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By canoe, car, or foot: The journey to high-quality health data

March 30, 2022 by Marc Bosonkie, MD

High-quality health facility data are essential for maintaining health care services. But collecting these data can pose serious challenges.

Marc Bosonkie presenting on the results of the biomedical equipment survey at the Kongo Central Provincial Health Division in the Democratic Republic of the Congo. Photo: PATH/Marc Bosonkie.

Marc Bosonkie presenting on the results of the biomedical equipment survey at the Kongo Central Provincial Health Division in the Democratic Republic of the Congo. Photo: PATH/Marc Bosonkie.

During the COVID-19 pandemic, demand for medical oxygen—along with the equipment, training, and resources necessary to use it—increased in the Democratic Republic of the Congo (DRC), as it did in many other parts of the world.

As part of PATH’s COVID-19 Respiratory Care Response Coordination project, my team joined forces with the Ministry of Health (MOH) to support my home country’s respiratory care needs. But to address these demands, we first needed data.

We had to have data to answer some important questions: which health facilities had oxygen, but no supplies to administer the medicine? Which facilities had equipment that was broken and in need of repair? How many health care workers needed respiratory care training?

Using the country’s health information system, we identified a sample of health facilities to focus our efforts. We knew that the best way to gather these data was through visits to health facilities—as many rural facilities do not have sufficient network coverage for the numbers to be gathered virtually. We then worked with the MOH to adapt the World Health Organization’s biomedical equipment for COVID-19 case management inventory tool for the data collection—adding questions on COVID-19 and malaria.

The effort took off in July 2020 in Kinshasa and eventually extended to other provinces. Along the way, we learned many important lessons—some that apply beyond data collection and respiratory care planning.

Getting to the numbers

At more than 900,000 square miles, the DRC is a massive country with diverse terrain. Many roads throughout the country are in various states of disrepair. In other cases, there are simply no roads leading to particularly rural facilities. During the rainy season, roads can become impassable due to washouts or flooding. In the dry season, roads in some regions can become too dry and sandy for driving. Our data collectors often had to walk tens of kilometers to reach a facility.

Our team addressed these challenges as they arose, while making note of the experience and lessons, which can be applied for more efficiency and safety in the future. For instance, we’re recommending all-weather vehicles and other equipment for all-road travel before executing work within this context.

The Congo River offered additional challenges. The second longest in all of Africa and the deepest river in the world, the Congo runs through the heart of the country. But somewhat surprisingly, there is only one bridge across the river in the entire country. To address this challenge, our team partnered with local organizations to borrow canoes and boats to make water crossings to access many health facilities. These are the challenges we faced before ever arriving at a facility.

“Data are more than just numbers. We are trekking through the mud to get those numbers—and those numbers represent the state of reality. Those numbers tell stories.”
— Marc Bosonkie, MD, Market Dynamics Officer

Adapting our data collection methods

Upon arrival at a health facility, the data collection process began. We used a software application called Survey CTO to collect data on Samsung tablets. The survey included questions on facility infrastructure, human resources, respiratory care capacity, and COVID-19 and malaria diagnosis and treatment capacity.

We had to adapt quickly to the reality of unreliable electricity and inconsistent access to mobile network coverage. Where electricity was lacking, we used portable power banks to keep our tablets charged and operational. When working further away from a provincial capital, we had to troubleshoot any issues in real time and ensure that data collection remained coordinated.

While the process of uploading data to the servers for analysis was frequently interrupted by power or network disruptions, we learned to rely on the Survey CTO application’s ability to store data offline on the tablets until the team reached an area with network connection.

Data for better planning and decision-making

In the end, our team successfully collected relevant data from 692 health facilities nationwide by April 2021.

Throughout the course of this work, we were constantly reminded that data are more than just numbers. We are trekking through the mud to get those numbers—and those numbers represent the state of reality. Those numbers tell stories, and they are helping shape a better, safer future for many people.

The data we’ve gathered are being analyzed at national, regional, and subnational levels, and a national biomedical equipment report was recently published. PATH and the MOH are using the data to effectively manage distribution of medical devices and advocate for additional procurement.

The data have been crucial to supporting strategic planning for the DRC’s COVID-19 pandemic response. And overall, the data have been integral in highlighting the serious lack of medical oxygen availability across the country—especially in public health facilities. Using the data, our team also worked with the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria to identify gaps and calculate needs for the quantification of biomedical equipment for respiratory care.

With this information, PATH has been able to support the government to successfully develop a national oxygen roadmap to strategically guide investments for increased respiratory care access nationwide. The government envisions universal access to medical oxygen and pulse oximeters, so no patient admitted to a health facility ever dies due to lack of oxygen.

In many ways, this exercise in large-scale data collection—in terms of both its significance for planning and decision-making as well as practical difficulties of its implementation—underscores the need for robust, standardized, and regular data submission and collection systems. To this extent, PATH is supporting the MOH in developing and disseminating simple tools for facilities to regularly track and manage biomedical equipment data.

PATH and health facility staff conduct a data quality control check against paper-based forms at La Visitation Health Facility. Photo: PATH/Marc Bosonkie.

PATH and health facility staff conduct a data quality control check against paper-based forms at La Visitation Health Facility. Photo: PATH/Marc Bosonkie.

The lessons we’ve learned throughout this work, and the difficulties we overcame, are not just specific to data collection or to respiratory care—they can similarly impact any part of the health supply chain or patients’ access to a health facility. Overcoming these challenges and adapting our approaches to reach results is an essential part of the journey. By continuing to understand and account for such roadblocks, we are able to truly strengthen health systems across the globe.

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