It is common these days that all of us (policy makers, planners, managers, and even politicians) are advocating for evidence-based management, data-based decision (3D) making, or evidence-based medicine and so on. In all of these disciplines, “evidence base” is the heart of the matter and without which it is hard to push forward an agenda in a world where rationality, accountability, and fairness exist. We can also state here that our statement or any thought processes based on solid evidence is a practice that has been handed over to us since ancient years. In a way, it is a practice of seeking truth or near the truth. And truly, we have arrived at such a juncture of history that we are witnessing a rapid boom in Information technology (IT) that we are now entering into an era of Artificial Intelligence (AI). We hear of automation (autonomous car/rocket/ 3D printing), big data, drones, Internet of Things (IoT), open data, Mars travel, human colonization of exoplanets or more recently of plasma-based engines, space-faring civilizations, ultimate traveling to planets around Alpha Centauri, our nearest star. Why I am bringing these technology-based revolutions that are happening and disrupting the way we do science, simply because we need to catch up and explore in that direction of utilizing these available ideas and tools for our day to day work and activities. For our case in strengthening our health care delivery system from the health information system to hospital management to logistic supply and its delivery to remote parts of our country and improving the lives of our citizens.
We can safely say that IT and health sectors are two fields that have proportionately grown at a fast pace compared to other fields. Just recently (2017), Nepal Telecommunication (NTC) launched 4G/LTE service. Now, we can communicate in video mode and google any information from any towns all of the countries, be it in Simikot or Mugu. Such a fast pace we are moving ahead in this field. Also, we have to stress here that public health services are one of the most widely distributed public services that reach each and every corner of our country. There are numerous challenges that have been discussed for such a long time that we need to fix the ailing health care delivery platform if we are to provide quality health care. It is said that poor quality health care kills more people than communicable or non-communicable diseases. It is very clear in front of us, we can solve many such governances, management, logistics as well as a hospital as well as public health issues utilizing IT as well as informatics integrated into the health system. For this matter, we are so lucky that Health Informatics is a term describing “the acquiring, storing, retrieving and using of healthcare information to foster better collaboration among a patient’s various healthcare providers. Health Informatics plays “a critical role in the push toward healthcare reform.” This field is “an evolving specialization that links information technology, communications, and healthcare to improve the quality and safety of patient care.”
It is timely to remind us here and that the Nepal Constitution 2072 in its Clause 51 (Policies of the State) and that relates to Sub-clause “(b) Policies relating to political and governance system of State” also says that:
While Sub clause “Policies relating to development” also reiterate:
Whatever we proclaim as fundamental rights in our constitution, we will not be able to achieve such goals if we are not efficient in measuring the inputs, processes, outcome, and impact of any budget and program allocated and implemented through public services. Therefore, it is exactly true when we say, “ if we do not measure then we do not know where we are going”. Compare this scenario to an aeroplane taking off, in flight and during landing, if the pilots are equipped without all those radars and other metrics that measure altitude, speed, direction, fuel gauge, temperature, pressure, wind speed and so on, then we can’t imagine from traveling from A to B in an airplane. So is the similar scenario of health - care delivery.
As we enter the 21st century, the world population is approaching 8 billion and most of this humanity reside in Asia, particularly India and China. In between these two giants - Nepal is situated with a population approaching 30 million for this small country. We are sustaining to our habits and habitat till now. However, time ahead does not look that easy with increasing population density, climate changes, alarming deforestation, rising poverty, and unemployment rate and brewing conflict with political instability despite a decade long wasted years of people’s war. Despite all these challenges in the vicinity, people have expectation from elected government and our new constitution 2072 have loudly stated that fundamental rights related to health and welfare, education, food security, clean air and water, transportation and so many aspirations are written in letters. In this respect, our government of Nepal (GoN) recently passed public health and safer motherhood acts in order to ensure basic health rights that include emergency care wherever and whenever. Above all, GoN is also a signatory to global health as well as developmental commitments such as Universal Health Coverage (UHC) and Sustainable Development Goals (SDG). The key principle that underlies all these noble endeavors is that “no one should die or fall ill not because one is poor such that no one is left behind”. Therefore, it is the responsibility of the government to provide financial protection from illness or diseases such that nobody has to get trapped in poverty.
For this, the best approach would be the comprehensive approach that SDG has espoused to fight poverty, inequality, pollution, illiteracy. So to be a part of this noble cause of global as well nation’s commitment, we need to implement the key strategies that are e-governance policy of Nepal. For this to be successful, we need to establish a dedicated Health Informatics division within MoHP such as "Health Informatics and Analytic" as a division to be lead by 11 level or alternatively, we can accommodate this "Health Informatics & Analytic" component into the current Population Management Division to be lead by 11 level health professional or population scientist. For this, we can follow the model of measure evaluation. We need to establish a framework for strong coordination and collaboration specifically to align Policy, Planning, Monitoring, Regulation, Quality of Care, Health Economics and Research wings and carry out following key activities:
- Strengthen data-based decision making, which will feed Evidence-Based Policy and Planning within MoHP
- Provide technical leadership through collaboration at local (provincial governments), national (Other governmental sectors, NHRC/CBC/VBDRTC/Universities/Research Organizations / non - gov organizations etc), and global levels (UN organizations/foundations/universities/research organizations etc) to advance the field of global health monitoring and evaluation.
- Build the sustainable capacity in evidence-informed decision making, which will vitalize evidence-based Policy and Planning within MoHP
- Create, implement, and facilitate state-of-the-art methods for and approaches to improving monitoring and evaluation, health information systems, and data use.
- Establish data derived decision (3D) making framework, which is vital for aligning policy, planning, monitoring and evaluation, quality of care, health economics and Implementation research activities within the broad framework of UHC as well as PHC revitalization.
- Establish a health economy unit (Attention: we should not minimize the importance of the health economy as a discipline)
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