Abstract
BackgroundInformation-use is an integral component of a routine health information system and essential to influence policy-making, program actions and research. Despite an increased amount of routine data collected, planning and resource-allocation decisions made by health managers for managing HIV programs are often not based on data. This study investigated the use of information, and barriers to using routine data for monitoring the prevention of mother-to-child transmission of HIV (PMTCT) programs in two high HIV-prevalence districts in South Africa.MethodsWe undertook an observational study using a multi-method approach, including an inventory of facility records and reports. The performance of routine information systems management (PRISM) diagnostic ‘Use of Information’ tool was used to assess the PMTCT information system for evidence of data use in 57 health facilities in two districts. Twenty-two in-depth interviews were conducted with key informants to investigate barriers to information use in decision-making. Participants were purposively selected based on their positions and experience with either producing PMTCT data and/or using data for management purposes. We computed descriptive statistics and used a general inductive approach to analyze the qualitative data.ResultsDespite the availability of mechanisms and processes to facilitate information-use in about two-thirds of the facilities, evidence of information-use (i.e., indication of some form of information-use in available RHIS reports) was demonstrated in 53% of the facilities. Information was inadequately used at district and facility levels to inform decisions and planning, but was selectively used for reporting and monitoring program outputs at the provincial level. The inadequate use of information stemmed from organizational issues such as the lack of a culture of information-use, lack of trust in the data, and the inability of program and facility managers to analyze, interpret and use information.ConclusionsManagers’ inability to use information implied that decisions for program implementation and improving service delivery were not always based on data. This lack of data use could influence the delivery of health care services negatively. Facility and program managers should be provided with opportunities for capacity development as well as practice-based, in-service training, and be supported to use information for planning, management and decision-making.
Highlights
Information-use is an integral component of a routine health information system and essential to influence policy-making, program actions and research
Limited information-use is in part related to the suboptimal quality of data generated by the routine health information systems (RHIS) [5,6,7,8,9,10,11], and the absence of a culture of information-use [12,13,14] defined as “the capacity and control to promote values and beliefs among members of an organization by collecting, analyzing and using information to accomplish the organization’s goals and mission” [3]
The key informants included district managers/coordinators, sub-district coordinators, prevention of mother-to-child transmission of HIV (PMTCT) program managers, monitoring and evaluation (M&E) officers, facility managers (FMs), and staff involved in data collection (Table 1)
Summary
Information-use is an integral component of a routine health information system and essential to influence policy-making, program actions and research. Based on work by Aqil et al [3], the Health Metric Network [1, 16], and Patton [17], this model involves the use of eight interventions that aim to improve data demand and use: assessing and improving the data-use context; engaging data users and data producers; improving data quality; improving data availability; identifying information needs; building capacity in datause core competencies; strengthening organizations’ data demand and use infrastructures; and monitoring, evaluating, and communicating results of data-use interventions [4] This model has been applied in Ivory Coast to improve the use of data in decision-making, which increased information-use at the district level from 40% in 2008 to 70% in 2012, through building linkages between data collection and decision-making processes such as program review, planning, advocacy and policy development [18]
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