Integrating into routine data systems

Integration of these indicators into national data systems makes this process more automated and efficient and would allow planners and implementers to have easier access to this critical information. Ideally, much of the needed data are already or will be incorporated in registers and case notes; in regular program reports from facilities to higher levels of the system; and in electronic information systems such as the DHIS2. Some countries, such as Senegal, have been working with the developers of DHIS2 to create modules to add to their DHIS2 system to aggregate the needed information on EmONC electronically and routinely.

In countries with a large private sector, it is important to include private sector data in routine data collection systems (HMIS). Some strategies for engaging the private sector in this process can be found in Box 1.

Box 1: Engaging the private sector in routine monitoring – Ideas from Bangladesh (2023)¹

In Bangladesh, a significant amount of maternity services are delivered in for-profit and non-profit private sector health facilities.² In a qualitative study conducted in 2023, researchers learned that for-profit private facilities were less likely to report obstetric-related data to the government HMIS because of the following factors: Private facilities believe they have a different model of care and therefore their service statistics are not comparable to government facilities’ data; they are concerned that if they disclose the number of patients they see and cesarean sections they perform (and charge for), the government will increase their taxes; with recent government concern over the high rates of cesarean section in the country, private facilities fear being shut down if it is detected that they have high cesarean section rates; and, they fear that by reporting deaths, their reputation will be affected.

Respondents – including representatives of private facility associations, physicians from public and private facilities, nurses and managers of public facilities, government representatives (including from the departments of planning and medical information systems), and development partners – were asked to share their ideas on how private facilities could increase their reporting to the national HMIS. They suggested: Linking private facility licensure to routinely reporting data; using both motivation (e.g., rewarding private facilities for consistently reporting data to the HMIS) and penalties (legal action, probation, suspension or non-renewal of operating licenses) to ensure compliance; bringing in a third-party organization (e.g., a professional association) to monitor compliance, thus serving as a bridge between private facilities and the government and helping private facilities understand the importance of providing their data for national planning purposes; establishing better communication and stronger relationships between the private and government health sectors, potentially achieved by collaboration in quality improvement and by including private facility health providers in government in-service training sessions; and, to increase private facilities’ confidence that they will not be penalized, taxed or punished based on the data they report, it was suggested that private facilities report their data under unique identification codes, thus ensuring their data would be used only for planning and monitoring purposes.

Chowdhury, Mahbub Elahi; Khan, Rasheda; Soltana, Nahian; Alam, Falguni; Jahan, Shamin Ara: Afsana, Kaosar. Re-Visioning Emergency Obstetric and Newborn Care (EmONC) Framework: Bangladesh Case Study Final Report. Dhaka, Bangladesh: 2023. ↩︎
Hossain, A.T., Hazel, E. A. et al. (2024). Effective multi-sectoral approach for rapid reduction of maternal and neonatal mortality: the exceptional case of Bangladesh. BMJ Global Health. 9:e011407 ↩︎