Better Data for Better Decisions: Building Health Information Systems with Women’s Perspectives

By Stephanie Watson-Grant, Deputy Director, CHISU & Nasolo Thompson, Regional Coordinator, Eastern and Southern Caribbean/Latin American and the Caribbean, CHISU

While women are more visible in public life in the Caribbean than in other parts of the world, they do not have an equal role in decision-making. Only about 30% of members of parliament are women, and regional complexities, like the 22–44% of households that are solely headed by women, often hide gender imbalances. Furthermore, the gender digital divide (the inequality between men’s and women’s access to and use of digital technology) is a significant stumbling block to achieving equity and stronger health systems. Women are largely excluded from making decisions that shape health information systems. Their absence creates a blind spot, potentially perpetuating health inequities for women and communities.

We recently led a learning exchange in Port-of-Spain, Trinidad and Tobago focused on health information systems in the Caribbean for countries to learn from each other’s efforts to accelerate digital transformation. Stakeholders from 15 countries and six regional institutions discussed Caribbean countries’ initiatives in data protection, enterprise architecture, and electronic medical records. The Country Health Information Systems and Data Use (CHISU) program, USAID’s flagship data and information system project led by JSI and implemented with partners, hosted. The event highlighted the commitment to strengthening health information systems in the Caribbean and revealed gender disparities in the region.

How can we reduce these disparities? First, we need data to inform decisions that affect people’s lives, and that starts with the questions we ask. If gender-informed questions are not considered from the beginning, data to inform more equitable policies and practices won’t be available, no matter how well a system is designed. While women are involved in data collection and operational roles, most health information systems are designed by men, who are unlikely to ask the same questions that women would.

For example, learning tools deployed on mobile communication platforms are often designed for community health workers (usually women) to use when convenient to build and maintain job skills. The assumption that these tools are convenient fails to consider women’s caregiving roles and social responsibilities and how the use of the tools may affect those. Though the tools can technically be used anytime, the expectation is that women will do so when they have time, which usually means outside working hours. That time, however, is frequently allocated for caregiving, domestic responsibilities, and other earning opportunities. The person (likely a man) designing the tool may not think about the implications of women taking time from their household responsibilities and the consequences this can have on gender dynamics in the family. Women can be at increased risk of gender-based conflict, including intimate partner violence, when external pressure is placed on their gendered social responsibilities. Designing health information systems and tools from a singular perspective that presumes the neutrality of technology and its application can widen gender gaps.

Representation, whatever the percentage, is not the same as equity. Having women in leadership positions is commendable, but equity requires power and influence in shaping the systems that affect people’s health. Additionally, it is a fallacy to assume that simply having more women in the room will solve the problem. We need people, including diverse voices from all genders, who prioritize equity to challenge ingrained assumptions and build truly inclusive systems. In the example above, access to information and increased skills were likely presumed to contribute to gender equity. But that goal can be thwarted without nuanced data, which are preceded by nuanced questions.

We need to acknowledge that most health information systems are designed by men and how that affects data collection, system design, and ultimately, health equity. We need to ask:

• Who is developing the strategies that guide which data are collected and how? Male-dominated design teams might overlook factors specific to women’s health, leading to inaccurate or incomplete information. Race, class, ethnicity, education level, sexual orientation, and other social considerations should also inform data collection and system design.
• How are the systems and data used? Systems built on analyses without consideration of how women use them (especially since many of those who enter data are women) can exacerbate inequities and blind spots.
• How does the gender digital divide hinder women’s engagement with these systems? In low- and middle-income countries, an estimated 300 million fewer women than men have access to the internet, and their smartphone ownership is 20% lower. Women are also less likely to be employed in professions associated with technology. As a result, their interactions with electronic systems are compromised from the start.

The Caribbean’s efforts to achieve universal health care require more than numbers. They demand a transformation of power dynamics to ensure that women have equal voice and influence in designing the systems that affect their lives and the health of their communities.