24 BOX G District Health Information Software 2 District Health Information Software 2 (DHIS2) is open source software for the entry, analysis, and presentation of health data. The Myanmar National Health Plan (2017–2021) underscores the use of DHIS2 as a common national platform to integrate existing, parallel health-information systems whose “fragmentation” has “overloaded” grassroots healthcare workers with reporting burdens. Although the use of DHIS2 is widespread in government hospitals and public health offices, certain functions and uses are still in pilot mode as the national rollout of the platform continues. DHIS2 is used in selected government hospitals to record births, deaths, and the number of current in-patients, among other statistics. The process begins as a daily, paper-based census of hospital wards, which is then used to create a master list in the Archives Department, ultimately to be entered into DHIS2. In one general hospital, for example, two workers—so-called “DHIS2 focals,” chosen for their computer skills—transcribe paper ledgers into DHIS2. They are several weeks behind: one individual describes his work catching up on this data lag as “repaying a debt.” At another hospital, one DHIS2 focal recalled the frustration of a five-day interruption in internet service, but added that her hospital has benefited from DHIS2, in that many of her colleagues now make routine use of spreadsheet software. She has designed her own Excel template to record emergency admissions to the hospital. She hopes to use this admissions dataset to map where hospital patients are coming from. She says, “I want to start with one month’s data and show the results to the head of the hospital. If he agrees, I want to map a whole year’s worth of admissions.” DHIS2 is primarily used for data entry and reporting, and a 2016 review found that the software’s more advanced data-analysis and visualization functions were rarely used. Observations in three townships in late 2019 found that DHIS2 was still used primarily as a data-entry tool. Clear deadlines, consistency standards, and lines of reporting all the way to the Union ministry ensured timely data from township offices, but evidencebased planning and management at the township level were still limited. more efficient. For officials collecting data in the field, mobile phones are powerful devices that can improve data-collection practices. Mobile phones are increasingly being used by township officials to make notes, take pictures, and record sound and video. This data needs to be categorized, structured, and secured to ensure effective retrieval and data security. There are free apps that can create customized data-collection forms, helping to ensure good data and synchronize data to the cloud, and perform analysis. They are relatively intuitive and can be used without extensive training. Custom app development is complicated, but Myanmar has a growing number of homegrown app developers. Government must evaluate whether to provide officials with government hardware. Phones and tablets are expensive, have limited lifespans, and rely on local tech support. Even when the government provides them, officials can be reluctant to use tablets or phones outside the office for fear of breaking them and having to pay. For example, officials provided with tablets have been observed using pen and paper in the field, then recording the information to tablets back in the office. Digital data collection can be more difficult in remote areas that lack mobile service, reliable electricity, and tech support. Government must weigh the competing merits of digitization and digitalization. Digitization and digitalization are often conflated. Digitization is the process of converting information into a digital format; digitalization is the transformation of existing processes with digital technologies. Digitizing data can have lower hardware costs, but it may also be more labor intensive, as it requires people to manually enter data from paper records. Digitization can also affect data quality by introducing data-entry errors. Digitalizing data collection can reduce the amount of time spent rewriting the same information, typically a requirement of paper systems, and it allows data to be collected and shared in real time. For instance, within seconds of data being entered into a digital form on a tablet, information (and analysis) can be made available to decision-makers. In 2018, DAOs in Magway began parallel processes of digitization and digitalization, creating an interesting case study in the relative merits of the two approaches (box H).