This community innovation has been accepted at the 2026 DHIS2 Annual Conference as a digital poster.
Bridging the Tertiary Care Data Gap in Nepal
Bridging the Tertiary Care Data Gap in Nepal.pptx (124.4 KB)
Nepal’s emerging Digital Public Infrastructure (DPI) ecosystem represents a transformative opportunity to strengthen integrated, data-driven, and citizen-centered governance. The ecosystem is evolving through interconnected foundational layers, including digital identity, digital payments, interoperability and data exchange, data governance with consent and cybersecurity, and digital service delivery systems. National platforms such as the National Identity Card (NID), Nagarik App, and DHIS2-based health information systems demonstrate Nepal’s growing commitment toward digital transformation and integrated public service delivery. Although the Government of Nepal has initiated nationwide issuance of unique digital identity numbers through the National Identity Card program, implementation remains largely limited to identity verification, with cross-sector interoperability and routine service integration still under development. Limited integration between digital identity systems, health information platforms, social protection systems, and hospital EMRs continues to constrain continuity of care, longitudinal patient tracking, and evidence-based decision-making. Strengthening interoperable, consent-based, and secure digital public infrastructure presents a critical opportunity to improve data quality, enhance disease surveillance, optimize service tracking, and build a resilient learning health system through integrated digital health ecosystems such as DHIS2. Advancing this integration is essential for accelerating equitable, efficient, and evidence-informed progress toward universal health coverage and sustainable digital governance in Nepal.
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Background: DHIS2 serves as Nepal’s health data ecosystem backbone, successfully digitizing primary healthcare. However, critical data blind spots persist at tertiary hospitals despite national adoption. Weak integration causes systemic under-reporting of outpatient volumes, surgical procedures, diagnostics, and non-communicable disease burden, fragmenting evidence-based planning and undermining SDGs monitoring. Methods: We conducted systems-level assessment of DHIS2 implementation across Nepal’s health tiers (2020–2025) using routine monitoring data, periodic data quality assessments, and structured stakeholder consultations. The WHO Health System Building Blocks framework systematically categorized barriers to evaluate scalability and interoperability in high-volume hospital environments. Results: Analysis identified deeply interconnected systemic barriers across four domains. Service delivery challenges include overwhelming patient volumes making dual documentation (paper registers plus digital entry) operationally unsustainable, while Health Information Officers shortages diminish clinical ownership and reporting consistency. Information systems suffer from fragmented EMRs optimized for billing and pharmacy, lacking FHIR-compliant APIs for automated DHIS2 integration. Absence of standardized data dictionaries and ICD-11 coding compromises semantic consistency. Infrastructure vulnerabilities, erratic electricity, unreliable internet, inadequate computing equipment, and insufficient technical support create persistent reporting disruptions, aggravated by volatile health financing. Governance deficiencies include weak institutional ownership, minimal private-sector engagement, and absence of comprehensive national digital health strategy with enforceable mandates. These failures systematically underestimate tertiary-level service utilization and disease burden, producing distorted indicators that undermine evidence-informed policy and resource allocation. Conclusion: Transforming DHIS2 from compliance burden into high-performing learning health system requires coordinated investments in EMR-DHIS2 interoperability, workforce professionalization, and resilient infrastructure. Strengthening tertiary integration is essential for comprehensive data use, accurate disease burden measurement, and evidence-based health system strengthening toward UHC.
Primary Author: PARVATI BISTA
Keywords:
DHIS2; Interoperability; Digital Public Infrastructure; Tertiary Care; Health System Strengthening; Nepal; Data Quality