Evaluating performance of routine health information system for reproductive health in Tshwane

Abstract

The Routine Health Information System (RHIS) in South Africa utilises the District Health Information System (DHIS) to manage reproductive health programme data. The reproductive health programme requires an RHIS that is capable of generating quality data that will be used for decision-making. The study intended to evaluate the performance of the RHIS using DHIS in generating quality reproductive health information in the Tshwane district. The study was conducted in 13 facilities in the City of Tshwane. A sequential explanatory mixed-method design was employed to evaluate the performance of the RHIS in generating quality reproductive health information. A Delphi technique was then used to develop strategies to improve the management of reproductive health data. The stratified random, purposive critical case and purposive sampling were used to select health care providers (HCPs), facility managers and experts, respectively. Data were collected from HCPs, facility managers and experts through questionnaires, in-depth interviews, and the modified Delphi technique, respectively. Quantitative data were analysed using the Statistical Package for Social Sciences (SPSS) program for Windows, and thematic analysis was employed for the qualitative data. The majority of HCPs were not trained on the RHIS. Data generated from the system was therefore of poor quality. Managers played a critical role in managing reproductive health information by ensuring the generation of high-quality data. Reproductive health information was used in managing the facility and improving the service, however the culture of information use was suboptimal. Several challenges related to behavioural (HCPs’ competence, confidence, interest and commitment), technical (complex design of data collection tool), and organisational (training, resources, supportive supervision and information culture) factors affected data quality and the use of information negatively. The reproductive health programme was not performing well due to a lack of skills for inserting intrauterine contraceptive devices, patients’ preference for short-acting reversable contraceptive (SARC) methods, and the use of private practitioners who failed to report reproductive services on the RHIS. The performance of the RHIS was below expectation because of the suboptimal level of data quality and use of information. Strategies were developed to address the factors affecting the data management process, with the aim of improving the performance of the RHIS in managing reproductive health information.