Community Health Information System Research Articles

Digital communication between mothers and community health workers to support neonatal health (CHV-NEO): study protocol for a randomized controlled trial

BackgroundProvision of essential newborn care at home, rapid identification of illness, and care-seeking by caregivers can prevent neonatal mortality. Mobile technology can connect caregivers with information and healthcare worker advice more rapidly and frequently than healthcare visits. Community health workers (CHWs) are well-suited to deliver such interventions. We developed an interactive short message service (SMS) intervention for neonatal health in Kenya, named CHV-NEO. CHV-NEO sends automated, theory-based, actionable, messages throughout the peripartum period that guide mothers to evaluate maternal and neonatal danger signs and facilitate real-time dialogue with a CHW via SMS. We integrated this intervention into Kenya’s national electronic community health information system (eCHIS), which is currently used at scale to support CHW workflow.MethodsThe effect of CHV-NEO on clinical and implementation outcomes will be evaluated through a non-blinded cluster randomized controlled trial. Twenty sites across Kisumu County in Western Kenya were randomized 1:1 to provide either the national eCHIS with integrated CHV-NEO messaging (intervention) or standard of care using eCHIS without CHV-NEO (control). We will compare neonatal mortality between arms based on abstracted eCHIS data from 7200 pregnant women. Secondary outcomes include self-reported provision of essential newborn care (appropriate cord care, thermal care, and timely initiation of breastfeeding), knowledge of neonatal danger signs, and care-seeking for neonatal illness, compared between arms based on questionnaires with a subgroup of 2000 women attending study visits at enrollment in pregnancy and 6 weeks postpartum. We will also determine CHV-NEO’s effect on CHW workflows and evaluate determinants of intervention acceptability, adoption, and fidelity of use through questionnaires, individual interviews, and messaging data.DiscussionWe hypothesize that the CHV-NEO direct-to-client communication strategy can be successfully integrated within existing CHW workflows and infrastructure, improve the provision of at-home essential newborn care, increase timely referral of neonatal illness to facilities, and reduce neonatal mortality. The intervention’s integration into the national eCHIS tool will facilitate rapid scale-up if it is clinically effective and successfully implemented.Trial registrationClinicalTrials.gov, NCT05187897. The CHV-NEO study was registered on January 12, 2022.

Reviewing the availability and integration of community health information system for HIV/AIDS in Lesotho

Background: Universal Health Coverage (UHC) is an integral part of the Sustainable Development Goals, with community-based services playing a crucial role. Various stakeholders contribute to human immunodeficiency virus (HIV) interventions, which must be documented and shared with others for informed decision-making.Aim: This study aims to review the availability of a community health information system (CHIS) in Lesotho and its integration between the Ministry of Health (MOH) and the National AIDS Commission (NAC).Setting: The study is based on the Ministry of Health and the National AIDS Commission in Maseru, Lesotho.Method: A scoping review used peer-reviewed articles, documents from MOH and NAC, and other relevant reports from non-governmental organisations. The community information systems were examined for inclusion of clinical and non-clinical information. Possible linkages of information between MOH and NAC were reviewed.Results: Clinical information from CSOs is recorded in DHIS2 at the MOH facilities, while non-clinical information is reported in LOMSHA. However, clinical information from VHWs is currently not included in DHIS2 and formal reporting tools are being developed. There are no links between MOH and NAC, which limits information sharing.Conclusion: Although a CHIS exists, it lacks the necessary linkages. Community-based information from VHWs is not reported through DHIS2. Therefore, the country does not benefit fully from community-based health information.Contribution: Community health information systems review has never been conducted in Lesotho before. Therefore, this review will raise awareness about its importance and use in decision-making.

Intention to Use an Electronic Community Health Information System Among Health Extension Workers in Rural Northwest Ethiopia: Cross-Sectional Study Using the Unified Theory of Acceptance and Use of Technology 2 Model.

IT has brought remarkable change in bridging the digital gap in resource-constrained regions and advancing the health care system worldwide. Community-based information systems and mobile apps have been extensively developed and deployed to quantify and support health services delivered by community health workers. The success and failure of a digital health information system depends on whether and how it is used. Ethiopia is scaling up its electronic community health information system (eCHIS) to support the work of health extension workers (HEWs). For successful implementation, more evidence was required about the factors that may affect the willingness of HEWs to use the eCHIS. This study aimed to assess HEWs' intentions to use the eCHIS for health data management and service provision. A cross-sectional study design was conducted among 456 HEWs in 6 pilot districts of the Central Gondar zone, Northwest Ethiopia. A Unified Theory of Acceptance and Use of Technology model was used to investigate HEWs' intention to use the eCHIS. Data were cleaned, entered into Epi-data (version 4.02; EpiData Association), and exported to SPSS (version 26; IBM Corp) for analysis using the AMOS 23 Structural Equation Model. The statistical significance of dependent and independent variables in the model was reported using a 95% CI with a corresponding P value of <.05. A total of 456 HEWs participated in the study, with a response rate of 99%. The mean age of the study participants was 28 (SD 4.8) years. Our study revealed that about 179 (39.3%; 95% CI 34.7%-43.9%) participants intended to use the eCHIS for community health data generation, use, and service provision. Effort expectancy (β=0.256; P=.007), self-expectancy (β=0.096; P=.04), social influence (β=0.203; P=.02), and hedonic motivation (β=0.217; P=.03) were significantly associated with HEWs' intention to use the eCHIS. HEWs need to be computer literate and understand their role with the eCHIS. Ensuring that the system is easy and enjoyable for them to use is important for implementation and effective health data management.

Acceptability and use of the electronic community health information system and its determinants among health extension workers in Ethiopia: a retrospective cross-sectional observational study

BackgroundThe electronic community health information system has been increasingly developed and deployed to quantify and support quality health service delivery by community health workers in Ethiopia. However, the success and failure of the electronic community health information system depend on the acceptability and use by its users. This study assessed the acceptability and use of the electronic community health information system and its determinants among health extension workers in Ethiopia.MethodsA retrospective cross-sectional observational study was conducted among 587 randomly selected health extension workers from six regions of Ethiopia. The Revised Technology Acceptance Model was used as a theoretical framework for the study. Descriptive statistics, structural equation modeling, and principal component analysis techniques were used to analyze the data. For all significance tests, multiple comparison adjustments were made using the Bonferroni Correction Method.ResultsThere was near universal acceptance of the electronic community health information system, ranging from 94.4 to 97.4% among health extension workers. However, actual use of the system was considerably lower, at 50%. Perceived usefulness of the electronic community health information system had a direct and positive effect on acceptability (β3 = 0.415, p < 0.001). Perceived ease of use had both direct and indirect positive effects on electronic community health information system acceptability (β2 = 0.340, p < 0.001 and β1*β3 = 0.289, p < 0.001, respectively), while acceptability had a direct and positive effect on the use of the electronic community health information system (β3 = 0.297, p < 0.001).ConclusionsDespite the very high acceptability of the electronic community health information system among health extension workers, actual use of the system is considerably lower. Hence, an integrated and coordinated approach is required to close the acceptance-use gap.

Developing a patient flow visualization and prediction model using aggregated data for a healthcare network cluster in Southwest Ethiopia.

A health information system has been created to gather, aggregate, analyze, interpret, and utilize data collected from diverse sources. In Ethiopia, the most popular digital tools are the Electronic Community Health Information System and the District Health Information System. However, these systems lack capabilities like real-time interactive visualization and a data-driven engine for evidence-based insights. As a result, it was challenging to observe and continuously monitor the flow of patients. To address the gap, this study used aggregated data to visualize and predict patient flow in a South Western Ethiopia healthcare network cluster. The South-Western Ethiopian healthcare network cluster was where the patient flow datasets were collected. The collected dataset encompasses a span of 41 months, from 2019 to 2022, and has been obtained from 21 hospitals and health centers. Python Sankey diagrams were used to develop and build patient flow visualizations. Then, using the random forest and K-Nearest Neighbors (KNN) algorithms, we achieved an accuracy of 0.85 and 0.83 for the outpatient flow modeling and prediction, respectively. The imbalance in the data was further addressed using the NearMiss Algorithm, Synthetic Minority Oversampling Technique (SMOTE), and SMOTE-Tomek methods. In conclusion, we developed a patient flow visualization and prediction model as a first step toward an end-to-end effective real-time patient flow data-driven and analytical dashboard in Ethiopia, as well as a plugin for the already-existing digital health information system. Moreover, the need for and amount of data created by these digital tools will grow along with their use, demanding effective data-driven visualization and prediction to support evidence-based decision-making.

Community and Facility Health Information System Integration in Malawi: A Comparison of Machine Learning and Probabilistic Record Linkage Methods

Community and Facility Health Information System Integration in Malawi: A Comparison of Machine Learning and Probabilistic Record Linkage Methods

Individual and contextual level enablers and barriers determining electronic community health information system implementation in northwest Ethiopia

BackgroundThe government of Ethiopia has envisioned digitalizing primary healthcare units through the electronic community health information system (eCHIS) program as a re-engineering strategy aiming to improve healthcare data quality, use, and service provision. The eCHIS is intended as a community-wide initiative to integrate lower health structure with higher administrative health and service delivery unit with the ultimate goal of improving community health. However, the success or failure of the program depends on the level of identifying enablers and barriers of the implementation. Therefore, this study aimed to explore individual and contextual-level enablers and barriers determining eCHIS implementation.MethodWe conducted an exploratory study to determine the enablers and barriers to successfully implementing eCHIS in rural Wogera district, northwest Ethiopia. In-depth interviews and key informant interviews were applied at participants from multiple sites. A thematic content analysis was conducted based on the key themes reported. We applied the five components of consolidated framework for implementation research to interpret the findings.ResultsFirst, based on the intervention's characteristics, implementers valued the eCHIS program. However, its implementation was impacted by the heavy workload, limited or absent network and electricity. Outer-setting challenges were staff turnover, presence of competing projects, and lack of incentive mechanisms. In terms of the inner setting, lack of institutionalization and ownership were mentioned as barriers to the implementation. Resource allocation, community mobilization, leaders’ engagement, and availability of help desk need emphasis for a better achievement. With regard to characteristics of the individuals, limited digital literacy, older age, lack of peer-to-peer support, and limited self-expectancy posed challenges to the implementation. Finally, the importance of mentoring and engaging community and religious leaders, volunteers, having defined plan and regular meetings were identified elements of the implementation process and need emphasis.ConclusionThe findings underlined the potential enablers and barriers of eCHIS program for quality health data generation, use, and service provision and highlighted areas that require emphasis for further scale-up. The success and sustainability of the eCHIS require ongoing government commitment, sufficient resource allocation, institutionalization, capacity building, communication, planning, monitoring, and evaluation.

Barriers, facilitators and motivators of electronic community health information system use among health workers in Ethiopia.

The electronic community health information system (eCHIS) has been implemented in Ethiopia to support health services delivered by community health workers. Despite the many benefits of digitizing community health information systems, the implementation of the eCHIS is challenged by many barriers resulting in low uptake. This study assessed the barriers, facilitators, and motivators of eCHIS use among health workers with focus on health extension workers (HEWs) in Ethiopia. Phenomenological approach was used to assess the barriers, facilitators and motivators of eCHIS use in Amhara, Harari, Oromia, Sidama, South West Ethiopia and Southern Nation Nationalities and People's regions of Ethiopia. Data were collected from 15-29 May 2022. A total of 54 face-to-face in-depth interviews were conducted among HEWs, HEW supervisors, health information technicians and managers. The interviews were audiotaped using Open Data Kit, transcribed verbatim and translated into English. OpenCode 4.03 software was used for coding and categorizing the data. Thematic analysis was used to analyze the data. The HEWs and other eCHIS users reported lack of infrastructure and resources; poor quality of training, follow-up, and supervision; parallel recording using the manual and electronic system; and HEWs' workload as barriers hindering eCHIS use. Data quality, retrievability, and traceability; tablet portability; encouragement from supervisors; and positive image in the community resulting from HEWs using tablets in their routine activities were the main facilitators of eCHIS use. The study identified various barriers that adversely affect the use of eCHIS. An integrated and coordinated approach to eCHIS implementation that encompasses removing the barriers, and reinforcing facilitators is required.

The Effect of Community Health Information System on Health Care Services Utilization in Rural Ethiopia.

In Ethiopia, the community health information system (CHIS) is implemented at the health post (hp) level with the aim of improving service delivery and use. We conducted a national level assessment of CHIS utilization and explored the associations of CHIS utilization with use of antenatal care (ANC), postnatal care (PNC), institutional delivery and child immunization in rural Ethiopia. We conducted a cross-sectional study measuring community-based health service use and HP based CHIS assessment from March to May 2019. Data were collected from 343 HPs and 2,864 women who delivered in the last five years, and multistage sampling was used to select the study subjects. We used descriptive statistics for CHIS implementation and service utilization and multilevel logistic regression to investigate the association of CHIS implementation with maternal and child health care services use. Fifty five percent of the HPs were implementing CHIS. These HPs were using a paper-based household data collection tool called family folder (FF). Of the HPs, one third implemented lot quality assurance sampling (LQAS) based data quality check and 60.4% documented and followed execution of decisions. Overall, among the eligible women, 40% used ANC, close to 50% of currently married women used ANC services; 28% of women that fall in the high wealth index category used PNC within 48 hours after delivery; and 86.1% of women who had at least a high school education delivered at a health facility. Implementation of CHIS and family folder utilization and conducting LQAS based data quality check in the HPs were significantly associated with increased odds of ANC, delivery, and vaccination services use. We found that better implementation of CHIS was associated with better maternal and child health service use which implies that increasing utilization of CHIS at HPs will improve mother and child health service use.

Lessons and Implementation Challenges of Community Health Information System in LMICs: A Scoping Review of Literature.

Accurate and timely information on health intervention coverage, quality, and equity is the foundation of public health practice. To achieve this, countries have made efforts to improve the quality and availability of community health data by implementing the community health information system that is used to collect data in the field generated by community health workers and other community-facing providers. Despite all the efforts, evidence on the current state is scant in Low Middle Income Countries (LMICs). To summarize the available evidence on the current implementation status, lessons learned and implementation challenges of community health information system (CHIS) in LMICs. We conducted a scoping review that included studies searched using electronic databases like Pubmed/Medline, World Health Organization (WHO) Library, Science Direct, Cochrane Library. We also searched Google and Google Scholar using different combinations of search strategies. Studies that applied any study design, data collection and analysis methods related to CHIS were included. The review included all studies published until February 30, 2022. Two authors extracted the data and resolved disagreements by discussion consulting a third author. A total of 1,552 potentially relevant articles/reports were generated from the initial search, of which 21 were considered for the final review. The review found that CHIS is implemented in various structures using various tools across different LMICs. For the CHIS implementation majority used registers, family folder/card, mobile technologies and chalk/white board. Community level information was fragmented, incomplete and in most cases flowed only one way, with a bottom-up approach. The review also indicated that, technology particularly Electronic Community Health Information System (eCHIS) and mobile applications plays a role in strengthening CHIS implementation in most LMICs. Many challenges remain for effective implementation of CHIS with unintegrated systems including existence of parallel recording & reporting tools. Besides, lack of resources, low technical capacity, shortage of human resource and poor Information Communication Technology (ICT) infrastructure were reported as barriers for effective implementation of CHIS in LMICs. Generally, community health information system implementation in LMICs is in its early stage. There was not a universal or standard CHIS design and implementation modality across countries. There are also promising practices on digitalizing the community health information systems. Different organizational, technical, behavioural and economic barriers exist for effective implementation of CHIS. Hence, greater collaboration, coordination, and joint action are needed to address these challenges. Strong leadership, motivation, capacity building and regular feedback are also important to strengthen the CHIS in LMICs. Moreover, CHIS should be transformed in to eCHIS with integration of different technology solutions. Local ownership is also critical to the long-term sustainability of CHIS implementation.

Immunization data quality and decision making in pertussis outbreak management in southern Ethiopia: a cross sectional study

BackgroundThe aim of this study was to investigate the quality of immunization data and monitoring systems in the Dara Malo District (Woreda) of the Gamo Administrative Zone, within the Southern Nations, Nationalities, and Peoples’ Region (SNNPR) of Ethiopia.MethodsA cross-sectional study was conducted from August 4 to September 27, 2019, in Dara Malo District. The district was purposively selected during the management of a pertussis outbreak, based on a hypothesis of ‘there is no difference in reported and recounted immunization status of children 7 to 23 months in Dara Malo District of Ethiopia’. The study used the World Health Organization (WHO) recommended Data Quality Self-Assessment (DQS) tools. The accuracy ratio was determined using data from routine Expanded Program of Immunization (EPI) and household surveys. Facility data spanning the course of 336 months were abstracted from EPI registers, tally sheets, and monthly routine reports. In addition, household surveys collected data from caretakers, immunization cards, or oral reports. Trained DQS assessors collected the data to explore the quality of monitoring systems at health posts, health centers, and at the district health office level. A quality index (QI) and proportions of completeness, timeliness, and accuracy ratio of the first and third doses of pentavalent vaccines and the first dose of measles-containing vaccines (MCV) were formulated.ResultsIn this study, facility data spanning 336 months were extracted. In addition, 595 children aged 7 to 23 months, with a response rate of 94.3% were assessed and compared for immunization status, using register and immunization cards or caretakers’ oral reports through the household survey. At the district level, the proportion of the re-counted vaccination data on EPI registers for first dose pentavalent was 95.20%, three doses of pentavalent were 104.2% and the first dose of measles was 98.6%. However, the ratio of vaccination data compared using tallies against the reports showed evidence of overreporting with 50.8%, 45.1%, and 46.5% for first pentavalent, third pentavalent, and the first dose of measles vaccinations, respectively. The completeness of the third dose of pentavalent vaccinations was 95.3%, 95.6%, and 100.0% at health posts, health centers, and the district health office, respectively. The timeliness of the immunization reports was 56.5% and 64.6% at health posts and health centers, respectively, while the district health office does not have timely submitted on time to the next higher level for twelve months. The QI scores ranged between 61.0% and 80.5% for all five categories, namely, 73.0% for recording, 71.4% for archiving and reporting, 70.4% for demographic information, 69.7% for core outputs, and 70.4% for data use and were assessed as suboptimal at all levels. The district health office had an emergency preparedness plan. However, pertussis was not on the list of anticipated outbreaks.ConclusionImmunization data completeness was found to be optimal. However, in the study area, the accuracy, consistency, timeliness, and quality of the monitoring system were found to be suboptimal. Therefore, poor data quality has led to incorrect decision making during the reported pertussis outbreak management. Availing essential supplies, including tally sheets, monitoring charts, and stock management tools, should be prioritized in Daro Malo District. Enhancing the capacity of healthcare providers on planning, recording, archiving, and reporting, analyzing, and using immunization data for evidence-based decision making is recommended. Improving the availability of recording and reporting tools is also likely to enhance the data accuracy and completeness of the community health information system. Adapting pertussis outbreak management guidelines and conducting regular data quality assessments with knowledge sharing events to all stakeholders is recommended.

Assessing Community Health Information Systems: Evidence from Child Health Records in Food Insecure Areas of the Ethiopian Highlands

ObjectivesThis study assessed the completeness of child health records maintained and collected within community health information system in Ethiopia.MethodsA household listing was carried out in 221 enumeration areas in food insecure areas of Ethiopia to determine the presence of a child less than 24-months. This list of children was then compared against the information stored at the local health posts. A household survey was administered to a sample of 2155 households that had a child less than 24-months of age to assess determinants and consequences of exclusion from the health post registers.ResultsOut of the 10,318 children identified during the listing, 36% were found from the health post records. Further analysis based on the household survey data indicated that health posts that had adopted nationally recommended recordkeeping practices had more complete records (p < 0.01) and that children residing farther from health posts were less likely to be found from the registers (p < 0.05). Mothers whose child was found from the registers were more likely to know a health extension worker (p < 0.01), had a contact with one (p < 0.01), and their child was more likely to have received growth monitoring (p < 0.05).Conclusions for PracticeThe incompleteness of the data collected at the health posts poses a challenge for effective implementation of the national health extension program and various complementary programs in Ethiopia.

Utilization of Community Health Information System and Associated Factors in Health Posts of Hadiya Zone, Southern Ethiopia

Background: the regular use of reliable health information from a well-designed routine health information system is indispensable for ensuring and sustaining improvements in health system performance. However, In Ethiopia the prevailing practice in terms of effectively utilizing health information is not satisfactory and utilization of health information at the local level is still a challenge. Objective: To determine utilization of Community Health information systems and associated factors in health posts of Hadiya zone, Ethiopia. Method: Facility based cross sectional study design was conducted in Health post of Hadiya zone, from February 1 to 15/2018 using both quantitative and qualitative approach. The calculated sample 420 Health Extension workers found in 210 Health posts was allocated to each district proportionally based on their number of health posts. Then, Health posts were selected by simple random sampling method from each District, and health extension workers found in the selected Health posts was part of the study. Quantitative data was collected using structured questionnaire. Multivariable logistic regression was used to identify significantly associated factors. For qualitative study, health extension workers who are not participated in quantitative study were selected purposively based on their work experience. Result: Overall, Good utilization of community health information was 41%. Monthly Supportive supervision (AOR=1.72; CI=1.02, 2.91), written feedback (AOR=5.33; CI = 3.27, 8.69) and Compiled and send additional parallel reports (AOR=4.41; CI =2.35-8.30) were factors significantly associated with utilization of community health information system. In qualitative study, the existing tools were difficult to use and understand because they prepared in English language, high burden of workload and no adequate work force at health post level were the main challenge in using CHIS. Conclusion and Recommendation : Utilization of health information at health post level was found to be far below the national expectation. It needs major improvement in frequency of supportive supervision, sending of written feedback and improving integrated reporting channel system. Keywords : Community health information systems, Health information, Ethiopia DOI : 10.7176/JMPB/63-03 Publication date: January 31 st 2020

Tracking of antenatal services and outcomes using community health information system in a slum population of North India

Background: Despite of improvement of public health service, the reach of these services has remained low in urban slums due to various socio cultural and environmental factors.Methods: An information and communication technology (ICT) based community health information system was installed in a urban primary health centre catering to urban slum populations in North India. The system was used to track all the antenatal cases registered over a period of one and half years for antenatal services, risk factors and antenatal outcome. The system allowed for tracking of antenatal cases for antenatal care (ANC) visits, investigations, high risk factors, delivery and perinatal care. Real-time monitoring of antenatal cases was made possible through dynamic dashboard with indicators.Results: Among 614 women tracked for ANC and outcome, majority were below 30 years of age (78.3%), belonged to lower caste (85.7%) and many were illiterate (42.8%). Out of all antenatal cases 68% got registered in 1st trimester and only 47% completed 4 ANC visit. Majority delivered in government hospitals (95.4%) with 22.8% delivered through caesarean section. Illiteracy was found to have significant association with higher gravida (&gt;2) (p&lt;0.001). The high risk factors were present in 29.5% of antenatal cases and it was found to be significantly associated with increasing age (p=0.02) and preterm deliveries (p&lt;0.001). Twin pregnancy was also found to be significantly associated with increasing age (p&lt;0.001).Conclusions: An ICT based community health information system can be an effective tool for real-time monitoring of health services, identifying the gaps and tracking of antennal cases especially in difficult to reach slum population.

The state of community health information systems in West and Central Africa

# Background The proliferation of siloed community-based reporting systems in developing countries has been observed to be inadequate in supplying community stakeholders and governments with the information they desire. There is a clear need for community-based reporting systems to feed into a single centralized, government owned information system. Here we assess the status of centralized, government owned community health information system (CHIS) in 17 West and Central African Countries. # Methods A comprehensive, 58 questions, CHIS macro self-assessment was developed. The assessment requires stakeholder engagement from all levels including community health workers (CHW) and community stakeholders. The assessment was conducted in 17 West and Central African Countries. Results, both qualitative and quantitative, were collected during direct observations of three assessments and during a one-week CHIS workshop in March 2018 where all countries were represented. # Results The assessment approach proved effective at gathering honest and valuable information about the state of the CHIS across all 17 countries as well as bringing in all range of stakeholders. The CHIS assessment has shown that the need and desire is high among countries to have a CHIS that harmonizes the fragmented landscape of CHW reporting tools and populates data into the national health management information system (HMIS). # Conclusions Countries face significant budget limitations to the development, deploy, and sustain a CHIS. Additional major challenges are CHIS governance, adherence to SOPs and system design. System administrators reported little prior direct engagement with CHW's and community stakeholders. Likewise, data feedback to CHW's and stakeholders is largely lacking. Infrastructure, access to cell phones, reliable electrical power supply, and mobile network, clearly continue to be a principal limitation to community information systems. Complex and expensive interoperability layers between mHealth apps and the CHIS will be unsustainable to Ministries given their financial constraints.

The state of community health information systems in West and Central Africa

# Background The proliferation of siloed community-based reporting systems in developing countries has been observed to be inadequate in supplying community stakeholders and governments with the information they desire. There is a clear need for community-based reporting systems to feed into a single centralized, government owned information system. Here we assess the status of centralized, government owned community health information system (CHIS) in 17 West and Central African Countries. # Methods A comprehensive, 58 questions, CHIS macro self-assessment was developed. The assessment requires stakeholder engagement from all levels including community health workers (CHW) and community stakeholders. The assessment was conducted in 17 West and Central African Countries. Results, both qualitative and quantitative, were collected during direct observations of three assessments and during a one-week CHIS workshop in March 2018 where all countries were represented. # Results The assessment approach proved effective at gathering honest and valuable information about the state of the CHIS across all 17 countries as well as bringing in all range of stakeholders. The CHIS assessment has shown that the need and desire is high among countries to have a CHIS that harmonizes the fragmented landscape of CHW reporting tools and populates data into the national health management information system (HMIS). # Conclusions Countries face significant budget limitations to the development, deploy, and sustain a CHIS. Additional major challenges are CHIS governance, adherence to SOPs and system design. System administrators reported little prior direct engagement with CHW's and community stakeholders. Likewise, data feedback to CHW's and stakeholders is largely lacking. Infrastructure, access to cell phones, reliable electrical power supply, and mobile network, clearly continue to be a principal limitation to community information systems. Complex and expensive interoperability layers between mHealth apps and the CHIS will be unsustainable to Ministries given their financial constraints.

Effectiveness of an Integrated Community and Hospital Digital Health Information System in Improving Maternal and Newborn Health Access in Northern Kenya

Background: Poor access to Antenatal Care (ANC), skilled delivery and post-natal check within 48 hours of delivery are associated with adverse pregnancy outcomes. Unequal uptake of these interventions in Kenya has resulted in large regional disparities with 15 out of 47 counties classified as high-priority. We implemented a digital health solution in a high-priority county to improve MNH uptake and evaluated its effectiveness. Methods: Between July 2017 and March 2019, we implemented an integrated community and hospital digital health information system (STONE-HMIS) in 10 primary and secondary health facilities and in 4 catchment community health units (CHUs), in Turkana County in rural Northern Kenya. We estimated the proportion of mothers who attended at least 4 ANC visits, received skilled assistance at delivery, and post-natal check within 48 hours of delivery in two of the CHUs, at baseline and at end-line 12 months later. We compared the results with those of the sub-county of extraction and the County of Turkana as reported in the Kenya Health Information System (KHIS). Results: Out of a catchment population of 4,300 women of reproductive age (WRA) in the study CHUs, a total of 692 and 608 women were interviewed at baseline and end-line respectively. We observed a 5%, 23% and 16% improvement in 4th ANC visits, skilled delivery rates and newborn post-natal check within 48 hours of delivery respectively, over the period of implementation. For the same evaluation period, at the sub-county and county levels, 57.7% and 65.8% WRA attended at least 4 ANC visits, 39.5% and 67.8% delivered with a skilled assistant, and 23.5% and 24% had post-natal check respectively. Conclusions: The integration of provider facility and community level digital health systems and alignment with health system priorities and processes contributed to the improvement of Maternal and Newborn health indicators in an under-served and difficult to reach locality. Funding Statement: The work evaluated by this study was funded through the UKAID-County Innovation Challenge Fund. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Informed consent was sought from every eligible participant. The study was approved by the AMREF ethical review committee and was conducted in consideration of the ICH GCP guidelines on study on human subjects.

A Consumer Health Information System to Assist Patients Select Quality Home Health Services

Patients evaluate the quality of home health agencies (HHAs) using the Health Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This paper describes a prototype community health information system to help patients select appropriate and quality HHAs, according to the location, proprietary status, type of service, and year of HHA establishment. Five HCAHPS indicators were selected: “summary rating”, “quality of care”, “professional care”, “communication”, and “recommend agency”. Independent t-test analysis showed that agencies offering Speech Pathology, Medical-Social, or Home Health Aide services, receive significantly worse HCAHPS ratings, while mean ratings vary significantly across different US states. Multiple comparisons with post hoc ANOVA revealed differences between and within HHAs of different proprietary status (p &lt; 0.001): governmental HHAs receiving higher ratings than private HHAs. Finally, there was observed a relationship between all five quality rating variables and the HHA year of establishment (Pearson, p &lt; 0.001). The older the agency is, the better the HCAPS summary ratings. Findings provided the knowledge to design of a consumer health information system, to provide rankings filtered according to user criteria, comparing the quality rankings of eligible HHAs. Users can also see how a specific agency is ranked against eligible HHAs. Ultimately, the system aims to support the patient community with contextually realistic comparisons in an effort to choose optimal HH service.

Community Health Information and Tracking System (CHITS): Lessons from Eight Years Implementation of a Pioneer Electronic Medical Record System in the Philippines

The CHITS (Community Health Information and Tracking System), the first electronic medical record system in the Philippines that is used widely, has persevered through time and slowly extended its geographic footprint, even without a national policy. This study describes the process of CHITS development, its enabling factors and challenges affecting its adoption, and its continuing use and expansion through eight years of implementation (2004 to 2012) using the HOT-fit model. This paper used a case study approach. CHITS was developed through a collaborative and participative user-centric strategies. Increased efficiency, improved data quality, streamlined records management and improved morale among government health workers are benefits attributed to CHITS. Its longevity and expansion through peer and local policy adoption speaks of an eHealth technology built for and by the people. While computerization has been adapted by an increasing number of local governments, needs of end-users, program managers and policy-makers continue to evolve. Challenges in keeping CHITS technically robust, up-to-date and scalable are already encountered. Lack of standards hampers meaningful data exchange and use across different information systems. Infrastructure for electricity and connectivity especially in the countryside must be established more urgently to meet over-all development goals specially. Policy and operational gaps identified in this study have to be addressed using peoplecentric perspective and participatory strategies with the urgency to achieve universal health care. Further rigorous research studies need be done to evaluate CHITS' effects on public health program management, and on clinical outcomes.

A Systematic Method to Document Population‐Level Nursing Interventions in an Electronic Health System

Many public health electronic health systems lack the specificity to distinguish between individual- and population-based levels of care provided by public health nurses. Data that describe the broad scope of the everyday practice of public health nurses are critical to providing evidence of their effectiveness in promoting community health, which may not be fully appreciated in an arena of scarce resources. This article describes a method to document population-based nursing practice by adding population-based interventions to the nursing taxonomy underlying an electronic health information system. These interventions, derived from the Intervention Wheel, were incorporated into the Omaha System taxonomy, the conceptual framework for the Automated Community Health Information System (ACHIS), which is a longstanding data system used to capture nursing practice in community nursing centers. This article includes a description of the development and testing of the system's ability to capture the practice of the district public health nurse model. This method of adapting an existing data system to capture population-based interventions could be replicated by public health administrators interested in better evaluating the processes and outcomes of public health nursing and other public health professionals.