Integrating disability related data into national Health Management Information Systems

Context

In low- and middle-income countries, access to assistive technology (AT) and relevant services remains very low, often below 10% of need, driven in large part by an absence of the routine data that governments rely on to plan, budget for, and deliver services.

With support from AT2030 over the last 8 years, Liberia and Sierra Leone have established foundational national policy commitments to delivering AT, but limited capacity to track the populations being screened, referred, or served through public facilities limits implementation of these commitments. National Health Management Information Systems (HMIS), the routine reporting platforms that aggregate facility-level data into the figures that governments use for planning, did not capture disability or AT indicators in either country prior to AT2030 intervention. As a result, decision-makers have no centralised view of AT needs or service delivery, which therefore remain largely invisible during budgeting and resource mobilization planning.

Without standardised data, governments cannot quantify need, forecast supply, monitor referral pathways, or account for partners providing services and donated products.

Between 2024 and 2026, under the AT2030 programme, CHAI worked alongside the Ministries of Health to define, validate, and embed a core set of disability identification and intervention indicators into national reporting systems. Both countries have followed broadly similar steps including updating facility-level reporting tools and ledgers, and providing training to key stakeholders on how to capture the new data. This case study sets out the process, achievements and the lessons learned for other governments and partners interested in strengthening inclusive national data systems.

The Challenge

Structural gaps in routine data systems prevent governments from leading AT delivery at scale.

To improve program delivery and avoid additional workload for service providers, disability and AT data must flow through the systems governments already use to plan and budget. Across Liberia and Sierra Leone, three key data barriers limit government-led delivery of AT:

• AT is invisible in national reporting. Routine data reported from facilities to national programs did not include how many people were being screened for disabilities, what conditions were being found, and which assistive products were needed and delivered. Without these numbers, AT and related services cannot compete with other health priorities for budget or attention.
• Facility-level reporting tools are fragmented. The registers, ledgers, and reporting forms used at health facilities differed across districts and were combined inconsistently at sub-national level. The lack of standardisation limits data quality, clarity, and comparability. Even where AT activity is being recorded at facility level, it is difficult to aggregate into a usable national picture.
• Partner activity is uncoordinated and largely unreported. AT donations and service-provision activities are typically delivered through ad-hoc partner initiatives, with no standard channel for reporting them back to government. Ministries of Health therefore have no consolidated view of what is being delivered and thus limited ability to fit partner contributions into national priorities and population needs.

Approach

Working under the AT2030 programme, CHAI supported Ministries of Health in Liberia and Sierra Leone to engage frontline stakeholders to understand what is being captured already, define and validate a core set of AT and disability indicators for uniformity across public facilities, validate these indicators through the national AT or rehabilitation technical working group, and integrate them into facility tools that feed into the national HMIS.

Step 1: Engaging frontline users to define indicators that reflect facility reality.

In each country, the starting point was frontline stakeholder engagement. CHAI worked with the Ministry of Health to convene national level Directors, program managers and technical staff, district health management teams, monitoring and evaluation officers, health facility staff including clinicians and rehabilitation providers, and Organisations for Persons with Disabilities to review the facility registers and reporting forms already in use. This served three purposes: it grounded the proposed AT indicators in language and definitions that frontline staff would recognise, revealed the inconsistencies in existing tools and directly drove the conversation on which indicators to prioritise. Several consultative workshops were held to ensure consensus.