Strategies for utilization of Routine Health Information System (RHIS) for management of child healthcare in Namibia

Abstract

The Health Information System (HIS) encompasses all the information that can be utilised for planning and decision-making in the health sector. Namibia still experiences childhood illnesses such as diarrhoea, malaria, and pneumonia. Therefore, the Routine Health Information System (RHIS) is expected to produce reliable and useful data supporting child healthcare management. This study aimed to develop strategies to enhance the use of RHIS in managing child healthcare. A qualitative collective case study was used to address the research objectives. The research was implemented in three phases: Phase 1, focus group interviews; Phase 2, individual in-depth interviews; and Phase 3, developing strategies to enhance the utilisation of RHIS for managing child health care using the modified Delphi technique. The study setting was Primary Health Care (PHC) facilities as well as district and regional offices in the ||Karas Region, and data was also obtained from healthcare managers at the national level. The population for Phase 1 was nurses at PHC facilities in ||Karas; the population for Phase 2 included healthcare managers at the district, regional, and national levels, who mainly used data to manage child healthcare and those working with HIS. In Phase 3, the population consisted of experts in child health care and HIS. Non-probability sampling techniques were used to recruit participants. Data were collected through focus group interviews with nurses, followed by individual in-depth interviews to explore healthcare managers’ experiences of RHIS utilising in the planning and management of child healthcare services. Phase 1 and 2 data were integrated and v used as the foundation for developing strategies. Phase 3 used a questionnaire to obtain the views of experts on the proposed strategies. Thematic analysis was used to analyse Phases 1 and 2. Phase 3 used descriptive statistical analysis to quantify the level of consensus among experts. The study revealed that Namibia still uses a hybrid approach in generating routine health data, exacerbated by inadequate Information, Communication and Technology (ICT) at health facilities and a lack of skills in District Health Information Software Two (DHIS2). The study showed dissimilarity in the understanding of RHIS between nurses and healthcare managers, with nurses having limited knowledge of broader concepts of RHIS, whilst healthcare managers had a good understanding. The majority of nurses could only generate and collate but could not analyse, disseminate, do quality checks, or use data. A good understanding of RHIS could enable them to generate quality data and utilise data for decision-making. This study showed that there were limited policies, guidelines and regulatory frameworks on HIS. This resulted in the absence of HIS standards, leading to information systems running parallel to DHIS2, being unable to exchange data between various users, and lacking defined roles and responsibilities of various stakeholders. The study also revealed that there was a lack of HIS plans at the health facility level. The study acknowledged that understanding RHIS functionality and experiencing its usability will contribute to the high performance of RHIS and child healthcare. Therefore, the researcher assumed that the focus areas in the proposed strategies would strengthen the use of RHIS in managing child health care.