WHO South-East Asia Journal of Public Health

: 2021  |  Volume : 10  |  Issue : 3  |  Page : 87--90

Using the SCORE for Health Data Technical Package to strengthen primary health care

Ruchita Rajbhandary1, Preeti Negandhi2, Anjali Sharma3, Sanjay Zodpey2,  
1 World Health Organization Regional Office for South-East Asia, New Delhi, India
2 Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India
3 Public Health Foundation for India, New Delhi, India

Correspondence Address:
Ms Ruchita Rajbhandary
World Health Organization Regional Office for South-East Asia, New Delhi

How to cite this article:
Rajbhandary R, Negandhi P, Sharma A, Zodpey S. Using the SCORE for Health Data Technical Package to strengthen primary health care.WHO South-East Asia J Public Health 2021;10:87-90

How to cite this URL:
Rajbhandary R, Negandhi P, Sharma A, Zodpey S. Using the SCORE for Health Data Technical Package to strengthen primary health care. WHO South-East Asia J Public Health [serial online] 2021 [cited 2022 Jan 24 ];10:87-90
Available from: http://www.who-seajph.org/text.asp?2021/10/3/87/309882

Full Text

 Primary health care and robust health information systems

A strong primary health care (PHC) system is paramount for achieving universal health coverage (UHC). PHC is the cornerstone of robust and resilient health systems and a major driver for cost-efficient, effective and equitable health service delivery throughout the lifespan of individuals and communities.[1] For PHC to succeed, countries need to produce complete, accurate and timely routine health data that are continuously used to monitor primary care services, analyse barriers to access, determine the quality of service delivery, and inform the right decisions to improve health outcomes – all of which are dependent on having a robust health information system (HIS).[2]

The 2030 Sustainable Development Goals (SDGs) agenda has refocused global attention on the urgent need to strengthen countries’ HISs.[3] However, progress has lagged, and countries in the World Health Organization’s (WHO) South-East Asia Region are at different stages of strengthening their HISs, with a range of health priorities and interventions to monitor, and varying capacities to analyse and use their data. To facilitate understanding of the range of HIS strengthening needs and effectively target investment, WHO developed the SCORE for Health Data Technical Package (SCORE package).[3]

 SCORE for Health Data Technical Package

The SCORE package brings together, for the first time, a set of five essential interventions, each of which includes recommended actions, tools and resources to support countries to address their HIS challenges and strengthen their HIS capacities and systems to generate health data for analysis and use.[3] The SCORE package builds on existing health measurement frameworks, guidelines and tools that countries can adopt according to their HIS needs.[3]

[Figure 1] describes the five essential interventions represented by the SCORE acronym and the corresponding key elements that contribute to a robust HIS. The first three interventions – “S”, “C” and “O” – focus on improving the availability and quality of health-related data from comprehensive data sources. The last two interventions aim to enhance the synthesis of, analysis of, access to and use of health data for action, with “R” focused on programming at national and subnational levels, and “E” focused on national high-level policy and planning.[3] The SCORE assessment instrument evaluates countries’ capacities to monitor the performance of their health systems with regard to these five interventions and key elements.{Figure 1}

 The SCORE assessment in the WHO South-East Asia Region

The SCORE assessment instrument was used to evaluate the HIS capacity of the 11 South-East Asia Region countries in relation to all five interventions. Countries’ capacities were measured for each key element using indicators composed of a set of criteria, with capacities scored on a 5-point scale, weighted by their importance in the overall HIS, and individual scores combined to give a total indicator score. [Table 1] describes how the capacity levels for three indicator criteria are mapped to the 5-point scale.{Table 1}

Countries’ capacities were informed by a desk review of their publicly available national and subnational HIS-related documents. Teams from each country shared additional documentation not available in the public domain to help complete any information gaps and validated the draft scores during regional consultations. The final assessment results were shared with countries for endorsement and sign-off.

There was an abundance of data to inform interventions “S” and “C”; however, the data informing interventions “O”, “R” and “E” were variable and inconsistent. Missing criteria may have affected the indicator scores, resulting in some limitations in interpretation.

 South-East Asia Region HIS capacities: results of the SCORE assessment

Across the region, countries’ capacities to survey their population and health risks (intervention “S”) are the most developed, especially for census and health security data, for which most countries have a well-developed or sustainable capacity. However, countries’ capacities for interventions “C”, “O”, “R” and “E” are variable. More than half of the countries have a limited or nascent capacity for intervention “C” – vital statistics and causes of death – with all but two countries having nascent/no capacity with regard to data on causes of death.

The availability of quality routine health-related data varies across countries, types of health data and levels of reporting; none of the South-East Asia Region countries has reached a sustainable level of capacity to fully optimize its health services data. Health workforce data are the most widely available data, followed by health financing data [Figure 2].{Figure 2}

 The need to improve service delivery data and their use to strengthen PHC

The availability of facility-based data lags behind that of other routine data, with all but one country having a moderate or lower capacity to report annually on key indicators derived from health facilities. These indicators are critical for monitoring the coverage and quality of service delivery, as well as national and global health targets. In addition, while some indicators may be available at the national level, countries struggle to report data at subnational levels and disaggregated by sex and age – a gap that poses challenges to countries with regard to effectively monitoring their progress towards UHC.

In the context of PHC, the capacities for intervention “O” are critical to ensure a continuous stream of service delivery data. Countries are at different stages of capacity with respect to the systems that support the availability of routine health service data. Except for four countries, most have a moderate or lower capacity for functional reporting systems. Most countries (n = 8) have a standardized system for electronic aggregate reporting of health facility data at subnational levels (districts, etc.). However, only two countries have a system in place for the standardized and electronic capture of patientlevel health data at primary care health facilities, suggesting that a plethora of data are not useable for analysis as they are not in aggregate form. Half the countries in the region have an institutionalized system of data quality assurance for all health facilities. This raises the question in the remaining countries of whether or not the data on primary care are robust enough to confidently inform decisions. There is a need to catalyse a culture shift, as the health workforce’s use of health data at all levels increases the demand for quality routine data.[4]

As countries further optimize their service delivery data, they will also need to optimize their capacities to analyse and use these data to monitor progress and performance. Except for three countries, there is limited institutional capacity for data analysis, particularly at the subnational level, and limited involvement of national public health/academic institutions to provide these analyses [Figure 3]. Half of the countries have a well-developed capacity to conduct regular analytical progress and performance reviews, with most countries regularly publishing analytical reports; however, most of these publications do not have adequate equity (socioeconomic and gender) and comparative analyses.{Figure 3}

 Moving towards robust PHC: the way forward for the SCORE package

In the context of the coronavirus disease 2019 (COVID-19) pandemic and the recognized need to strengthen PHC, more consideration of and resources for the optimization of health services data (“O”) and their use to measure progress and performance (“R”) are needed – there is untapped potential in the vast quantities of data already collected as part of routine primary care service delivery that could be “optimized” to enhance local and subnational decisions for improved primary care. The SCORE assessment found that, while South-East Asia Region countries are at different stages of HIS optimization, overall the region is not where it should be with respect to the availability and usability of health facility data. This information gap can limit countries’ ability to monitor service delivery disruptions during health crises or respond effectively to evolving epidemiology and health needs, to ensure the allocative efficiency of health resources.

While the past few years have witnessed substantive investments in the strengthening of HISs to produce quality health service data, particularly through the expansion of realtime reporting systems, such as the use of electronic medical records and the roll-out of the web-based open-source District Health Information Software 2 (DHIS2), mechanisms for the systematic recording, reporting and use of the data remain fragmented.[2]

Countries can use the SCORE package technical tools to provide standardized methods and approaches that can be adapted to their needs. Indonesia used the Health Equity Assessment Toolkit (HEAT) to conduct health equity analyses, which led to the publication of the 2017 report State of health inequality and revision of the country’s action plans for neonatal and maternal health.[5],[6] In Nepal, the HEAT equity analysis, coupled with a pilot study using the WHO Innov8 tool, identified subpopulations of adolescents who were missed by the health system, and incorporated them as a priority population in its national strategy on adolescents.[7] Bangladesh has initiated real-time monitoring of health indicators using the DHIS2 database platform. Facility and community health data from more than 14 000 public health facilities are presented through dashboards and are accessible at all levels, from health managers to the facility level.[8] The data system enabled health managers at all levels to monitor the utilization of essential health services during the COVID-19 crisis and take action to rectify service delivery.[9],[10]

Robust HISs are an essential driver of equitable and accountable service delivery, which are core principles of a PHC approach. As countries strengthen their health data to inform programme and policy decisions, with the aim of shaping the work of health systems to improve the health of people, health systems become more resilient and ultimately attain UHC, the health-related SDGs and the global pledge to “leave no one behind”.[10]

Source of support: None.

Conflict of interest: None declared.

Authorship: RR, PN, AS and SZ contributed to conceptualization of the paper. RR was responsible for analysing Table 1. RR and PN were responsible for writing the manuscript. AS and SZ reviewed the paper.


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