What is a system without good data?

Well, the best answer is “not much.” As I work on an HRIS implementation in Kigali, Rwanda, this week, I have been giving the need for accurate, continuously maintained data a lot of thought. Many developing countries have embraced decentralization—the shift of decision-making authority from the central level to the regional or local level. While decentralization has many good points, it presents challenges for collecting country-wide data. Imagine a situation where every region and district used a different method for collecting and sharing data on health workers! While separate methods of data collection might work well locally, lack of consistency across the country makes collection of data for use at the government level challenging at best. 

We all know databases rely on consistency of information to generate reports. To get consistent data, regional and local health managers must have a way of submitting standardized data to the central level that does not add an excessive additional burden. More importantly, local health leaders must see the benefit of providing data to the central government—access to country-wide aggregate information, increased services from the Ministry of Health or easier maintenance of their own health worker records. 

Ensuring a local level commitment to share data is only half the challenge. Western culture is data oriented—we love charts, graphs and numbers. Because current data is often lacking, many health leaders in developing countries have, by necessity, learned to rely on intuitive decision making. Add this to an increasingly rapid shift from paper based systems to databases and the process can be overwhelming.

For me, this is where Pam McQuide’s stakeholder leadership group model becomes so important. Stakeholders united in a common purpose and pursuing a shared benefit can agree on appropriate, effective ways to evolve well-entrenched methods of data collection.  Having seen the success of the stakeholder model time and time again, even I find myself here in Rwanda still fighting the siren song of the perfect system to focus on what is most important— local stakeholder leadership and the data itself.