Improving health data quality: Driving evidence-based action in Sierra Leone

Sierra Leone has struggled for a long time to improve the health of its mothers, newborn babies and children. Although progress was starting to be seen, when Ebola hit in May 2014 these successes were seriously undermined. The number of pregnant women delivering at a facility fell by 31%.

Consequently, Sierra Leone’s maternal health indicators remain among the worst in the world and too many mothers and babies continue to die from preventable causes. Improvements in Sierra Leone’s health data are essential to inform evidence-based actions to deliver better services and improve the health of women, adolescents and children.

Making sure international development programmes are aligned with national strategies is crucial to support sustainability. We’ve been working alongside the Ministry of Health and Sanitation (MoHS) since 2013, to ensure that the Improving Reproductive, Maternal and Newborn Health (IRMNH) programme is integrated and aligned with the country’s health strategies. Funded by the UKAid, IRMNH aims to increase the use of quality family planning, and reproductive, maternal and newborn health services with a focus on reaching young people.

As part of our partnership management, evaluation and learning function our role has been to promote effective information-sharing and coordination across the three implementing partners: UNFPA, UNICEF and Marie Stopes Sierra Leone.

We’ve also provided technical support and capacity building to the MoHS to restore and significantly improve the accuracy and reliability of health system data, including the reinvigoration of the health management information system (HMIS).

A country’s HMIS plays a vital role within a health system. When functioning properly, it should provide up to date and reliable information on routine health indicators, for example, the number of women delivering in facilities, attending antenatal check-ups, and the number of children that have been fully vaccinated. This information is essential for effective resource planning and for monitoring national health care delivery patterns and outcomes. It is particularly important during a health crisis such as Ebola to monitor behavioural changes, such as a decline in the use of routine health services or variations among different groups of the population.

Ensuring reliable health information is available in Sierra Leone has suffered serious setbacks in the last few years, particularly during the Ebola outbreak. Delays in receiving and analysing data compromised the value of the information and the government’s ability to act promptly. We supported the MoHS to conduct a study to identify and address blockages in the process, and to improve data collection and reporting.

Despite the challenges, we found that 80% of all facilities were still submitting data. However, there were significant inconsistencies between different levels in the system, which led to concerns over the reliability of HMIS data.

A key issue we identified was that teams at district level lacked the skills and knowledge needed to collect and enter data into the system. Therefore, we supported the recruitment and training of additional MoHS staff to support monitoring and evaluation functions at the district level. We also visited District Health Management Teams and health units to build their capacity to verify and analyse data. This included training staff in computer and data entry skills in four poor performing districts.

Even during the last year, we’ve seen significant improvements in the availability and quality of HMIS data. By February 2017, 96% of all facilities had completed their HMIS records, compared to 60% in 2012.

Sierra Leone is now swiftly moving towards full access to ‘real time’ data and there are no significant delays in receiving health data. There is also a noticeable shift in the use of data as policy and decision makers become more confident in the reliability of the HMIS. The MoHS has committed to ensuring that the improvements made to date continue, and that access to high quality data will be sustained.