Data Use Acceleration and Learning (DUAL)

The DUAL model is unique in that it builds on the direct experiences and lessons learned from five countries in Sub-Saharan Africa to identify the essential elements of sustainable digital transformation.

These 10 elements go beyond technology and hardware to include the other enabling factors needed to create change, including the development of governance structures to oversee digital initiatives and ensure they meet national standards as well as capacity-building mechanisms to train the health workforce for its future digital state.

The DUAL model evolves the World health Organization (WHO) and International Telecommunication Union (ITU) Building Blocks to include two new elements of data use ecosystems and change management.

• Data use ecosystems encompasses all aspects of data use and access, including data collection, quality, demand, and analysis. This element comprises the patchwork of hardware and software needed to collect, store, analyze, and act upon multiple data sources within a country’s health system.
• Change management acknowledges the foundational importance of developing a culture of using data for evidence-based decision-making. It also includes strategies for introducing technology systems to the health workforce to transition to the new tools and ensure widespread adoption.

Without an eye toward the data environment and a purposeful promotion of a culture of data use, digital transformation would not be sustainable. Used together, these 10 core elements can support countries with health systems at any stage in their digital transformation journey.

The DUAL report allows countries to identify the most appropriate starting point for their digital transformation journey based on the priorities and digital maturity of their health systems. Each element of the DUAL model is framed as a standalone chapter with key enabling factors, based on the evidence of what worked and what didn’t in the five focal countries DUAL studied. Specific actions are recommended for each enabling factor and country examples are used to illustrate the DUAL model at work.

Successful efforts to advance data use depend not just on putting tools and systems in place within the health sector but also on improving areas that affect and are affected by these technologies, such as governance, policies, infrastructure, and capacity-building for the health workforce. The DUAL model is not intended to be a step-by-step procedure for how to “do” digital transformation, but rather presents all of the necessary “ingredients” of digital transformation success. The model supports countries in taking a holistic view of digital transformation and considering all of the elements in their plans.

Implementing digital health tools and information systems can improve health service delivery, but not if done without considering the broader goals, vision, and data ecosystem of the country’s health system. The DUAL model for digitally transforming health systems to advance data use is based on countries’ actual experiences and emphasizes a holistic approach that considers not only tools, systems, and infrastructure but also strengthening governance, building the capacity of the health workforce, and cultivating a culture of data use throughout the health sector. We envision a future in which all stakeholders in digital health, both globally and nationally, work together to advance and accelerate digital transformation in alignment with current best practices and each country’s health goals and digital maturity.

Recommended actions to advance digital transformation efforts

The documents below include suggested actions for all stakeholders working on digital transformation efforts and specific recommended actions for four key stakeholder groups: country governments, implementers, funders, and global and regional policymakers.

DUAL Resources

• DUAL Frequently Asked Questions (FAQs)
• DUAL PowerPoint Presentation
• Webinar Recording

General Resources

• Defining and Building a Data Use Culture, PATH (2017)
• National eHealth strategy toolkit, World Health Organization & International Telecommunication Union (2012)
• Digital implementation investment guide (DIIG): Integrating digital interventions into health programmes, World Health Organization (2020)
• PRISM: Performance of routine information system management, Measure Evaluation (2011)

Resources from the five focal countries

Burkina Faso:

• Burkina Faso National Health Information System and 2010 – 2020 Strategic Plan Evaluation (English)
• Burkina Faso Évaluation du Système National d’Information Sanitaire (SNIS) et du plan stratégique  2010 – 2020 (French)

Tanzania:

• Data Use Partnership Journey
• Tanzania Digital Health Strategy 2019-2024
• Tanzania Digital Health Investment Road Map 2017-2023
• Tanzania Health Enterprise Architecture
• Building a Digital Health Investment Road Map in Tanzania: A Look Back at What Worked
• Article: New strategy and systems cement Tanzania’s digital health leadership

Ethiopia:

• Information Revolution Roadmap
• Ethiopia Health Sector Transformation Plan (2019/20-2024/25)

Malawi:

• Malawi National Digital Health Strategy 2020-2025
• Malawi National Health Information System Policy
• The Malawi National eHealth Strategy
• Monitoring, Evaluation, and Health Information Systems Strategy 2017-2022
• The Kuunika Project: Data Users Study-Intial Findings
• Assessment of EMR systems in Malawi
• 360 MHealth Analysis: Technical Deep Dive
• Kunnika: Data Use Campaign Update and Report Out

South Africa:

• National Health Normative Standards Framework for Interoperability in eHealth in South Africa