Enhancing Primary Health Care Operational Data Extraction and Transmission

Primary health care (PHC) is an approach to organizing and strengthening national health systems, bringing services closer to communities. It encompasses the essential package of health services and products needed to prevent disease, promote health, and manage illness. Timely, complete, and actionable data about PHC systems and operations is critical for informing performance management, planning, resource allocation, and health policy.

However, PHC systems in low- and middle-income countries often rely heavily on manual data collection and paper-based reporting. This leads to inefficiencies, data fragmentation, poor data quality, and an excessive administrative burden on frontline health workers.

To address these challenges, PATH, with support from the Gates Foundation, conducted a comprehensive assessment of PHC operational data transmission and extraction in four countries (Burkina Faso, Ethiopia, Kenya, and Nigeria). The assessment identified gaps across health system pillars and explored practical, innovative approaches to improve data extraction and transmission from both facility and community levels, with careful attention to gender considerations.

This research resulted in a suite of resources designed to guide improvements in PHC data systems, including a Landscape Report, an Innovations Scorecard, an Innovations Brief, a Map and Match Visualization, and an Expert Commentary Report.

PATH implemented a three-phase mixed-methods approach to document PHC operational data gaps, identify innovative solutions, and generate expert recommendations across four purposively selected African countries representing different regions, language contexts, and digital health maturity levels.

Phase 1: Documenting gaps (Landscape report)
PATH conducted a rapid literature review of 73 documents across all four countries and primary data collection in Burkina Faso (40 interview participants across two regions) and Ethiopia (90 interview participants across three regions). Data collection captured subnational perspectives from community to regional levels, guided by an analytical framework focused on the data value chain—particularly data extraction and transmission. Findings were synthesized to identify cross-country enablers and barriers across five categories: tools, infrastructure, processes, people, and governance.

Phase 2: Identifying solutions (Innovation Scorecard & brief)
PATH conducted a global landscape review identifying over 80 practical technological and non-technological innovations for strengthening PHC data extraction and transmission at community and facility levels. Twenty innovations were prioritized through detailed scoring, emphasizing adaptable approaches for resource-limited settings that don't require full system overhauls.

Phase 3: Synthesis and recommendations (Map and match visualization & expert commentary)
PATH developed a user-friendly matrix mapping prioritized innovations with documented gaps, including a cross-country matrix and dedicated matrices for Burkina Faso and Ethiopia. Complementary visualizations highlight the PHC pillars each innovation addresses and the associated adaptation opportunities. The approach was validated through two country workshops and consultations with 17 global, regional, and country experts. The Expert Commentary Report synthesizes insights from all phases into actionable recommendations for strengthening PHC dataflows in low- and middle-income countries.

Identified innovations are organized by where they strengthen the data value chain:

• Data extraction solutions that improve how data is captured at the point of service
• Data transmission solutions that enhance how data moves through the system
• Dual-purpose solutions that address both extraction and transmission
• Cross-cutting enablers that strengthen the entire data value chain

The project took a comprehensive view of PHC operational data, assessing the data value chain steps across health system pillars: finances, human resources for health, supplies, equipment, facilities and infrastructure, and service coverage.

Cross-country dataflow patterns
Common workflows emerged across countries: community health workers and facility staff routinely collect and aggregate PHC operational data into standardized reports submitted to districts. However, significant challenges persist. Most facilities—especially rural and low-volume sites—rely on paper-based systems with multiple overlapping reporting tools, requiring duplicate data entry. While countries are increasingly digitizing community-level reporting, digital systems often run parallel to required paper processes. Manual reporting continues to drive data quality gaps, and gender disparities exist in data responsibilities, with women concentrated in frontline data collection roles.

Barriers span health system pillars
Barriers to data extraction and transmission are interconnected across system levels and PHC pillars, affecting tools, infrastructure, processes, people, and governance. Expert consultations validated these findings and highlighted additional challenges, including: the financial and environmental costs of digital storage, collecting more data than used, a lack of maintenance culture for dashboards, performance-based incentives driving "data cooking", and the absence of unique patient identifiers. Some gaps, such as inadequate workspace, paper shortages, and lack of secure storage, have no corresponding innovations identified.

Innovations
The innovation scorecard can be considered a global good with wide applicability for supporting consistent assessment of innovations. The scorecard is designed to apply across a range of innovation types and to weight scores by domain to tailor results to local priorities. Twenty innovations were prioritized, scored, and mapped to the data value chain, although scoring was limited by available documentation for each innovation. Many emerging innovations—including several AI-driven solutions—were excluded because they lacked sufficient evidence to complete the scorecard.

Strategic recommendations
Countries are prioritizing nationwide digitalization, which directly addresses burdensome manual processes and paper supply constraints. However, nationwide digitalization is a long-term process, and there are immediate data gaps that can be addressed to improve PHC programs now. PATH recommends the following:

• Strengthen the fundamentals: Implement innovations to strengthen core PHC data value chain components (i.e., data responsibilities, reporting requirements, supervision, and capacity) that can provide immediate value and strengthen the foundation for long-term digitalization. Clear role definitions and collecting only essential data are foundational practices applicable across all maturity levels.
• Accelerate digitalization: Introduce innovations that support the scale-up of digitalization in line with national priorities, particularly solar-powered systems for reliable power and connectivity. Facilities with reliable infrastructure could consider more advanced digital innovations like Internet of Things, cold chain sensors, or biometric scanning devices.
• Support the transition: Consider innovations that provide interim support for PHC dataflows during digitalization, like temporary data sharing workarounds through Bluetooth-based data transfer or photo-to-digital solutions. National roadmaps should include plans for supporting dataflows during the transition period.
• Prioritize sustainability: Balance the introduction of new innovations with scaling proven solutions and strengthening the enabling environment. Strong governance, infrastructure, and standards are essential for sustainable implementation. Some barriers, like paper shortages or device availability, require straightforward resource allocation rather than innovation.
• Build the evidence base: Continued evaluation is needed as innovations are implemented, particularly for newer solutions where effective data is limited.