| Indicator ID | H9 |
|---|---|
| Indicator full statement | # of primary and community healthcare facilities using digital health tools to support clinical consultations. |
Purpose
| Importance | This indicator measures the adoption and use of digital health technologies at primary and community health facility levels where Tdh is conducting related activities. Its aim is to enhance the quality of care, improve patient outcomes, and strengthen health system efficiency through solutions like e-learning toolboxes, digitalized protocols (ANC, PNC, IMCI), electronic medical records (EMRs), and decision-support tools. These tools are expected to enhance healthcare worker skills through training, decision-making guidance, and support for protocol adherence. Adherence to national protocols is critical as it reflects the systematic process for client examinations and treatments, necessary for identifying health issues and providing appropriate care. This indicator helps track progress in strengthening healthcare infrastructure, enhancing data for service performance, planning public health services, and addressing health inequities. This indicator is closely linked with Indicator 6. Digital MNCH consultations (% - outcome). This indicator is considered as an output since it captures a low-level practice pilot change at the level of the facilities. It does not analyze how it is integrated in the full health system and how health care is enhanced through the use of the tool. |
|---|---|
| ToC pathway | This indicator directly refers to the Tdh Theory of Change (ToC) as it aims to contribute to 3the three inter-related pathways of change, namely 1) local health system, 2) communities, and 3) mothers, children, and their families. |
| Related services | It is used depending on the service provided by Tdh and can also be linked to Tdh’s IeDA maternity and IeDA IMCI. |
Definition
This indicator provides the total number of primary and community healthcare facilities that use digital health tools to support clinical consultations during a specified period. See Indicator 6.
Digital health tools are defined as technologies or systems that 1) aid healthcare providers in diagnosing, treating, or managing patient care, including digital clinical decision-making platforms (CDSS), 2) patient register (EMR or REC), 3) data reporting, 4) e-learning trainings and 5) digitalized protocols.
In order to fit the indicator, at least one of the sub-mentioned technology or system is integrated into routine clinical practice by trained and skilled health personnel to improve healthcare quality, service delivery, and patient outcomes.
Healthcare facilities include primary healthcare centers, community health clinics, and rural or urban health posts providing maternal, newborn, and child health (MNCH) services, as well as other preventive and curative health services.
How to collect & analyse the data
| What do we count? | Facilities |
|---|---|
| How to calculate the indicator's value | Numerator: Number of primary and community healthcare facilities using digital health tools to support clinical consultations during a specified period. Frequency and timing: Monthly, quarterly, and annual reporting from health facilities and HIS. Baseline, mid-term and endline studies through health facility survey/assessment to supplement routine data. |
| Data sources | Routine facility data sources: Facility-based data capturing all consultations using digital health tools, where available. Digital health platform records: Data from digital health platform that track the number of consultations conducted digitally (i.e., National Health Information System tracking active users and able to provide a complete count). Survey: Facility survey or assessments to collect information on the adoption and integration of digital health tools can provide valuable insights, particularly in settings where routine health information systems are not yet fully digital and where access to facility-based data are scarce. |
| Data collection methods and tools | |
| Disaggregation | Data should be disaggregated by - where appropriate depending on the data source :
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Limitations and precautions
This indicator serves as a proxy for assessing the quality of care provided at health facilities but does not account for the availability of inputs like diagnostic testing or treatment. While digital consultations are presumed to enhance quality and improve diagnostic accuracy, this indicator does not directly evaluate health outcomes or patient satisfaction related to digital maternal, newborn, and child health (MNCH) consultations. Additionally, it does not differentiate between various digital health tools, which may have different effects on care quality.
The indicator's results can be affected by disparities in access to digital infrastructure, such as internet connectivity, reliable electricity, and functional digital devices, leading to potential underreporting of digital tool usage, especially in rural areas. To effectively utilize these tools, healthcare workers require high-quality training, technical support, and motivation. Relying solely on this indicator may overlook gaps in facilities' readiness and skills to use digital tools, impacting care quality. Follow-up assessments are essential to evaluate training retention and practical application.
Factors such as motivation (understanding the impact on health outcomes), restraint (resistance to technology), and commitment (integration into Ministry of Health strategies) should also be assessed for a comprehensive understanding of this indicator, particularly where digital tools are available but not yet fully integrated into routine practices.
Digital health tools may be concentrated in urban areas, potentially leaving rural and underserved healthcare workers without access. Disaggregation by geographical location and facility type is crucial to ensure digital health literacy initiatives reach all relevant healthcare workers. Additionally, turnover among health staff across facilities should be considered when analyzing the indicator's impact. Collaborating with technology providers, government ministries, and international organizations is recommended to enhance digital health initiatives in rural and underserved regions.
What further analysis are we interested in?
Tracking the number of health facilities using a digital approach reflects the capacity of health systems to integrate technology to improve health outcomes. Indeed, the widespread use of digital health tools is critical for improving service delivery, data collection, and decision-making in low-resource and underserved areas.
This indicator allows the evaluation of the rate of adoption of digital health tools across healthcare facilities, identifying geographical or facility-type disparities in usage alongside with barriers to digital health tools adoption (i.e., healthcare worker capacity, policy challenges, infrastructure).
Following a proper health facility readiness assessment, it supports the project manager in the decision-making progress regarding the deployment of digital health tools.
It is interesting to cross-analyse this indicator with others such as patient satisfaction and maternal, newborn and child health outcomes to quantify any correlation.
Additional guidance
Resources: Under the technical assistance of HQ, Tdh M&E and operational teams in each delegation should work closely with health authorities to deploy and integrate the digital tools, collect and interpret the data.
Countries with limited health system infrastructure may consider partnerships with international organizations (e.g., WHO, UNICEF) and academic institutions to support capacity-building for data collection and MNCH service delivery.
Global strategy on Digital Health 2020-2025. Available at: https://www.who.int/docs/default-source/documents/gs4dhdaa2a9f352b0445bafbc79ca799dce4d.pdf (Accessed: 11 September 2024).