Developing Resilient Digital Health Systems: Lessons from Ethiopia’s post-conflict situation


Conflict has substantial direct and indirect effects on the proper functioning of national health information systems, as well as the monitoring and evaluation of health service coverage and diseases. During the conflict, patient, financial, logistic, and administrative records are misplaced, damaged, or destroyed. The loss of these records has a significant influence on the healthcare system as a whole, and impact service quality in particular. Monitoring illness and service trends, identifying epidemics, predicting outbreaks, forecasting and quantifying health commodities, and providing quality health services are challenging without historical patient and health service data. As a result, reporting and program monitoring activities are always limited to areas that are safe and accessible.

Restoring the Health Information System

The current conflict in Ethiopia‘s northern region has caused damage to the health sector. The conflict has left a trail of destruction in its wake. Medical supplies, infrastructure, and various health and medical records have all been lost or damaged. This is on top of the untimely deaths, injuries, lasting disabilities, internal displacements, and psychosocial issues that citizens in conflict places have experienced. According to the Ministry of Health’s (MOH) recent post-war health facility damage assessment study, 2,359 health posts, 516 health centers, and 41 hospitals in the Amhara, Afar, Benishangul Gumuz, and Oromia regions have been damaged. The preliminary information obtained from these sites raises several questions about the national health information system’s (HIS) ability to survive such adversity. The loss of patient data from medical recording rooms will have a significant impact, with little chance of recovery.

The Digital Health Activity is collaborating with the MOH and the Regional Health Bureaus (RHBs) to facilitate the restoration and recovery of the HIS in the affected health facilities. Until the entire HIS is restored and routine reporting begins through the national health management information system (HMIS) begins, the Activity has implemented a digital tool for capturing and reporting emergency and vital services. The information provided by this interim system will allow the MOH, RHBs, and other health system stakeholders to make informed decisions based on the current circumstances. HIS infrastructure assessments are also being carried out in the Amhara and Afar areas to enable informed planning of the long-term rehabilitation of the health information system in the damaged facilities. According to information obtained from RHBs, the damage is extensive, necessitating a huge mobilization of resources to restore the health facilities to their pre-war state.

Lessons Learned

Beyond the digitalization of the health system, one of the most important lessons learned is the significance of creating a safe and secure HIS that is resilient to shocks from man-made and natural calamities. To this end, it is necessary to reconsider the recovery strategy and seize the chance to implement long-term changes in the management of health data at the facility level. This necessitates taking bold and swift steps in creating and implementing new transformative projects that will propel countries beyond their pre-conflict condition. It is especially important in health facilities that have been heavily damaged, as recovering the prior manual health information system will be similarly costly without the added benefits of adding resilience to the new implementation. For example, we believe it is past time to deploy and fully transition to eCHIS in conflict-affected health posts. Similarly, at the health center and hospital levels, some sort of summary electronic and paper-based health information should be placed in the hands of the patient. There are technologies that allow patients’ health information to be stored on smart cards and retrieved in other institutions for service continuity.

Chronic patients in conflict-prone areas can also benefit from mechanisms that provide a summary of their diagnostic and treatment regimen in paper form. In order to avoid future data loss as a result of natural and man-made disasters, policies regarding data hosting, storage, backup, and recovery must be examined.

Aside from technological investments and the creation of a supportive regulatory environment, it is also critical to raise public awareness of the importance of health data so that it becomes a valuable asset that demands the greatest level of protection during conflicts. These steps, in our opinion, help to the development of resilient HIS in conflict-affected areas of the country.

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