PHISICC Paperbased Health Information System

Improving decision making through better designed paper-based information systems in Mozambique, Nigeria, Cote d’Ivoire

Using a multi-disciplinary approach that combines Human Centered Design with rigorous quantitative and qualitative research, the PHISICC project is investigating paper-based health information systems to test if redesigned paper-based tools and processes impact decision making and health outcomes.

In many low and middle income countries (LMIC), health data is generated, stored and transferred using paper-based tools. In an era of increasing digitalization, paper based information components have been neglected. However, they are essential because they are often the very source of all data used where it is produced and upstream the systems and, therefore, data issues and errors at the point of care at Primary Health Care level are inevitably transmitted and amplified to the highest levels of the health system. These settings often serve the most remote and vulnerable populations. Data about these remains underrepresented at best.

We believe that such critical parts of the health systems should be carefully researched and intentionally designed to improve health outcomes and facilitate equity. We focus on the paper components of the health information system in three African countries: Côte d’Ivoire, Nigeria and Mozambique.

We have gathered global and local evidence on health information system interventions and characterizing the role of paper-based systems in three countries. Then, in creative partnership with the countries, we have engaged in co-creative, collaborative and intentional design activities to redesign the tools and processes together with health workers and stakeholders. The process has started to test the effects of the intervention using randomised controlled trials (RCT), to feed into national health strategies and policies. The team will share the knowledge and lessons learned over the course of the project with decision and policy makers in the global health community.

The project is organised in a partnership between the Swiss TPH, Gravitytank/Salesforce, Sonder, the Universidade Lúrio (UniLúrio), the Ministério da Saúde (MISAU; ‘Ministry of Health of Mozambique’), the Centre Suisse de Recherches Scientifiques en Côte d’Ivoire (CSRS ‐ Côte d’Ivoire), the Ministère de la Santé et de l’Hygiène Publique (MSHP / MOH), the University of Calabar, the National Primary Health Care Development Agency (NPHCDA) of Nigeria and the Federal Ministry of Health of Nigeria. PHISICC is funded by The Bill & Melinda Gates Foundation.

Sonder has led the design of the new information system by:

  • Facilitating the co-creation process with stakeholders and health workers in the design of the information system.
  • Design the tools that will be part of the information system.
  • Test & iterate the information system design based on user feedback across the three countries.

The Co-Creation Process

The design process has been guided by Co-creation design workshops across the different countries to develop, design, test and evolve the design of the new information system.

PHISICC would not be PHISICC without our co-creation groups.  These team members, representing Côte d’Ivoire, Mozambique and Nigeria, have worked enthusiastically and consistently over many months with frontline healthcare workers to co-design and really breathe life – and real-world evidence – into the development of an entirely new paper-based health information system.

The process started ‘concepting’ workshop with the PHISICC team in Basel, followed by this workshop in Mozambique, Côte d’Ivoire and Nigeria. Central to the richness of this process is the diverse experience of our collaborators and exchange with frontline healthcare workers, who are brought into the process through multiple field trips. This approach enables user- and system- level insights to combine in a unique way and bring about key insights to inform the best designs.

There is a need to continually create new ideas and build on those of others – this is exciting but also requires a lot of listening and processing; you have to keep an open mind. I think the hardest things were not always reaching a point of certainty and always understanding everyone’s ideas to be clear about what made sense and what didn’t. There is a lot of experimentation but as the days passed, there was an increasing sense of having methodically brought the most relevant areas into focus and increasing confidence that the process was working. The prototyping and having to explain your ideas really help to clarify what looks most promising.

Caitlin Jarrett, PHISICC

Drawing on these focused efforts, the teams across the 3 countries have been conducting further design testing in their local health facilities to continue refining the details with health workers.

This is an intense but incredibly exciting time for PHISICC as we push towards a final design intervention. This intervention will soon be trialed across the three countries and hopefully, prove to be solid evidence of a novel and informative approach to support future health information system strengthening activities.

“It will help me to reduce the omission of data”

Nurse in Nigeria

For more information check the project website