Topic 06
Using Health Information Systems to Track Child Development
Strengthening Primary Health Care
to Promote Optimal Child Development
Effective health information systems (HIS) can be used to design and improve programs, develop policies that target appropriate groups, allocate scarce resources efficiently, and track progress. Gathering the right information helps implementers answer critical questions: “Are we doing what we planned to do? Does it lead us to the expected results?”
However, information is currently lacking on child development outcomes and home, health, and childcare environments. Most data collection efforts fail to capture whether children are receiving all components of nurturing care and are developmentally on track.
This lack of data is driven by the absence of tools that can collect information accurately, affordably, and consistently. As a result, developmental risks and service coverage remain poorly understood at the national level, and the global loss of developmental potential is likely underestimated. Even where tools are available, their use may be limited by staffing, training, and capacity constraints.
Strengthening existing HIS can help address these gaps in data collection and understanding.
Existing health information systems and levels of monitoring
Monitoring happens at three levels: the individual child, population, and program. Existing HIS operate across all three.
Developmental monitoring data collection (individual child level): Data collected during PHC visits to monitor and track a child’s development and growth, identify children at risk of or exhibiting developmental delays or disabilities, and connecting them with appropriate resources. (See Topic 3: Service Delivery for more information on growth and developmental monitoring for individual children)
Program evaluations (program level): Data collected about specific programs or services to assess their efficacy, often through monitoring, evaluation, and learning (MEL) frameworks. Data from NGOs and civil society implementing these programs can provide valuable insights to broader government monitoring and information systems.
Administrative and survey data collection (population level): Administrative data is collected routinely through a country’s HIS, often by local clinics or health facilities. This information is collected from routine visits with individual children, but the aggregate data can inform population and systems level information and decisions.
Survey data is collected via population-level surveys (from a representative sample of the population). Population surveys that include information on young children’s development include the Demographic and Health Survey’s (DHS) optional module on child well-being and household structure, and the Multiple Indicator Cluster Survey (MICS) questionnaire for children under five and questionnaire for child functioning under five (see Resource 8 in the full toolkit PDF). This information provides incidence data and is critical to target services appropriately, inform research, and track progress.
Four enabling factors to successfully strengthen HIS to promote nurturing care
1. Consensus and guidance on what nurturing care and child development indicators to monitor and how to monitor them.
Given the multisectoral and multidimensional nature of young children’s development, measuring child development outcomes is complex and varied. PHC decision-makers, service providers, and data specialists need a clear understanding of indicators the health sector should be measuring and how to do so in a standardized, ethical, and comparable way. Few indicators exist to assess responsive caregiving and early learning, and inconsistent terminology can cause confusion across programs and information systems. Clear definitions and guidance are needed to compare interventions, track progress, and monitor how governments and donors are investing in services that promote nurturing care.
2. Existing HIS are adequately resourced to collect and use agreed upon indicators.
There is currently untapped potential for HIS to help fill critical information gaps, but doing so will require additions to existing systems. For example:
- Administrative data collection (population level): National routine health management information systems do not collect sufficient information on nurturing care. Collecting additional indicators at facilities and in communities may require additional resources up front. In many countries, this routine visit information is collected in paper registers and then transferred into digital formats; adding indicators will require re-printing paper registers to be distributed across the country, as well as revising guidance documents and re-training health workers to ensure the data is collected correctly and consistently across the country. Once these up-front costs are covered, however, recurring costs should be minimal as the health workforce cadres that monitor and screen children are already in place.
- Population survey data (population level): Researchers have recently developed tools to assess responsive caregiving and early learning activities in population surveys, but they are not yet widely adopted. Incorporating these tools into existing population surveys is more cost effective than conducting stand-alone surveys, though up-front investment and training is required.
- Program evaluations (program level): Evaluating programs to gauge their reach, outcomes, and areas for improvement is critical to improve program implementation and impact. Developing disaggregated, responsive, and sustainable MEL systems requires sufficient time, finances, and expertise to be built into project budgets from the outset.
3. Robust coordination between sectors and ministries allows data to be shared and aggregated, providing a comprehensive picture of child development outcomes and how nurturing care is being promoted.
In many countries, policies and services to promote optimal child development are designed and implemented by multiple sectors and ministries — including health, nutrition, education, social protection, and community development. Information from the health sector is only telling part of the story, usually limited to health and nutrition. Strong coordination between sectors ensures that data is shared across ministries and programs to improve holistic decision-making.
Some countries have pioneered data dashboards to support coordination and aggregate critical information. Although aggregating cross-sector data is essential, it is equally important to collect and report disaggregated data (e.g., by gender, geographic location, socio-economic status, and disability) to better identify disparities in child development outcomes so resources can be directed to the communities that need them most.
4. Data is available to PHC decision-makers and caregivers in a user-friendly format.
Quality data is only valuable if it is used. An effective information system should make it easy to accurately interpret and act on results. Data can also hold PHC decision-makers and service providers accountable to stated goals by measuring progress against them, and help change caregiver behavior based on the newly available information on nurturing care.
But data collected at the facility and population level is often not visualized in a way that is accessible for non-data experts. Bridging this gap is critical for planning, accountability, and maintaining community trust. See an example from Tanzania’s experience below.
Examples of specific actions that PHC decision-makers can take to realize these conditions include:
- Establishing and articulating consensus on the indicators that can be used to monitor interventions that promote optimal child development.
- Developing appropriate architecture to support data sharing between health and other relevant sector information systems.
- Using tools like scorecards to make data accessible and user-friendly for PHC decision makers and other stakeholders.
Lessons from Tanzania’s ECD Scorecard
In 2021, Tanzania launched its National Multisectoral ECD Program (NMECDP) 2021 – 2026 to provide an organizing framework for the promotion of nurturing care. The NMECDP encourages a unified, multisectoral approach to delivering interventions that promote nurturing care and includes a costed implementation plan to identify specific actions to achieve this goal. Additionally, the NMECDP Secretariat and the Tanzania Early Childhood Development Network (TECDEN) developed the National Multisectoral ECD Scorecard to review performance on key activities and processes on a quarterly basis, ensuring that there was continued alignment with the NMECDP. The ECD Scorecard includes 14 key indicators drawn from the five domains of nurturing care: good health, adequate nutrition, early learning, responsive caregiving, and safety and security.
The ECD Scorecard was launched in December 2025 and introduced to Council Social Welfare Officers from all 184 Councils and 26 regions across the country through a three-day national training program. Representatives from the Ministry of Health, Ministry of Education, Science and Technology, Ministry of Community Development, Gender, Women and Special Groups, and the Prime Minister’s Office were present at the launch of the tool, reflecting strong leadership and multisectoral collaboration.
Case Study: Kenya’s experience integrating nurturing care and child development indicators into routine health information system data collection
Kenya’s Ministry of Health incorporated nurturing care indicators into the existing health information system (DHIS2) in 2020-2021 to capture and standardize data on child development services already being delivered through mother-child health clinics nationwide. The process involved sustained advocacy, the establishment of a national technical working group, cross-sector collaboration, field visits to document existing practices, and iterative testing and revision of registers, reporting tools, job aids, and standard operating procedures. Updated materials were ultimately distributed to more than 3,000 health facilities, enabling the routine collection of data on developmental milestone delays, referrals, and linkages to services. While implementation has faced challenges — including printing costs, staff turnover, and interoperability issues with electronic medical record systems — the effort demonstrated how routine health information systems can provide more timely and locally actionable data to support planning, resource allocation and service improvement. To learn more about Kenya’s experience, including key lessons for other countries looking to integrate nurturing care indicators into routine data collection, visit the full toolkit PDF.Read the case study
The following additional resources can be found via the links below, or by downloading the full toolkit PDF:
- Resource 6 includes a table with the full list of enabling factors and corresponding actions for Health Information Systems.
- Resource 7 includes reflection questions to support discussion and planning related to Health Information Systems.
- Resource 8 features a sample of population-level measures of child development that can be integrated into national surveys and along with tools and resources to support nurturing care data collection through HIS.
