Peer-Performance Review as a Strategy for Strengthening Health In-formation Systems: A Case Study from Ghana

Abstract

Background and Purpose: The Ghana Health Service (GHS) in 2012 embarked on an ambitious programme to improve its health information system (HIS) in order to improve upon healthcare delivery and also to meet the health related millennium development goals (MDGs). This resulted in nation-wide implementation of the District Health Information Management System (DHIMS2), software based on the District Health Information Software (DHIS2), in all its facilities and some private and quasi government health facilities. The DHIMS2 is the Ghanaian version of the global DHIS2 software developed by the University of Oslo. Methods: As part of its mandate the GHS holds periodic peer reviews meetings at different levels of its structure as a mechanism for measuring service performance in order to identify service gaps that will lead to interventions to improving the coverage and quality of service to its client. This paper is a qualitative assessment of the DHIS2 software based on specified criteria from some of these review meetings in selected regions towards achieving the set goals. The paper will look at the status quo with respect to infrastructure, resources in general, human resource, stakeholder involvement, data quality and data use since the implementation of the DHIS2 project in Ghana. Data collection and analysis was qualitative using participant observation, focused group discussions, semi-structured interviews and document analysis. Results: Our research has shown that the GHS has successfully implemented an integrated and sustainable web-based HIS. Data quality in all aspects has been improved through institutional arrangements such as peer-performance reviews using DHIS2 data and establishment of data quality assurance teams at all levels. This implicitly has promoted data use for decision making. The online system has also ensured data transparency and accessibility. ‘Break-downs’ in the system such as lack of funds, faulty equipment, lack of adequate and skilled human resource for data management is seen as some major challenges to data quality. Such ‘break-downs’ may also be seen as opportunity for system strengthening and sustainability as end-users are compelled to use personal resources for managing data. Through institutionalized peer-performance review processes using data from the DHIS2 is improving the quality of health service data for planning and decision making. Conclusions: This research has demonstrated that with the right technology, policy and collaboration from interested stakeholders it is possible to implement a sustainable HIS in developing countries such as Ghana. We have also shown that institutionalized arrangements for data use has significantly improved the quality of service data generated which will aid planning and decision-making