Learning Health System - A Need of the hour Post 16 / 24 (April 2018)

This year - I consider myself fortunate to attend "4th National Summit of Health and Population Scientist in Nepal" organised by Nepal Health Research Council (NHRC) and Ministry of Health and Population (MoHP) in collaboration with External Developmental Partners (EDPs) on 11 - 12 April, 2018. The conference theme was "advancing evidence for changing health system in Nepal" of which we are all in the best of time to observe and analyse the health system service delivery in our present context. All the presentation of this conference are the link: http://summit.nhrc.gov.np/news-2/ as 2017 Summit Presentations.

In this post - let me explore what is "learning health system"? before sharing my observations and thoughts that got excited during the conference. In my personal opinion, the system which incorporates implementation science as its core element that drives the decision making process is actually "learning health system". In this kind of system, all the policy and planning activities are guided by Data Driven Decision (3D) making and this scientific learning activities plays an important role in identifying barriers to and enablers of, effective public health programming and policy making and leveraging the knowledge to develop evidence based innovations in effective delivery approaches. It is also imperative for us to understand here - what is implementation science? This growing field in current global as well as public health arena is "the study to promote the adoption and integration of evidence - based practices, interventions and policies into routine health care and public health settings." In order to better understand this system, we need to get insights into various dimensions that are necessary to be taken into accounts. For this - I would like to reference most of its elements from "The learning health system series" of National Academy of Medicine.

1. Data Utility: Everywhere we go we generate data. For example - we implement TB program from Federal to local level, we are generating data in the continuum of input, process, inputs and outcomes that we expect from this program for the benefit of the population. In this way, we are surrounded by data everywhere like air is all around us. The only question is how to characterise and analyse these huge data accumulated in our system, through system for the goods of people and community? Therefore, it is high time we mine data as well as focus our resources in establishing a competent and SMART data management team within our ministry, otherwise we will always be dictated or guided by subjective or poor evidences, which may have negative consequences in the short or long term. It is therefore we are in the best of time to advocate for SMART data management structure within our system. By which we can establish an engine for real - time data generation, which has a potential for real transformation of health care in Nepal as everywhere. For real transformation in data management throughout our 3 tiers of government, we have to invest in digital platform, which is now practically doable with tremendous coverage of NTC service coverage in the country. As a positive consequence, we would be the best position to collect data quality of highest standard in terms of accuracy, completeness, timeliness, validity and consistency. This will enable us to build a robust health metric system, which is an essential component of resilient health care system. 
2. Evidence: The culture of using scientific evidence generated through basic, clinical, social, economic or operational studies can be said to represent the nature of robust as well as learning health system. It is for this reason, there is an establishment of National Health Research Council (NHRC) in the premise of Ministry of Health and Population (MoHP), Kathmandu. All the rules and regulation that relates in the process of evidence generation through systematic studies are under the purview of NHRC. It is noteworthy to mention here that there is also a separate Policy and Planning Division (PPD) directly under Health Secretary office. It is simply understood that all the evidences generated in the field health sector are systematically archived and used appropriately in national health policy of the country in close coordination between NHRC and PPD. The implementation research conducted in real health care delivery set up guides all of us in deciding what works the best and what intervention generates the value for money and has the maximum impact in the community, while reaching the unreached in every corner of the country. 
3. System Engineering or health system strengthening: This is one of the most important element that is needed to fix ailing or dysfunctional health system. Some call it system engineering, while some like to call it health system strengthening. In Nepal, it is popular as Nepal Health System Strengthening (NHSS), which aims to improve the organisation, structure and function of the delivery, monitoring and change processes in health care. In this effort, various partner organisations like GIZ, WHO, DFID, USAID, WB, UNICEF, UNFPA, KOICA are working in alliance as technical assistance (TA) supporting of Ministry of Health and Population (MoHP). There can always be a debate on whether this kind of TA is really needed or we have to devise our own home based talents and grow with it rather than relying completely on external partners? However, my personal opinion is that we need to build a strong team within MOH and work closely with NHRC, teaching universities, research organisations (both national and international) and non governmental organisations. This will lead us into strong operational research base, which is needed the most at current landscape of health system in Nepal. 

May 14, 2018

Dhangadhi