Abstract
BackgroundFor evidence-based decision-making, there is a need for quality, timely, relevant and accessible information at each level of the health system. Limited use of local data at each level of the health system is reported to be a main challenge for evidence-based decision-making in low- and middle-income countries. Although evidence is available on the timeliness and quality of local data, we know little about how it is used for decision-making at different levels of the health system. Therefore, this study aimed to assess the level of data use and its effect on data quality and shared accountability at different levels of the health system.MethodsAn implementation science study was conducted using key informants and document reviews between January and September 2017. A total of 21 key informants were selected from community representatives, data producers, data users and decision-makers from the community to the regional level. Reviewed documents include facility reports, district reports, zonal reports and feedback in supervision from the district. Thematic content analysis was performed for the qualitative data.ResultsRespondents reported that routine data use for routine decision-making was low. All health facilities and health offices have a performance monitoring team, but these were not always functional. Awareness gaps, lack of motivating incentives, irregularity of supportive supervision, lack of community engagement in health report verification as well as poor technical capacity of health professionals were found to be the major barriers to data use. The study also revealed that there are no institutional or national-level regulations or policies on the accountability mechanisms related to health data. The community-level Health Development Army programme was found to be a strong community engagement approach that can be leveraged for data verification at the source of community data.ConclusionThe culture of using routine data for decision-making at the local level was found to be low. Strengthening the capacity of health workers and performance monitoring teams, introducing incentive mechanisms for data use, engaging the community in data verification and introducing accountability mechanisms for health data are essential to improve data use and quality.
Highlights
For evidence-based decision-making, there is a need for quality, timely, relevant and accessible information at each level of the health system
We aim to investigate the different factors affecting the use of data at each level of the health system in Ethiopia, which in turn is affecting the performance of the health system and progress towards universal health coverage in the Amhara region, northwest Ethiopia
The main objective of this study was assess the level of data use at each level of the health system in Ethiopia and its effect on data quality, accountability and overall health system performance
Summary
For evidence-based decision-making, there is a need for quality, timely, relevant and accessible information at each level of the health system. Limited use of local data at each level of the health system is reported to be a main challenge for evidence-based decision-making in low- and middle-income countries. This study aimed to assess the level of data use and its effect on data quality and shared accountability at different levels of the health system. Primary healthcare services, such as immunizations, are fundamental to improving health and health equity, in the context of low- and middle-income settings where resources are scarce. Health programs in low- and middle-income countries need evidence-based decision-making to effectively deliver health services to all citizens with the available limited resources [1]. At higher levels, aggregated data are needed for strategic policy-making and resource allocation [3]
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