"CBHIS have the potential to engage community members, provide them with an avenue to health services, and hold them accountable, contributing to the goals of sustainability."
Community workers (CWs), including community health workers (CHWs), community health extension workers (CHEWs), and community social service providers, require key health information to do their jobs, and their managers require information to monitor their work. Likewise, Governments and donors require information to better plan community health programmes and to monitor progress against goals. This information, how it is collected, and how it flows, is a community-based health information system (CBHIS), and it is the subject of this MEASURE Evaluation literature review.
This focus on CBHIS may be explained by the fact that CWs can meet critical service gaps, as they live in the communities they serve and provide outreach services to people who may otherwise not receive them. Their work needs systems that involve data collection, management, and analysis of health and related services provided to communities outside of facilities. CBHIS should enable information to be shared among community-based services and between community-based services and higher-level health facilities. Moreover, to some extent, they should feed into national health management information system(s) (HMIS).
MEASURE Evaluation conducted a literature search in May 2015 using the following databases: PubMed, POPLINE, and the United States Agency for International Development (USAID)'s Development Experience Clearinghouse. They also searched specific journals. They grouped results in the following CBHIS functional areas:
- Case management
- Documenting individual-level needs to support individual care planning - The Child Status Index (CSI) collects data on orphans and vulnerable children (OVC) on 12, allowing child and family services to be tailored to the needs identified at each encounter/presentation. It is being used in at least 17 different countries.
- Enabling bidirectional referrals - Originally designed for the SIDALE ("AIDS Go Away") project in Haiti, IQReferrals is a tool used to track clients who have been referred to and from multiple programmes and link them across the continuum of care. The USAID-funded Linkages across the Continuum of HIV Services for Key Populations Affected by HIV Project (LINKAGES) is applying a similar, smartphone-based approach to facilitate real-time tracking of clinic referrals among key populations in Papua New Guinea, Laos, and Thailand.
- Tracking patients lost to follow-up - One key innovation was keeping a family folder for every family in the catchment area of a health post as part of CBHIS. CHEWs also used the boxes/health cards to plan follow-up with pregnant women, family planning clients, and children for immunisation.
- Accountability - For example, the Nigeria Evidence-based Health System Initiative (NEHSI) used CommCare to connect its CBHIS with the provincial and national HMIS for planning. Community field workers were given Android mobile devices, which they used to register 5,600 people and link that data to the larger information systems. Benefits of the mHealth system were: ease of use as expressed by field workers; savings both in material and human resources, because fewer man-hours were needed to collect, manage, and synchronise data; and improved data quality.
- Planning, resource allocation, and advocacy - For example, in Nyanza Province, Kenya, CHEWs and CHWs were trained to facilitate community dialogue and maintain the CBHIS and the village register. Health status data from each household were routinely collected and maintained by CHWs through the village register and then analysed by community members and committees and at the health centre. Data-driven participatory action planning by the community and health centers helped to improve services. The districts saw statistically significant improvements in immunisation coverage, health-facility childbirth, use of insecticide-treated bednets, and treated drinking water in comparison with control sites.
A common challenge experienced with CBHIS was lack of technical capacity of CWs. Another challenge in adding to new CW responsibilities is the lack, or early stages, of integration of CBHIS in formal HMIS. Without complete integration, there are duplicate efforts in data collection, analysis, and reporting. One potential solution to cumbersome physical data is use of electronic data collection systems, but this is not always possible in lower-resource settings, and priority should be placed on collecting the right data. Other challenges mentioned are: data collection tools often not in a language CWs are most comfortable using; weak data quality; high turnover or vacant district-level positions; and lack of data collection supplies in remote areas.
As this review demonstrates, CBHIS come in various structures and cover diverse health areas, with different uses of technology and integration in formal HMIS. CBHIS can be used for different goals, including identifying people in need of specific services, facilitating access to community health services, and reporting to higher HMIS for programme planning. "Integration in national HMIS and putting resources into the training and support of CWs will strengthen CBHIS."
MEASURE Evaluation website, June 9 2016. Image credit: MEASURE Evaluation