In the pandemic, real-time data is transformed into real-time action

A multitude of Needs and Limited Resources

As countries mark a year after the detection of their first case of COVID-19, many continue to face the myriad of challenges posed by the needs of their health systems. They not only need to provide COVID-19 care but also overcome the difficulties of ensuring the delivery of essential health services, and the multitude of tasks associated with the roll-out of the biggest vaccination campaign they have ever managed. 

Facing these challenges with limited information on the supplies available to undertake all these tasks poses additional risks, and a burden on already overstretched health systems. Often, countries from across all regions and income groups, do not have clear and up-to-date information on the status of their health care workers, health facilities, or the medical needs of the communities they serve. 

More than ever, the pandemic has highlighted the importance of this information.  It is needed for countries to make critical decisions on how to promote the recruitment of nurses or doctors for COVID-19 care, contact tracing, essential health service delivery, vaccination campaigns, where to deploy limited personal protective equipment (PPE) or, more recently, COVID vaccines. Having access to timely and correct data on any of these will determine which actions need prioritizing.

Global efforts to strengthen health systems while responding to Covid-19

To tackle the pandemic and roll-out of COVID-19 vaccination campaigns, the international community is supporting countries to increase the availability of critical data needed to make informed decisions.   These also mitigate the effects of the pandemic on health systems and household welfare. For example, the World Bank, in partnership with the World Health Organization (WHO), UNICEF, the Global Fund and Gavi is supporting countries assess their policies and plans for vaccination roll-out through the assessment of Country Readiness for COVID-19 vaccines (the VIRAT-VRAF 2.0 tool).  

Complementing these efforts, the Health Systems Connector of the Access to Covid Tools Accelerator (ACT_A), a global effort to develop tools to fight COVID-19, made available a suite of assessment tools that focus on better understanding frontline health services and providers.

Led by the World Bank, WHO, Global Fund, and the Global Financing Facility, the tools have been helping governments, partners, and donor, generating real-time data from health facilities.

Using daily interactions with patients and communities, the tools help facilitate the scale-up and delivery of essential COVID-19 resources. They also guide strategies and plans to maintain essential health services in the countries.

Tools providing real-time data on important dimensions of delivering health services

Some examples include:

• Facility Assessment: Is the country ensuring continuity of essential health services throughout the pandemic? This tool assesses the capacities of primary care and hospital facilities to deliver essential health services (which include the availability of health workers, isolation and triage capacities, adherence to infection control standards, and the availability of essential medicines and supplies). It also helps track changes in service utilization and modifications in service delivery.
• Community Assessment: What are community needs, perceptions, and demand for health services and COVID-19 vaccines? This tool collects information on unmet health needs, changes in care-seeking behaviors, and barriers to care that may affect service demand.  
• Hospital Assessment (including diagnostics, therapeutics, and vaccine readiness): Do facilities have the needed COVID-19 case management capacities? This tool assesses health facilities’ capacity in managing COVID-19 cases, including the availability of diagnostics, therapeutics, and other essential health products such as oxygen and PPE, as well as cold chain capacities.

As a pioneer using these tools, the Kenyan Ministry of Health was able to successfully implement these assessments across more than 100 facilities , as of December 2020. Through phone interviews with community health workers, it was able to complete the work within one month, and with a small budget.

The strategy drew on strong leadership from the ministry. It also benefited from the training and oversight of the interviewers, and time invested in outreach to participating facilities to ensure their collaboration in the data collection process.  

Assessments used for decision-making: Kenya’s efforts

Using these assessment tools, Kenya was able to identify and prioritize areas that required more investments and financing.  Among these, the need to invest in PPE for all staff and patients, particularly in rural areas was critical. The country also identified the need to strengthen the communication of safety protocols and other priority areas such as providing additional psychosocial support for health workers and modifying the service delivery though telemedicine to mitigate service disruption.

The community assessments identified a need to invest in proactive risk communication and community engagement. This was relevant in at risk areas where there was a Covid-19 vaccine hesitancy, as some of the sources of concern included safety, effectiveness and a general mistrust of the vaccine.  The assessment also highlighted the need to accelerate and expand the diagnostics capacities.

Although Kenya has been benefitting from previous immunization programs, the magnitude of the country’s efforts to distribute the COVID-19 vaccine will require additional cold chain capacity across facilities, particularly in rural areas.

Timely information translates into timely action

Kenya foresees the need to repeat the data collection with one or all the tools within the next three months, to continue making the right choices on what needs attending first. This continued monitoring will allow the Ministry of Health to complement its routine information systems with data on changes in staffing, availability of equipment and medicine. It will also inform efforts to improve available PPE, cold chain capacity and risk communication strategies.  

No country, no health system has limitless resources. The pandemic ensured the reserves became even more scarce. The health system needs are vast, no matter countries’ economic status. Only the decisions informed by correct and timely data can guide appropriate actions.

Kenya has shown that with a relatively small amount of resources, the use of an existing data collection infrastructure to implement new tools, an adequate decision-making process can take place on what ought to be prioritized to maintain health systems’ stability.