District of Excellence in Laos

Executive summary

In an effort to continuously improve the health information systems in countries across the globe, “Districts of Excellence” (DOE) have been established as a model with support from Norad and other funders. DOE are meant as a departure of business as usual with the health information system, as kind of a living laboratory where next generation and newly established best practices can be applied and learned from, before expanding these changes out to the overall country.

Numerous successful models of DoE have been implemented worldwide, showcasing the effectiveness of engaging local governments, ministries of health, partners, and the HISP Community in fostering innovative solutions for data quality improvement and enhanced service delivery.

In alignment with this global initiative, a DOE project has begun in Phon Hong District, located in the Vientiane province of Laos. The objective is to create a practical implementation site to test and document innovative solutions, extracting valuable insights on their efficacy and applicability which can be applied to greater Laos, and offered as learning to other countries using the DHIS2 platform.

As a partner of the HISP Centre at the University of Oslo, and a collaborator with the local HISP Vietnam and HISP Laos groups, DevOtta has provided support for the establishment and learning from this DOE.

Ongoing Interventions

Development of a master client registry

A key challenge in offering proper healthcare in low- and middle-income countries is the lack of consistent identification of patients and clients. For chronic and long lasting illnesses, as well as health programs such as vaccinations, it is imperative that the healthcare provider know the identity of the individual that they are caring for, and what their prior treatment, diagnoses and allergies are. Like most LMIC’s Laos has suffered from inconsistent source data for consistent identification of patients. During the Covid-19 pandemic, the DHIS2 software was utilized to register nearly 100% of the Laos population, effectively creating a national client registry. Work has been ongoing to support the conversion of this database into a usable master client registry which can be linked to the disparate health software used at clinics and hospitals, providing a secure identification and reliable access to past patient history.

Development of a master facility list

Similar to the need for a reliable database of patients and clients, there is a consistent need in Laos and other LMICs for an authoritative list of health sites, clinics, hospitals, vaccine points, etc. The lists for these locations are often maintained by different programs and groups within the Ministry of Health, and are difficult to combine into a master list or keep up to date, both with regards to those that newly opened or are closed, as well as knowing what services are offered at these sites. Without this information, it is difficult to centrally manage the provision of medical supplies; identify sites that require staff update or training; and ensure that the availability of health posts is adequate for the surrounding population. The structure of the DHIS2 system requires a complete working list of all health domains, and is constantly updated based on reporting rates, and the types of reports that are generated, providing nearly all of the information required for a complete overview of all health facilities in the country. Work is ongoing to take the health hierarchy featured within the DHIS2 system, and formally establishing it as the authoritative list of health sites across the country, accessible to other information systems and the programs and decision makers that need access to them.

Data exchange between systems

The profile of information systems in Laos mirror those in many countries, with a fragmented landscape of software that have been rolled out over the years from different programs, different funders, and for different purposes. Much duplicated data is collected across these systems, and placing a significant burden on the health and administrative workers that are expected to use them on a regular basis. Beyond this, there are enhanced opportunities for improved analysis of data if they can be combined in a systematic way. For example, there are ongoing efforts in Laos to link climate and health data, learning new lessons about the way that the shifts in rain patterns are effecting intestinal diseases. In the DoE, specific emphasis is placed on linking health data to the Civil Registry and Vital Statistics system (CRVS). The CRVS is responsible for the official identification of births and deaths, and the issuing of birth and death certificates. Most of the data for this information is generated naturally within the health system, but has traditionally been kept separate, with reports to the CRVS coming from other sources. In the DoE, they seek to combine the birth and death information into a format that can automatically be shared with the CRVS, both increasing coverage and accuracy of that data, while reducing the burden and time lag in reporting it.

Systems Infrastructure

In order to achieve these goals, the DoE is attempting new architecture for their DHIS2 systems, desiginating specific DHIS2 instances to manage clients, others to serve as a master facility list, and streamlining the data collection and reporting of data important for vital statistics. IF successful, this new architecture could become a standard recommendation with guidance for the entire national Laos IS infrastructure, as well as for other countries to learn from in the HISP Community

Collaboration

The DevOtta team completed a field visit in Laos in Spring 2023, working closely with the HISP Vietnam and Laos teams as well as the Ministry of Health in order to develop plans and recommendations for these approaches; provide direct technical troubleshooting support; and establish close working relationships between both the software developers and the leads on both sides. Specific emphasis has been on the creation of new tools within DHIS2, such as plugins for the Capture app detailed in another Case, as well as routine planning and update meetings. Information from this collaboration was presented at the DHIS2 Annual conference in 2023, with representatives from countries all over the world. The information and learning was specifically targeted at other countries attempting their own DoE’s, notable Uganda and Tanzania.

 Impact

The DoE work continues with support from DevOtta, and has resulted in close connections between the teams in Norway and those in Vietnam and Laos. The work performed to create plugins and other features to support these use cases are being made available through the core DHIS2 platform for other countries to adopt. The lessons learned so far have been compiled and shared both in presentations and as recorded events that are available free on line. The expectation is that this approach will not only lead to an improved system in Laos, but also an improvement to the tools, guidance and recommendations being made globally through the HISP community to all countries using DHIS2. Beyond these software specific recommendations, the DoE is demonstrating the power of designing an overall systems architecture that allows the leveraging of various software solutions, with lessons learned and suggestions for greatest impact. The collaboration between DevOtta and the teams in Laos and Vietnam are expected to continue into the future, with benefits for the global community, as well as tangible benefits to the health systems in Laos, as well as the expansion of work and innovation opportunities in the countries that HISP Vietnam and Laos support, such as Cambodia, Vietnam and other countries in the Southeast Asia and Pacific regions.