District decision-making for health in low-income settings: a case study of the potential of public and private sector data in India and Ethiopia

Abstract

Many low- and middle-income countries have pluralistic health systems where private for-profit and not-for-profit sectors complement the public sector: data shared across sectors can provide information for local decision-making. The third article in a series of four on district decision-making for health in low-income settings, this study shows the untapped potential of existing data through documenting the nature and type of data collected by the public and private health systems, data flow and sharing, use and inter-sectoral linkages in India and Ethiopia. In two districts in each country, semi-structured interviews were conducted with administrators and data managers to understand the type of data maintained and linkages with other sectors in terms of data sharing, flow and use. We created a database of all data elements maintained at district level, categorized by form and according to the six World Health Organization health system blocks. We used content analysis to capture the type of data available for different health system levels. Data flow in the public health sectors of both counties is sequential, formal and systematic. Although multiple sources of data exist outside the public health system, there is little formal sharing of data between sectors. Though not fully operational, Ethiopia has better developed formal structures for data sharing than India. In the private and public sectors, health data in both countries are collected in all six health system categories, with greatest focus on service delivery data and limited focus on supplies, health workforce, governance and contextual information. In the Indian private sector, there is a better balance than in the public sector of data across the six categories. In both India and Ethiopia the majority of data collected relate to maternal and child health. Both countries have huge potential for increased use of health data to guide district decision-making.

Keywords: Ethiopia; HMIS; Health system blocks; India; private sector; public sector.

Figure 1.

Nature of data available in the district public sector for different levels of the health system in India (n = 11 329) and Ethiopia (n = 3793). ASHA: Accredited Social Health Activists; AWW: Anganwadi Workers

Figure 2.

Private sector data elements available at district level in India (n = 513) and Ethiopia (n = 2732)

Figure 3.

Inter-sectoral linkages in health data flow and sharing in India

Figure 4.

Inter-sectoral linkages in health data flow and sharing in Ethiopia