Honorable Minister of Health, Gagan Thapa delivering his key note speech before launching the SMART HEALTH initiative
"In order to bring changes in Nepal's public health sector we need to embrace the notion of transparency and accountability as our guiding principles. If we can be transparent by opening up data and information […] we can establish the regime of accountability".
With this message in his keynote speech at Kathmandu Open Data Day 2017, honourable Minister of Health, Gagan Thapa launched SMART Health, a new initiative to improve public health service delivery by establishing transparency and accountability. SMART HEALTH is a web-based open data system to enable the monitoring of plans and tracking of performances of different health agencies, monitoring the availability and absenteeism of health staff, provision of information about the nearest health institutions, and the tracking of the Ministry’s progress in improving the health sector. This launch of this new initiative is a significant milestone in the growing sphere of government open data initiatives in Nepal, as is the new open data initiative within Nepal's public procurement sector. The Public Procurement Monitoring Office is working with the Open Contracting Partnership to open up procurement data through the 'Public Procurement Transparency Initiative in Nepal’. You can find out more about this initiative in our blog here.
Open Data Day 2017 presented the perfect opportunity for Nepal’s community of open data enthusiasts to learn more about the government’s new efforts to underpin better production, sharing and use of data. Here are some key takeaways from the day’s panel sessions:
5 things we learned about data in Nepal's public health
1. We must stop blaming the inadequacy of resources for underperformance in the health sector, the real problem is lack of robust government systems. Gagan Thapa, Minister of Health urged that rather than focusing on lack of resources as a root cause for underperformance in Nepal's public health sector we need to focus on building robust internal management and monitoring systems to more effectively and efficiently channel the available funds so that health services reach those in need. The new SMART HEALTH initiative is an important part of this process.
2. There are widespread cultural and institutional barriers to data sharing prevalent in the health sector. The panel shared that there is a culture of withholding data by bureaucrats working in the health sector, suggesting that bureaucrats believe this preserves the power they exert in influencing decisions. Fear of technology among the bureaucrats was another cultural barrier discussed by the panel which has prevented the use of new technologies for data sharing. The lack of legal provisions for governing and safeguarding data, and lack of institutional provisions to store and share data also act as disincentives.
3. Without data standardization, interoperability across datasets from different systems is a herculean task. According to the panel, there are around nine management information systems within the health sector, none of which follow the same reporting standards or share unique health identifiers. This restricts data interoperability (combining two datasets together to carry out cross analysis). For example, according to the panel moderator, Sudip Pokharel, director of MedicMobile and advisor to Ministry of Health, the Health Management Information System and Logistics Information Management System use different data standards which is problematic when combing data from these two systems.
4. A significant portion of the health data produced is not widely used. From her experience of working in the National Health Insurance scheme, Franziska Fuerst from the GIZ Nepal told us that the big chunk of health data produced from all over the country is hardly used even within the health sector. According to her, 5000 variables are produced from 5000 health centres is shared only in aggregated form which limits its use in planning health programs. However, government plans to begin e-reporting data from districts to the Health Management Information System could enable easier detection of patterns and gaps and enable greater use of health data.
5. The digital divide is a bottleneck in better sharing and use of data. Not all health staff along the health data supply chain are data literate or know how to use data in a most efficient way. Many health facilities do not have computers or access to electricity which restricts their ability to access and use data. These factors are creating a wide digital divide limiting the use of data to just those that have access and skills to use technology.
Panel Discussion on Public Health
5 things we learned about data in Nepal's public procurement
1. Just building data information systems is not enough, we need to stimulate their use. "In Nepal a greater percentage of the allocated budget, especially in construction projects remain unspent until few months close to the end of a fiscal year. This means, either the projects are not commenced on time or there has been slow progress in the projects that have already begun, or projects have been stalled. Because of these reasons government agencies dealing with those projects are hesitant to enter data and information about the projects in project management systems" said Ramsharan Pudasaini, joint secretary of the Ministry of Finance. He asserted the need to build strong institutional mechanism to encourage use of existing information systems and remove blocks in data sharing and use.
2. Building capacity within government and outside of government to use data is essential. Those in charge of procurement at different government agencies and outside contractors in Nepal use paper-based contracting systems and are not always familiar with how to report and use contracting data. Manish Bhattarai, IT director from Public Procurement Monitoring Office told us that "Without the users having the right skills to access and use data it makes no sense of opening it up".
3. Information needs to be in the hands of civil society for them to be able to demand accountability. Bansidhar Ghimire, member of the Transparency International Nepal asserted that civil society needs to have easy and timely access to relevant project information such as the contractor's name, project period and completion timeline, project budget etc. Only with this information can civil society be able to hold to account the contractors and government agencies implementing the project.
4. Inaction in the procurement process is the biggest challenge in public procurement. As highlighted by Shambhu Prasad Uprety, senior procurement specialist at the World Bank in Nepal, "There are several occasions where procurement processes are not initiated even towards the end of the fiscal year and procurement budgets are held for a longer period of time". These factors create loopholes for corruption in the public procurement systems. Greater transparency through open contracting could shed a light on where and why these hold ups occur.
5. Public procurement data can have high value if linked with other processes like government budgeting and planning. "The first thing to do is to maintain the quality and completeness of the procurement information and link it to other data, such as the budget and planning data so that we can look at procurement data in terms of how the allocated money is being expended" explained Lindsey Marchessault, Director of Data and Engagement, Open Contracting Partnership. She said that by linking up data people can identify gaps and know whether funds have been allocated. This information can support government, private sector and civil society actors to ask questions such as why the procurement process has not been initiated despite the allocation of budget, etc.
Panel Discussion on Public Procurement
Both the panels concluded that partnerships and collaborations between government, techies, civil society and media are the way forward in improving the production, sharing and use of data in the respective sectors.
Year-on-year we are witnessing a gradual but growing progress in Nepal's effort to revolutionise production, sharing and use of data-evident by proactive involvement of home-grown community of data enthusiast in innovative data interventions, increasing government buy-in in open agendas and support from the international organizations and big donors in the uptake of large-scale open data projects. With the on-going advancements we are excited to see what the coming years might bring. Events like Open Data Day are a wonderful platform to connect all these actors and weave their efforts into a common thread. We hope this enthusiasm continues to grow in the years to come!