ATuServicio.uy
Ministerio de Salud Pública

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
In Uruguay there’s a special period during February where people that comply with certain basic requirements can change health providers. At this time, marketing efforts of health service providers are huge but the Ministry of Health’s responsibility is to foster informed decision based on data. For the last five years data with key indicators was published by the Ministry on it’s website, but access was very limited and very little impact was made on press and public opinion. The dataset was published in a closed, non-machine readable format, and not available as Open Data. On 2014, the year before ATuServicio.uy was launched, only 500 downloads of the data were recorded. Meanwhile, citizens changing providers were choosing based on marketing and perceptions, many times ignoring that key services were unavailable in their area or discounting public and free options with better coverage nearby. The goal was to dramatically broaden the access to key performance indicators of 100% of health providers in Uruguay, in order to help better decision making for the around 1,5 million people who could change health service provider.

B. Strategic Approach

 2. What was the solution?
The solution was to increase visibility and impact of the data through more transparency, co-creation with civil society actors and exploiting the Civic Tech movement to reach people all around the country. Partnering with a civil society organization with experience in Open Data and public outreach such as DATA Uruguay allowed the Ministry to find completely new ways of showing and publicizing the data, that included the app itself with it’s visualization and comparison capabilities but also a joint effort in reaching the press and a targeted online campaign aimed to that target audience. From it’s design, the app was thought out to help specially population living in remote areas, where choice of health providers is highly sensible. This included huge efforts in the inclusion of data of structure of every provider, with details of every service given (or not) in each location. Civil Society participation gave better credibility to the initiative and government participation warranted accuracy of the data, in a win-win situation.

 3. How did the initiative solve the problem and improve people’s lives?
ATuServicio.uy is a webapp where any citizen can visualize and compare over 300 individual perforamance indicators and other datapoints of every single health service provider in Uruguay, both public and private. It offers a general infographic view in it's homepage, but also detailed item-to-item comparison of up to three providers on issues such as structure, waiting times, health goals compliance, human resources, prices and number of affiliates. It goas as deep as specifying which services are provided in each location -no matter how small- to help those farthest away from services to choose their health provider with all the information they need. For the first time ever, the decision on that health provider to choose could be based on actual, reliable, officially sourced data, instead of marketing material or personal recommendations. But beyond that, the publicity of this data meant that other types of comparisons and analysis could be done, which was previously impossible. The data itself, which is used within the Ministry for policy decisions was vastly improved after publication, simply because providers starting to really look into it since their users could see it. Mistakes on several parts of the data management chain were resolved after this. And users who saw data conflicting with their personal experiences, started to present their claims to the Ministry, which eventually led to a specific communication channel for those. Now on it's third edition, ATuServicio.uy has meant a big transformation in how health providers present themselves towards users, switching from pure marketing materials to purposely trying to improve performance indicators since they now know they are easily compared with others. This includes never before seen price drops and great concern for the information being updated and accurate.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
The initiative exploits several innovative approaches to reach it's goals. An obvious one is technology, specially in a country that has very high connectivity, including within the most vulnerable population thanks to several digital inclusion plans. At the same time it reaches it's policy objectives while improving transparency, involving social actors and fully embracing Open Government and Open Data. However, the greatest merit of ATuServicio.uy is not in the technological tool, rather in the fact that the government and civil society unite to provide the citizens with the delivery of a new quality service, with very accesible data, at the right time. As a consequence of that, a greater demand for data was created and established a new reference point for the information that every citizen needs to choose their health care services.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
Beyond being co-created, the initiative is also co-implemented by the Ministry of Public Health and DATA Uruguay. This brings to the table interests of government and its policies as well as civil society and it's demands. It's also worth mentioning that both parties participarte in the national Open Government Initiative and through that dialogue with other civil society organizations has been enabled, framing the initiative in a broader ecosystem of collaboration. Among the main partners, the distribution of tasks is according to areas of expertise, while the project as a whole and each of it's sections are agreed upon both parties. The Ministry holds responsibility over the collection, digitalization, update, revision and proper formatting of the data, proper usage of technical terms, academic revision of the platform and so on. DATA Uruguay on the other hand is responsible for the software, visualization, user interface, user experience and interpretation/presentation of the data. Overall both parties take consensus based decisions for the platform and it's development, being a true co-creation and co-implementation project. The affected population is at the very least the 1,5 million people who every year have the possibility to switch health providers in february. However, we believe that the broader objective is not reduced to those switching providers, but to give every Uruguayan better information over their health providers, having greater transparency and accountability.
 6. How was the strategy implemented and what resources were mobilized?
The project started after the ministry shoed interest in a small data journalism experiment done by DATA Uruguay with the previously available data. The link for both organizations was the Open Government Initiative led by the uruguayan eGov agency (AGESIC). After agreeing to work together on the project, the planning stage started, involving the co-creation of a prototype as well as the collection of extra data and it's formatting not only for use within the app but for publication as Open Data. The funding for the first iteration was mixed, coming 50% from the Ministry itself and another 50% by the Latin American Initiative for Open Data (ILDA) and AVINA Foundation through DATA Uruguay. The beta version was launched on february 2, 2015 and shortly after a new government was sworn in. The initiative was not only maintained by the new authorities but the commitment reinforced with a plan spanning to the end of the administration (2020), that includes funding. Work for the 2016 edition started shortly after, focusing on improving the user interface with the feedback collected from the beta. After the new version was launched showing a significant improvement in user reach and experience, the focus shifted to broadening the amount of data available, which is one of the news for the recently launched 2017 edition. The plan is already in place for next year, where the strategy is to broaden the use of the tool beyond february, adding other kinds of data related to user rights in health services.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The Ministry of Health and DATA Uruguay were the two main partners, responsible for co-design and co-implementation. Within the Ministry Elena Clavel played a key role in the fruition of this idea, with critical support from Jorge Scarone and Diego Soria. After the administration change, Soledad Acuña took the role of initiative lead within the Ministry. AGESIC also played a significant role through the Open Government Initiative and facilitating contact. Finally, ILDA and AVINA provided funding that allowed the full development of the beta.

 8. What were the most successful outputs and why was the initiative effective?
Firstly it gave the population as a whole a new level of transparency and accountability for both public and private health which included monitoring of sanitary goals directly related to the SDG'd such as maternal and child mortality, mother-to-child HIV transmission and universal sanitary coverage. This is also directly related to SDG 16 in the creation of efficient, accountable and transparent institutions. Allowing to compare in detail over 300 different datapoints in an easy, fast and simple manner, it gave -specially those most vulnerable, living father from cities or with less resources- to learn more about the performance of health providers, without the need to move or gather incompatible information from different sources. A clear example of this is the services provided in a specific clinic, which might be much more important for a person living in a remote town, than the overall services that the provider offers, if they imply trips to the capital. Another clear example is the recommendation of the tool among migrants, who face the decision of choosing a health provider without any previous knowledge of the offer. Beyond that, a much broader discussion on quality was fostered, and for the first time based on data. The app and it's data was used in different instances and places by government (including the Health Minister himself) to present results, by opposition parties to demand changes, by unions to demand even grater transparency, press to analyze diverse aspects of the health system through data journalism and civil society to demand reforms or further data.

 9. What were the main obstacles encountered and how were they overcome?
The main obstacles had to do with the systematization and availability of data, that was distributed among separate areas of the Ministry. After a very tough first year collecting this data from all parties and convincing then of the importance of making it public and transparent, a system was installed, and every party involved in the design process of presenting their data. Today, each edition of ATuServicio.uy implies representative from diverse areas of the Ministry collaborating and reaching consensus among them as well as with DATA Uruguay. The solution to the problem was in fact strengthening collaboration among areas.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
ATuServicio.uy implied a 15.000% growth in access to indicators (from 500 downloads in 2014 to over 75.000 sessions in the app in 2016). The initiative was shared by thousands of citizens in Facebook and Twitter and dozens of articles locally and abroad mentioned the initiative. More interestingly, several small investigations based on the data have spawned in the local papers. Also, a broader debate on the quality of the data gathered by the Ministry of Public Health emerged thanks to the initiative, with the participation of local politicians, the press, unions and government authorities. The broad accessibility of the data has made evident imprecisions in the data, it’s reporting by health providers or the methods of collection they use. For the first time, health service providers have shown great concern on the quality of their data, something that hadn’t happened in the last three years where publication was in plain spreadsheets. Also for the first time, after the success of the fist year, some health providers decided to lower their prices for 2016, since they knew now those would be easily comparable. This was an absolute novelty, with no previously recorded voluntary decrease of prices in health services through the Integrates National Health System. On the users side, new types of data were demanded, with some of that demand getting response in the 2017 edition through new indicators and many others in the future thanks to a long term sustainability plan reaching at least 2020. Finally, but most importantly the public was able to monitor and oversee the data, raising many concerns by citizens that felt that published data didn’t reflect their experience were presented to the Ministry for investigation.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
It's impact on accountability it's through transparency, and includes public and private services. The biggest health service provider in the country is public and it's data is one that is regularly consulted by civil society, opposition parties and the press to demand improvements or reform.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
The data for sanitary goals in particular is directly linked to the public policy on the matter and aligned with the SDGs. Data on pregnancy, newborns and children is not only present but new data has been added through the development of the initiative for being considered a priority. The data on structure on the other hand is specifically aimed at those living farthest from cities and with little resources, who face much tougher decisions since the selection of a health provider might imply regular trips to other cities, resulting in extra time and money.

Contact Information

Institution Name:   Ministerio de Salud Pública
Institution Type:   Ministry  
Contact Person:   Soledad Acuña
Title:   Directora del Departamento de Comunicación y Salud  
Telephone/ Fax:   +598 99 628011
Institution's / Project's Website:  
E-mail:   sacuna@msp.gub.uy  
Address:   Av. 18 de Julio 1892 of. 103
Postal Code:   11200
City:   Montevideo
State/Province:   Montevideo
Country:  

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