Strategies to strengthen health management information systems in public health centres in Addis Ababa, Ethiopia

Abstract

A health management information system (HMIS) is the intersection between the business process of healthcare and information systems to deliver better healthcare services. A health information system is one of the health system's building blocks. The purpose of this study was to develop strategies to strengthen health management information systems in Ethiopia. The study used the Performance of Routine Information System (PRISM). It adopted a quantitative research approach and implemented it over three phases. The first phase involved a retrospective document review of the quality of maternal health data across registers, tally sheets, DHIS2 databases, and data quality monitoring logbooks in ten randomly selected healthcare facilities using a standard quantitative checklist. The focus was on three data quality dimensions: accuracy, completeness and timeliness of specific maternal indicators and data elements. Maternal health programme was selected among different programmes which were found to have challenges with data quality. The second phase involved a descriptive cross-sectional survey using a close-ended questionnaire. The population for this phase included health professionals working in Addis Ababa public health centres who used the health management information system. These professionals were recruited from the ten public health centres used in Phase 1 through multistage stratified sampling techniques. The collected data were analysed using SPSS Version 26. The findings of the two phases were combined to derive meta-inferences. In the final phase, a Delphi technique was used to develop strategies that were validated by a team of experts to strengthen the data quality, data management and information use in public healthcare facilities. The first phase of the document review revealed that the overall data quality was poor across the maternal data sources in terms of accuracy, completeness, and timeliness. Furthermore, key findings of the second phase indicated that the components of data management were not consistently practised, a large amount of data was shelved and unprocessed, and information was not used for decisions in accordance with standards in healthcare facilities due to a variety of factors. These issues were further linked to organisational, technical and behavioural factors. In conclusion, combined key findings indicate that a large amount of data was not properly managed across data management processes, lacked data quality, and was not used satisfactorily at all levels. As a whole, the importance of data quality, data management and information needs was not recognised and practised, particularly at case teams level. Hence, HIS strategies were developed to address the identified gaps..