Strengthening communities, data and health systems in Jordan
Globally, achievement of the UN Sustainable Development Goals is being challenged by numerous events, including the COVID-19 pandemic, ongoing conflicts and the worsening climate situation.
The Middle East region is no different and is, in fact, at the forefront of these development challenges. Jordan, for example, has seen waves of refugees and displaced migrants from the region over the last several decades. Health systems across the globe — including in Jordan — are overstretched and are being challenged to provide quality universal services in the face of conflict, climate shocks or epidemics/pandemics. In this context, health information systems (HIS) are critical to provide reliable, ongoing information about health-care services to ensure responsiveness to health needs and prudent use of scarce resources.
Research highlights
- Health-care systems globally are being challenged by the ramifications of the COVID-19 pandemic, ongoing conflicts and the climate-change crisis.
- Universal access to health care, a long-standing goal of the World Health Organization, is becoming harder to achieve.
- Health information systems (HIS) can be critical to strengthening health systems and their overall goals of universality and equity.
- Robust HIS can provide evidence that can facilitate decision-makers' response to the health-care needs of the population, including those of vulnerable groups.
The Jordanian government has committed to achieving universal health coverage by 2030 through the Ministry of Health’s 2023-2025 Strategy and the Country Cooperation Strategy 2021-2025 for the World Health Organization and Jordan. However, health care access remains fragmented and hospital-centric, and only 70% of Jordanians are insured. While Jordan’s inclusion of refugees in all aspects of the public health response to the COVID-19 pandemic was hailed as exemplary, the health-care system remains strained due to pandemic ramifications and a reduction in humanitarian funding for the Syria crisis response.
While these challenges remain, there is a need to strengthen health systems so that they are responsive, equitable and resilient. To attain this goal, sustained attention to reliable data and localized solutions in light of the generated evidence are important to redress health inequities and promote better health and wellbeing.
To enhance the efficiency of the health-care system, the Jordanian government piloted an e-health initiative system in public hospitals in 2011 to store, retrieve and update the electronic patient health records managed by health-care facilities. However, the country’s health information systems face inherent challenges, including reported weak governance and poor management, lack of coordination among numerous government entities that run health services and weak monitoring of the private health sector.
Other reported challenges include a lack of regulations and policies to support HIS, a shortage of financial resources, an undersupply of qualified personnel and a lack of standard forms for handling patient data, leading to an inadequate health record system. In fact, information confidentiality, informed consent and privacy are also serious hindrances to the full utilization of e-health systems in Jordan, and the Jordanian government’s Health Information System Strategic Plan (2019-2023) is yet to be upgraded to address these challenges.
IDRC-funded researchers are working to bridge this gap by strengthening HIS and digital platforms, generating evidence to improve decision-making in addition to patients’ access to and experience of care.
Research highlights
- In recent years, IDRC has supported research projects that respond to the HIS challenges in Jordan and to policy initiatives from the Jordanian government to strengthen its HIS.
- Researchers in Jordan, with support from their Lebanese counterparts, have carried out the first comprehensive assessment of HIS, particularly capturing the needs of vulnerable population groups.
- Researchers from the Jordan University of Science and Technology developed and implemented the first standardized electronic surveillance and reporting system to support health-care decisions during pregnancy.
- Researchers from EMPHNET, the Eastern Mediterranean Public Health Network in Amman, have developed and implemented a reproductive health registry to focus on strengthening representation of underserved population groups.
Strong health data systems mean better care and decision-making
Through IDRC grants, researchers conducted the first comprehensive assessment of HIS in Jordan, strengthening the collection, analysis and use of data to inform health policies and practice. In particular, the study assessed the extent to which Jordan’s existing systems and their built-in indicators capture the experiences and priority needs of vulnerable groups, including metrics for maternal, adolescent, child and refugee health. Jordan’s Ministry of Health has already begun to revise its existing systems using findings from the assessment.
In parallel, IDRC funded a project to develop and implement Jordan’s first standardized electronic surveillance and reporting system for perinatal and neonatal mortality data. The resulting Jordan Stillbirths and Neonatal Deaths Surveillance System (JSANDS) collects, organizes, analyzes and disseminates data on stillbirths and neonatal deaths as well as their causes.
Female nurses in Jordan report that the system has empowered them within health care teams by giving them the information needed to support informed patient care. Rudaina Shdefat, a nurse unit manager working at one of the five hospitals that serves disadvantaged populations, was very happy with the interventions that have taken place to improve the survival rate of newborns and track stillbirths, including the formation of a committee to examine the causes contributing to stillbirths and neonatal deaths and identify actions that could reduce similar preventable deaths. Shdefat told one of the JSANDS members, “I can’t tell you how much I’m pleased with what the members of the Death Review Committee come up with after each meeting in order to prevent similar deaths.”
Facilitating access to care via digital platforms
Additional IDRC-funded research projects have focused on strengthening direct patient care and access through digital platforms and systems.
Jordan’s Mafraq governorate, which borders Syria, Iraq and Saudi Arabia, faces particular health concerns given its vulnerable population. With two large camps for Syrian refugees, Al-Mafraq and Al-Za’atari, the governorate has a large population of Syrian refugees. Within this context, IDRC undertook a project to support the development of an electronic harmonized reproductive health registry (hRHR) for both refugee and non-refugee populations in Mafraq. The registry was developed following a participatory approach that strengthens the representation of underserved groups — particularly refugees, women and children — throughout the development and trial period.
As a result of this project, a computerized hRHR has been developed and rolled out across 19 health facilities in Mafraq. The registry digitizes existing mother and child health-care files and is synchronized and interoperable with the Ministry of Health’s information system. The system also includes a non-computerized hRHR to allow for broader reach. The participatory approach allowed the resulting registry to be responsive to the situation and needs of vulnerable and disadvantaged groups. An evaluation of the study has shown that women utilizing the system report improved continuity of care, confidentiality and easy retrieval of their health data.
Lessons learned
Health data can be the strategic asset that helps decision-makers steer resource allocation, spot gaps and realize the impact of an intervention. Several of the Jordanian government’s policy initiatives to strengthen HIS and attain universal access to health care must be supported through ongoing research. The evidence generated and the strengthened research capacities are critical to gain a streamlined research-to-policy continuum. The gaps in policy implementation, for example in reaching those that are the most vulnerable, can thus be filled through evidence generated by research and improving equity in the health-care system.