stronger MEL within government institutions that links data with the objectives, goals, and visions of a program by developing a framework for understanding it at the department, facility and sector levels. MEL also facilitates equal service delivery by disaggregating data, equity and social inclusion and identify gaps and challenges. It then ensures that experience and knowledge is shared, so that mistakes are not replicated, and resources wasted.

The relationship between MEL and the above-mentioned technologies, software and digital solutions could have been given more prominence in the Forum. It is unfortunate that MEL is not prioritised in many of these contexts, particularly within government institutions. Technology is attractive and has ‘silver bullet’ appeal, but without a proper vision and framework to guide the ways in which data is used and communicated with stakeholders and communities, the potential for missed opportunities and unethical conduct is significant.

MEL also ensures that data is used ethically. In the health sector, almost all of the data is sensitive: consent and privacy demand careful attention. MEL allows practitioners and users to see which data has been used, and how. In doing so, it enables us to critically assess that data and its utilisation, in turn allowing us to identify problems or inappropriate actions and change course where necessary. 

Like any other application, digital solutions must be sustainable. This remains an area of concern for Pacific countries. Key questions include how much solutions will cost, and to what extent governments can procure services domestically and internationally to fulfil requirements, invest in technology, and establish skilled teams. 

There are numerous digital solutions introduced in these contexts with the support of donors and funders that are working well. But if the environment and resources needed to continue them are inaccessible or inconsistent, these solutions risk destroying existing, traditional systems and data can be lost. In countries with small populations, the relative expense of introducing new systems should be evaluated on a cost-benefit and value-for-money basis before decision-makers forge ahead. Ideally, transparent, independent reviews of digital initiatives should be planned, financed, and communicated openly to ensure that lessons are shared and mistakes are not repeated.

There are some excellent examples of how an integrated team and a clear e-health strategy have contributed to an efficient and effective data system in the Pacific. In Samoa for example, a team of MEL, IT and aid program managers worked together to inform the policy framework, provide inputs to the developer, and ensure the data needs were addressed at different levels. The joint efforts of this team helped to align the data to the needs of health service delivery and donor program reporting by following the e-health strategy, aligning the indicators, and updating the MEL framework at the Ministry of Health level. This maximised the efficient use of resources and avoided duplication.

Technological advancement and progress in digital MEL in the health sector offer many lessons, and there is wide scope for spill over impacts in other sectors, including education, social security and, increasingly, in programs responding to climate change. But for that to happen, digital solutions must be more sustainable. Organisations, contractors, and development partners need to commit to sustainability from the start. Short and long-term capacity building plans for local teams, as well as any required training and coaching should be included in budgets, while risks to long-term sustainability should be identified and discussed transparently with communities as part of dedicated community engagement activities. 

The Forum showed us how digital solutions can improve implementation and positively impact delivery. It is up to us to step up and apply those solutions responsibly and sustainably.