Abstract
BackgroundRoutine health information systems can provide near real-time data for malaria programme management, monitoring and evaluation, and surveillance. There are widespread concerns about the quality of the malaria data generated through routine information systems in many low-income countries. However, there has been little careful examination of micro-level practices of data collection which are central to the production of routine malaria data.MethodsDrawing on fieldwork conducted in two malaria endemic sub-counties in Kenya, this study examined the processes and practices that shape routine malaria data generation at frontline health facilities. The study employed ethnographic methods—including observations, records review, and interviews—over 18-months in four frontline health facilities and two sub-county health records offices. Data were analysed using a thematic analysis approach.ResultsMalaria data generation was influenced by a range of factors including human resource shortages, tool design, and stock-out of data collection tools. Most of the challenges encountered by health workers in routine malaria data generation had their roots in wider system issues and at the national level where the framing of indicators and development of data collection tools takes place. In response to these challenges, health workers adopted various coping mechanisms such as informal task shifting and use of improvised tools. While these initiatives sustained the data collection process, they also had considerable implications for the data recorded and led to discrepancies in data that were recorded in primary registers. These discrepancies were concealed in aggregated monthly reports that were subsequently entered into the District Health Information Software 2.ConclusionChallenges to routine malaria data generation at frontline health facilities are not malaria or health information systems specific; they reflect wider health system weaknesses. Any interventions seeking to improve routine malaria data generation must look beyond just malaria or health information system initiatives and include consideration of the broader contextual factors that shape malaria data generation.
Highlights
Routine health information systems can provide near real-time data for malaria programme management, monitoring and evaluation, and surveillance
The second explains how routine data on malaria diagnosis are generated at frontline health facilities, and highlights some of the data quality issues that were observed during records review, while the third section focuses on a description of the practices and processes that shape data collection and recording practices and identification of the underlying systems factor influences
To fill the staffing gaps, health facility management committees used locally generated resources and other discretionary funds received from the national government to hire laboratory technologists and other support staff
Summary
Routine health information systems can provide near real-time data for malaria programme management, monitoring and evaluation, and surveillance. There are widespread concerns about the quality of the malaria data generated through routine information systems in many low-income countries. Routine health information systems (HIS) are crucial for effective malaria control and elimination [1]. Where functional, these systems can provide near real time data on malaria cases reported rather than relying on mathematically modelled estimates of malaria burden [2]. The Global Technical Strategy for Malaria 2016–2030 stresses the need for sufficient investment in the management and use of data from routine health information systems to support programme planning, implementation and evaluation [3]
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