Health system strengthening or health system support? A qualitative case study application of the Chee et al framework to the Nigeria Routine Immunization dashboard project. Open Access

Acharya, Neha Navur (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/k930bx99g?locale=en
Published

Abstract

Objectives: Routine immunization (RI) in Nigeria requires timely and evidence-based data for programmatic change. The objective of this study is to evaluate the District Health Information Systems-2 (DHIS2) RI dashboard project in light of concepts of "health systems strengthening (HSS)" and "health systems support." Modifying the Chee et al. 2013 framework to incorporate both strengthening and supportive elements that make for long-term system gains, this evaluation determines reoccurring project components, its strengths and weaknesses, and how the components relate to the Chee et al. established HSS criteria.

Methods: This study used a modified Chee et al. methodology by observing project components' strengths and weaknesses in relation to HSS using four main criteria. Through a thematic analysis of 100 DHIS2 RI project documents and seven key informant interviews, this study reviewed project successes and weaknesses in light of its relation to the criteria.

Results: Major project components were as follows: "Coordination," "Health Workforce," "Technology and Vaccine Stock," "Quality of Data," "Sustainability," and "Government Ownership," and "Financial Resources." This analysis revealed that component successes within states that adhered to its corresponding criterion helped strengthen the system, but that weaknesses occurring in other states hindered systems progress. Supportive elements were found within the project components of "Coordination" and "Technology and Vaccine Stock," where deployed health workers from other projects were temporarily assisting the DHIS2 RI project, and laptop provisions by CDC were a short-term gain. The analysis showed that some states experienced both strengthening and supportive project components simultaneously.

Conclusions: This study has useful implications for the CDC/BMGF implementers of DHIS2 RI who invested time, money, and resources. Providing an understanding of project weaknesses, this study hopes to influence areas of improvement before the project end-date, or for future health information systems projects in similar contexts. By forming a modified framework, this study uniquely accounts for the often critical supportive elements that are necessary for strengthening systems in resource-poor areas.

Table of Contents

CHAPTER 1: INTRODUCTION

1

1) Health System Strengthening and Support

1

2) Aims and Objectives

3

3) Study Setting: Routine Immunization District Health Information Software (DHIS2) in Nigeria

3

CHAPTER 2: LITERATURE REVIEW

7

1) The Development of Health Systems Thinking

7

2) Vertical vs. Horizontal Efforts

10

3) Prioritizing Health Systems Thinking

12

4) Health System Strengthening Concepts

13

5) Health System Support

16

6) Vaccine Health Information Systems

17

7) District Health Information Software (DHIS2) Routine Immunization in Nigeria

19

8) Chee et al. Framework and Subsequent Studies Designs

24

CHAPTER 3: MANUSCRIPT

26

CHAPTER 4: PUBLIC HEALTH IMPLICATIONS

58

APPENDIX

62

REFERENCES

64

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