When Systems Start Asking Their Own Questions: Strengthening Public Health Systems Through Data and Learning

Reflection on Public System Partnerships

SNEHA’s Public System Partnership (PSP) program’s journey began with a simple but powerful belief: every pregnant woman should reach the right facility, at the right time, and receive the right care.

This belief has shaped SNEHA’s maternal referral work across municipal corporations in the MMRDA region to overcome three delays of maternal referral. What started as small pilots gradually evolved into structured referral mechanisms-system that are now increasingly owned and led by the public health system.

This is not just a program story. It is also a story of reflection and learning-of how data, when used with intention, can strengthen systems from within.

As we come together after this year’s Partners Meet, this blog offers a pause: a moment to look back and reflect on how change actually unfolded, and what role data review played along the way.

Working From Within the System

In the late 1990s, maternal and child health outcomes in Mumbai’s informal settlements were deeply concerning. Referral pathways were unclear, documentation was weak, and continuity of care was fragile.

Early on, SNEHA recognized that meaningful change would not come from parallel systems or quick fixes. Sustainable improvement would require working with the public health system and strengthening it from the inside.

This thinking gradually evolved into what is now the Public System Partnership approach. Programmatically, it focused on mapped referral pathways, standardized clinical protocols, and capacity building. From an M&E lens, it focused on something equally critical: simple, usable data that could support everyday decision-making. Data review was embedded into routine processes such as referral slips, review meetings and case discussions. Over time, review became less about reporting and more about reflecting together.

When Data Started to Matter

The journey began in Mumbai, where tertiary hospitals were managing very high delivery loads. Initial data trends highlighted high referral volumes, incomplete documentation and limited clarity on referral outcomes.

The first response was structural: establishing referral links, clear yet comprehensive documentation formats and periodic review meetings. As data quality improved, something more subtle began to shift-how data was perceived and used.

Referral numbers were no longer viewed only as counts. They became signals. Teams started noticing patterns: where referrals were coming from, why women were being referred, and when referral volumes fluctuated.

Periodic reflections started shaping conversations, not just reports.

From Insights to Readiness

As the program started expanding its geographical boundaries, learning travelled to other cities and data revealed diverse realities. In some settings, it pointed to over-referral. In others, it surfaced gaps in documentation or follow-up. In a few, it highlighted capacity constraints rather than clinical gaps.

Across contexts, the most important shift was not in indicators, but in questions. Conversations moved from what happened to why it happened-and what could be done differently. Gradually, ownership began to shift. Public health teams started maintaining their own datasets, leading review meetings, and using data to guide decisions. SNEHA’s role evolved from managing data to facilitating reflection and strengthening capacity.

These were milestones to readiness.

Handover Is Not a Moment

In public health systems, handover rarely happens on a single day. Handover is a gradual process. The process becomes visible when systems begin to ask their own questions, review their own data, and act on it. When data review shifts from being done for the system to being done by the system.

This understanding shaped SNEHA’s approach across cities. The intent was never to manage referral systems indefinitely, but to support public systems to monitor, review, and strengthen their own processes.

Looking Ahead

These journeys are beyond improved referral numbers or better documentation. They are about systems learning to observe themselves.

Handover, in this sense, is not an endpoint. It is a transition-where systems take responsibility not only for service delivery, but also for tracking, reviewing, and improving their own performance.

Each corporation started at a different point and moved at its own pace. Yet across geographies, the direction remained consistent: towards data-informed decision-making, stronger coordination, and public ownership. What remains constant is the role of monitoring and evaluation-not as an external lens, but as an internal capability that enables public health systems to learn, adapt, and lead.