Exploring data quality and use of the routine health information system in Ethiopia: a mixed-methods study.

Gulilat Tefera,Della Berhanu,Tesfahun Bishaw,Tewabe M. Adege ,Mesoud M Ahmed,Mamo Dereje,Tsega H. Desta ,Heven S. Firew ,Meresha W. Nega ,Freweini Gebrehiwot,Yakob Wondarad,Null Author_Id ,Miraf Tesfaye,Admasu Teketel,Abyot Adane,Tsion Tsegaye,Joanna Busza,Tefera Taddele,Netsanet Berhanu,Zemzem M Yusuf,Abera Dibabe,Seblewengel Lemma,Annika Janson,Sorsa F. Jama ,Magdelawit Mengesha,Kidist Zealiyas,Yidnekachew Degefaw ,Abiy Kiflom,Addis Girma,Eshetu Cherinet,Lars‐Åke Persson ,Binyam Kemal,Habtamu Anteneh ,Mebratom H. Zeweli ,Emiamrew S. Ayalew ,Israel Ataro Otoro ,Zenebech Gella,Kidist Woldesenbet,Zuriash Halefom,Etenesh Gebreyohannes,Joanna Schellenberg,Kalkidan Mekete,Misrak Getnet

doi:10.1136/bmjopen-2021-050356

Abstract

ObjectiveA routine health information system (RHIS) enables decision making in the healthcare system. We aimed to analyse data quality at the district and regional level and explore factors and perceptions affecting the quality and use of routine data.DesignThis was a mixed-methods study. We used the WHO toolkit for analysing data quality and interviewed staff at the point of data generation and along with the flow of data. Data were analysed using the Performance of Routine Information System Management framework.SettingThis study was performed in eight districts in four regions of Ethiopia. The study was nested within a 2-year programme of the Operational Research and Coaching for government Analysts.ParticipantsWe visited 45 health posts, 1 district hospital, 16 health centres and 8 district offices for analysis of routine RHIS data and interviewed 117 staff members for the qualitative assessment.Outcome measuresWe assessed availability of source documents, completeness, timeliness and accuracy of reporting of routine data, and explored data quality and use perceptions.ResultsThere was variable quality of both indicator and data element. Data on maternal health and immunisation were of higher quality than data on child nutrition. Issues ranged from simple organisational factors, such as availability of register books, to intricate technical issues, like complexity of indicators and choice of denominators based on population estimates. Respondents showed knowledge of the reporting procedures, but also demonstrated limited skills, lack of supportive supervision and reporting to please the next level. We saw limited examples of the use of data by the staff who were responsible for data reporting.ConclusionWe identified important organisational, technical, behavioural and process factors that need further attention to improve the quality and use of RHIS data in Ethiopia.

Highlights

High-q uality, real-time data on the burden of disease and performance of the health sector are critical for decision-m aking and resource allocation.[1]
We identified important organisational, technical, behavioural and process factors that need further attention to improve the quality and use of routine health information system (RHIS) data in Ethiopia
The quality and use of RHIS data continues to be a challenge in Ethiopia[11,12,13,14] and elsewhere.[15,16,17]

Summary

Introduction

High-q uality, real-time data on the burden of disease and performance of the health sector are critical for decision-m aking and resource allocation.[1] A routine health information system (RHIS) aggregates information across the health system.[2,3,4] Despite improvements, efforts to increase coverage, quality, equity and accountability of health services are often hampered by the lack of reliable data.[5,6,7]. The Ethiopian Ministry of Health (MOH) named the Information Revolution as one. Of four agendas in its first Health Sector Transformation Plan,[8] aiming to advance information collection, analysis, presentation and dissemination. The web-based open-source computer software District Health Information System was introduced in 2015.9 10 Data are forwarded and aggregated at district, regional and national administrative levels. The quality and use of RHIS data continues to be a challenge in Ethiopia[11,12,13,14] and elsewhere.[15,16,17]

Methods

Results

Conclusion