From notebooks to smartphones: Senegal’s data-driven fight against malaria
The country's decision almost two decades ago to build a robust national health information system has helped it make historic gains against the disease, and transformed its ability to monitor and deliver health care
Over the past nearly two decades, Senegal has cut its malaria cases by 73 percent and its death rate from the disease among children under five by 90 percent. This remarkable achievement can be traced back to a pivotal moment in 2004, when the country was battling some of the highest malaria mortality rates in the world.
“At this time, when our [malaria funding] partners wanted to understand the impact of their investment, we couldn’t provide any data on case numbers, on what had been distributed, nothing,” said Mame Birame Diouf, the former deputy coordinator of the National Malaria Control Program. “We had no data because we had no data system.”
Recognizing that making a meaningful impact on malaria rates required an evidence-based approach, Senegal’s leaders began investing in and building a national, data-driven strategy system for health. This data system transformed not only the country’s approach to malaria control, but also its ability to monitor and deliver health care across the country.
Senegal’s data system began modestly, with health authorities giving thousands of community health workers notebooks ,and asking them to start tracking malaria diagnoses, treatments, and prevention services. The data was then transcribed and shared, via paper-based reports, up the chain of command until they reached the capital – generating the first national malaria database.
“It was all paper-based,” said Yakou Dieye, the regional director for malaria in West Africa for PATH, an nonprofit global health organization based in Seattle. “It was difficult to do a rapid analysis. It took three months just to enter all the data.”
And at the end of those three months, however, health leaders were left with data of questionable quality because of transcription errors. “Senegal’s health leaders recognized that the objective of collecting data is to make informed decisions,” said Dieye. “If you have good data hygiene, then you can have good data-based decisions.”
Towards that end, community health workers were trained to collect data using their smart phones and routine data quality audits were instituted using a peer review approach.
Today, Senegal’s robust digital health data system includes regular malaria indicator surveys and weekly electronic updates from community health workers – both of which are captured in a web-based national platform and included in weekly bulletins shared with funding partners. While challenges remain, progress can be tracked in nearly real time on a national malaria dashboard. Health leaders with decision-making power have passwords and access to this dashboard. Every year, the country produces an accessible and detailed malaria report with data visualizations. And every two years, health leaders conduct a “mid-term review” to evaluate the national malaria plan.
In addition to malaria-specific data, the country collects data related to other health indicators and access to health services. Today, Senegal conducts DHS surveys on a continuous basis, while many of its neighbors conduct DHS surveys every five years. In addition, Senegal conducts Malaria Indicator Surveys on a biennial basis. This robust data culture is widely recognized as one of the three key success factors for Senegal’s malaria strategy, along with leadership and partner engagement and the achievement and maintenance of high intervention coverage levels. In fact, data has become so central and valuable to health leaders that when Senegal's health officers go on strike, their key act of defiance is withholding data.
“Senegal is also very innovative in using data for predictive modeling to weigh the potential impact of various interventions,” said Hana Bilak, malaria technical advisor at PATH. “The better the data, the more the models can tell you.”
Senegal's use of data demonstrates how countries are increasingly embracing data not just as a tool for performance evaluations, but also as a powerful decision-making tool.
The country's data systems also inform health leaders, allowing them to move quickly, allocate resources where they are needed most, design and target effective public information campaigns, and respond to fluid circumstances. The COVID pandemic illustrated this clearly. Senegal health leaders were able to layer in COVID data into their existing dashboards – harnessing established and functional tools to address the new threat.
For example, by monitoring health facility attendance during the pandemic, Senegal’s health leaders could see where malaria might be going undiagnosed and untreated. “Health leaders could see in March 2020 that fear of COVID sparked a significant decline in the use of health facilities. Malaria hadn’t disappeared. But people were afraid to go to health facilities to get their malaria symptoms checked and treated. Health leaders recognized this quickly and could respond quickly by launching communications efforts and community outreach. They then could see the use of health facilities rebound,” Dieye said.
Bilak added that “good data also helps with fundraising and advocacy. Funders want to see their impact.”
Countries identified as exemplars in under-five mortality, stunting, community health workers, and vaccine delivery, all shared such an approach to data. They prioritized investments in good quality, national and local data collection systems for priority topic areas. They conducted small-scale or local research studies to pilot innovations to collect localized data before scaling up. They used data to identify priority areas, populations, and tailored interventions to local context. And they worked to ensure that the data they collected was used to inform decision-making, building a strong data-driven culture at national and local levels (e.g., encouraging data literacy among leaders, and using data for performance-based programming).
By effectively harnessing data, Senegal has been able to do more with less. The country has been identified as both an exemplar in childhood stunting and under-five mortality despite extreme shortages of health workers and resources. Across all of Senegal, with its 16 million people, there are fewer than 1,200 health posts, centers, or hospitals. And the number of doctors and nurses in the country is similarly extremely low. The WHO recommends countries have 2.3 health workers per 1,000 population. Senegal has a fraction of that: 0.38 as of 2016. And most of those doctors and nurses are concentrated in Dakar and other urban areas, leaving the one in three Senegalese who live in rural areas reliant on community health workers for access to essential healthcare.