PHISICC - Operations Research to Improve Paper-based Health Information Systems in Comprehensive Care

Sound decision making is paramount to maintain and improve the organisation and delivery of health care. The myriad decisions people make throughout a health system, from clinicians choosing a course of treatment, to policy makers establishing funding priorities, to patients choosing whether to vaccinate their children or not, are all based on judgments, which should rely on evidence and data. In many low and middle income countries (LMIC), health data is generated, stored and transferred using paper-based tools. A prevailing bias of attention towards supporting health information systems through IT risks to leaving behind settings where paper-based tools are and will continue to be central to the experience of data producers and users in LMIC. These settings often serve the most remote and vulnerable populations. Data about these groups remains underrepresented at best. We believe that paper-based components of the health information system should be carefully researched and intentionally designed to improve health outcomes and reduce inequities.

Objectives and Aims
The aim of the project is to design and test paper-based information systems interventions to improve the use of data and quality of care, especially focusing on child health and immunisation. The project will include several work streams: (1) a systematic review of health information systems interventions, (2) an assessment of countries information systems, (3) the design of new tools and interventions, and (4) testing them in three countries using experimental research designs.

Methods / Approaches
We will gather global and local evidence on health information system interventions and will characterize the role of paper-based systems in three LMIC countries. In creative partnership with those countries, we will engage in co-creative, collaborative and intentional design activities to redesign the tools and processes to improve paper-based systems. We will then use robust experimental study methods to test the effects of paper-based design interventions on the quality and use of data and on health systems performance outcomes. Finally, we will share the knowledge and lessons learned over the course of the project with decision and policy makers in the global health community.

The inception phase has been completed with all studies protocols written and agreed among partners. The systematic review of the literature has been finalised and a complementary ‘framework synthesis’ is on course. The characterisation of the HIS in the three countries has also been completed and the reports produced. We are currently starting the collaborative, co-creative design activities.

Target Groups
Paper-based information systems support critical information which links communities and health professionals, supporting health care delivery, public health services and evidence to inform decision making. Data at the health facility level is the main (and often unique) source, for example, to identify unvaccinated children, pregnant women due for antenatal care consultations or tuberculosis treatment defaulters.

Further lines of action / next steps
We are applying the HIS theoretical framework to the collaborative, co-creative designs. We have defined 12 core functions of the HIS and we are devising mechanisms to translate those into design options. When this stage is finalised, we will test the resulting innovations with randomised controlled trials.

Other important information
The project, led by the Swiss TPH, will run in collaboration with the Ministries of Health in Côte d’Ivoire, Mozambique and Nigeria, with the design companies gravitytank / Salesforce / Tomorrow Partners / YAAY / Sonder Design, the Centre Suisse des Recherches Scientifiques (Côte d’Ivoire), the University of Lúrio (Mozambique), the Eduardo Mondlane University in Maputo (Mozambique) and the University of Calabar (Nigeria).

Watch the short film about the project :

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Selected projects at this location:

Involved Regions: Africa
Involved Countries: Côte d'Ivoire, Mozambique, Nigeria

Bosch-Capblanch X, O'Donnell D, Krause L.K, Auer C, Oyo-Ita A, Samba M, Matsinhe G, Garba A.B, Rodríguez D, Zuske M, Njepuome A.N, Lee S.M.M, Ross A, Gajewski S, Muloliwa A.M, Yapi R.B, Brown D.W. Researching, co-creating and testing innovations in paper-based health information systems (PHISICC) to support health workers’ decision-making: protocol of a multi-country, transdisciplinary, mixed-methods research programme in three sub-Saharan countrie. Health Res Policy Syst. 2021;19:112. DOI: 10.1186/s12961‑021‑00768‑0

Ekpenyong N, Heitz Tokpa K, Nwankwo O, O'Donnell D, Rodriguez Franco D, Berté S, Amani Kouassi S, Eteng G, Undelikwo V, Auer C, Guessan Bi G.B, Oyo-Ita A, Bosch-Capblanch X. Using and improving the PHISICC paper-based tools in the health facility laboratories: examples of Human Centered Design taking systems thinking into practice, in Côte d'Ivoire and Nigeria. Front Public Health. 2022;10:916397. DOI: 10.3389/fpubh.2022.916397

Zuske M.K, Auer C, Oliver S, Eyers J, Bosch-Capblanch X. Framework synthesis to inform the ideation and design of a paper-based health information system (PHISICC). Int J Health Plann Manage. 2022;37(4):1953-1972. DOI: 10.1002/hpm.3487

Bosch-Capblanch X, Oyo-Ita A, Muloliwa A.M, Yapi R.B, Auer C, Samba M, Gajewski S, Ross A, Krause L.K, Ekpenyong N, Nwankwo O, Njepuome A.N, Lee S.M, Sacarlal J, Madede T, Berté S, Matsinhe G, Garba A.B, Brown D.W. Does an innovative paper-based health information system (PHISICC) improve data quality and use in primary healthcare? Protocol of a multicountry, cluster randomised controlled trial in sub-Saharan African rural settings. BMJ Open. 2021;11(7):e051823. DOI: 10.1136/bmjopen-2021-051823

Jarrett C, Clarke C, Ferriera J. PHISICC - Healthcare workers, data and decision-making. A journey of co-design [Video]. Basel: Swiss TPH

Vaccines and Immunisation Programmes


Xavier Bosch-Capblanch

Xavier Bosch-Capblanch, PD, MD, MSc, PhD
(no function)


Project Facts

Collaborating Institutions