Accessible evidence leads to better decisions for health in Nepal

Sound decisions in public health are rooted in evidence. Evidence serves as the backbone for rational choices. This is just one of the reasons why substantial funding is being invested in generating evidence.  The Nepal Health Sector Support Programme funded by UKAid from the UK government, and implemented by the Options-led consortium in Nepal, has been investing in facilitating better decision-making by making evidence accessible and easy to understand.

In Nepal, evidence in health primarily originates from two sources. The first comes from routine information systems such as the Health Management Information System (HMIS). This provides regular data on key indicators that need to be monitored to assess the use of services and performance of the health system. The second source is the population and institution based surveys such as the Nepal Demographic and Health Survey (NDHS) and Nepal Health Facility Survey (NHFS). These are conducted periodically to measure the impact indicators for assessing long term progress towards national and international targets.

But this wealth of information does not necessarily reach or get used by decision-makers due to several challenges; decision-makers are hard pressed for time, may not necessarily have the statistical skills to understand complex reports, or can inadvertently ignore data if it is not brought to their attention.

Over the years of working with the Government of Nepal, the NHSSP team has seen that evidence-based decision-making has led to better planning and policy practice. This however, needs to permeate at all domains of the government so as to strengthen the local level health planning and service delivery. The Nepal Health Sector Strategy (2015-2020), the principal document currently guiding the health sector, also explicitly acknowledges the need for informed decisions and emphasizes the strengthening of research and promoting the use of evidence.

Current evidence shows that although Nepal has made significant progress in major health outcomes, achievements at the national and sub-national level and between different socioeconomic groups are unequal. And there has been limited effort towards improving the understanding of equity gaps.  NHSSP identified this as a crucial gap that could be addressed by making disaggregated data more accessible to decision-makers. Therefore, we supported the Ministry of Health and Population (MoHP) to develop and promote the use of online interactive data dashboards.  Using data from HMIS, NDHS and NHFS, the dashboards help to visualize the data. They display the current status of metrics and key performance indicators of the national health system. Using interactive charts, they help to consolidate and arrange numbers, metrics and sometimes performance scorecards so that they can be understood effectively by everyone.

The use of dashboards has helped the MoHP to conduct evidence-based reviews and planning. It has effectively informed national reviews, and annual work plan and budgeting processes. For example, for the national annual review report in 2018, wealth quintile and caste/ethnicity specific estimates were generated to analyze progress in major health indicators. By sensitizing the policy makers on equity gaps, dashboards are contributing to health policies including those who are being left behind. They also track the progress made towards achieving sectoral and health related sustainable development goal targets, thus constantly encouraging policymakers to work towards the universal health coverage agenda. Before the availability of dashboards, data was limited to either bulky reports or databases that required intensive data drilling by experts. In this digital age, interventions like online dashboards have helped to make sense of available data by keeping the focus on key indicators; therefore driving equity-based decisions.

The dashboards are hosted on the MoHP’s website and can be accessed here http://www.mohp.gov.np/en/