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Interoperability Toolkit Helps Integrate Health Information Systems in Developing Countries

December 5, 2017
MEASURE Evaluation

Low- and middle-income countries struggle to provide quality, accessible healthcare. Health system innovation and integration and accurate, comprehensive data are needed to improve health outcomes and policy.

In response, policymakers, funding organizations and health program implementers are increasingly exploring the use of information and communication technologies to eliminate barriers to care. Stronger health information systems (HIS) provide better evidence of health system performance and the impact of health services on people’s lives.

But while the rapid expansion of connectivity and use of technology can help improve healthcare quality, they also present challenges. Digital health programs must scale and work together to maximize health benefits.

A new solution

To address these challenges, MEASURE Evaluation, a project funded by the United States Agency for International Development (USAID) and the Digital Health and Interoperability Working Group of the Health Data Collaborative have spent the past year developing a new health information interoperability toolkit. “Interoperability” refers to the ability of computer systems or software to exchange and use information, or the ability for groups to operate in concert.

The toolkit includes an assessment tool, a users’ guide and a maturity model that address not only the interoperability of health data, but also connections among funding mechanisms, the workforce and governmental and organizational leadership needed for strong and interoperable HIS.

Sam Wambugu, who leads the health informatics portfolio for MEASURE Evaluation and who helped develop the toolkit, describes how the assessment and maturity model work together. He says, “Countries can use the assessment tool to determine the status of interoperability components and then map that status into the maturity model, which can help countries define future goals and how to measure and achieve them.”

Countries can assess and map their status at any time and use assessment results to appeal to stakeholders and funding organizations for help in plugging the gaps and progressing toward stronger and more mature information systems.

Collaborative development

In developing the toolkit, Wambugu and his team gathered input from many sources. In Kenya and Ghana, they worked with the ministries of health and representatives from the private sector, universities and health informatics associations. They also looked at how maturity models have been used in other sectors, particularly in technology development, which requires continuous improvement and updates.

By working closely with USAID and the Health Data Collaborative, the team has aligned the toolkit with broader strategies for integrating technology in the health sector. Making the toolkit available through these organizations will help establish it as a singular resource. Projects sponsored by USAID and the Health Data Collaborative are recognized by numerous development organizations, donors and national governments around the world.


When used successfully, the toolkit should lead to several benefits in developing countries. Strengthening interoperability should improve disease surveillance and the control of outbreaks by providing more early warning signals to support decisions to intervene.

Interoperability should also make more and higher-quality data available to decision makers. A well-functioning interoperable system employs checks and balances to meet certain thresholds for data quality.

Sharing health data and expertise also improves continuity of care, reducing misuse of resources and supporting patient movement throughout the healthcare system.

Next steps

Wambugu and his team hope to begin piloting the toolkit in two or three countries. Applying the assessment tool in the field will help determine if it is sensitive enough to detect the attributes described in the maturity model and whether those attributes are adequately defined.

After making any updates resulting from the pilots, the team hopes to translate the toolkit into French and make it accessible for mobile phones and tablets.

Wambugu says several countries have already expressed interest in using the toolkit. “Having so much interest in the toolkit is motivating for us as we come to the end of the first phase of development,” he says. “We’re excited to share it.”

To learn more about MEASURE Evaluation’s work to strengthen health information systems in developing countries, visit the MEASURE Evaluation website.

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