Background : Ethiopia is investing in the routine Health Management Information System. Improved routine data are needed for decision-making in the health sector. Objective : To analyse the quality of the routine Health Management Information System data and triangulate with other sources, such as the Demographic and Health Surveys. Methods : We analysed national Health Management Information System data on 19 indicators of maternal health, neonatal survival, immunization, child nutrition, malaria, and tuberculosis over the 2012–2018 time period. The analyses were conducted by 38 analysts from the Ministry of Health, Ethiopia, and two government agencies who participated in the Operational Research and Coaching for Analysts (ORCA) project between June 2018 and June 2020. Using a World Health Organization Data Quality Review toolkit, we assessed indicator definitions, completeness, internal consistency over time and between related indicators, and external consistency compared with other data sources. Results : Several services reported coverage of above 100%. For many indicators, denominators were based on poor-quality population data estimates. Data on individual vaccinations had relatively good internal consistency. In contrast, there was low external consistency for data on fully vaccinated children, with the routine Health Management Information System showing 89% coverage but the Demographic and Health Survey estimate at 39%. Maternal health indicators displayed increasing coverage over time. Indicators on child nutrition, malaria, and tuberculosis were less consistent. Data on neonatal mortality were incomplete and operationalised as mortality on day 0–6. Our comparisons with survey and population projections indicated that one in eight early neonatal deaths were reported in the routine Health Management Information System. Data quality varied between regions. Conclusions : The quality of routine data gathered in the health system needs further attention. We suggest regular triangulation with data from other sources. We recommend addressing the denominator issues, reducing the complexity of indicators, and aligning indicators to international definitions.

Livestock diseases are a priority problem for livestock keepers throughout Ethiopia. Livestock keepers have also singled out poor animal health service delivery, which is largely the domain of the public sector, as the major constraint to improving animal health and productivity. In the current study, we describe the animal health service delivery system and compile from five questionnaire surveys involving 4,162 livestock keepers to characterize animal health service delivery in Ethiopia. The mapping of the animal health service delivery system along the livestock value chain clearly highlights the role of informal animal health services and variations of roles of the private sector. Also, the survey results clearly showed that livestock keepers' access to, use of and satisfaction with animal health services significantly varied across livestock production systems, geographic locations, socioeconomic strata, and service providers. Livestock keepers in crop-livestock and agropastoral systems had 5.5 (odds ratio = 5.453, P = 0.000) and 2.5 (odds ratio = 2.482, P = 0.000) times more access to services in reference to the pastoral system. In reference to private veterinary clinics, livestock keepers reported higher access to services provided by all the other service providers, particularly to services provided by extension agents, drug shops and CAHWs. Similarly, better access was reported by male than female (odds ratio = 1.098; P = 0.025) and wealthier than poorer (odds ratios = 1.40–1.79; P = 0.000) farmers and pastoralists. In general, low access to services was reported, 32.7, 25.2, and 19.3% of the respondents reporting access in crop-livestock, agropastoral and pastoral systems, respectively. Effective demand for services was evaluated through proxy variables, namely number of visits to service providers and health expenditures over a year. Highland farmers used the services more often than pastoralists (odds ratio = 2.86; P = 0.000), but pastoralists' expenses were significantly higher. Wealth (measured by livestock owned), gender and age also had significant effects on the use of services and expenditure on services. Satisfaction with services was evaluated based on four measures, namely availability (av), accessibility (ac), quality (qw), and timeliness (tm) of services. The average scores (out of 10) for av, ac, qw, and tm were 6.1, 5.9, 6.2, and 5.7, respectively. Principal component analysis was conducted to derive the latent variable “satisfaction” from the four measures, extracted only one factor, indicating the four variables are measuring the same construct (satisfaction). Regressing the latent variable satisfaction on the four measures gave significant (P = 0.000) b values of 0.22, 0.20, 0.13, and 0.14 for av, ac, qw, and tm, respectively, indicating strong relationships between the latent variable satisfaction and its measures. There was a significant dissatisfaction with the public sector, with average scores of 0.06 and 0.19 for the public and private service providers, respectively. It can be concluded that livestock keepers in remote regions of the country, pastoralists, women, poorer, and older livestock keepers have less access to services. Satisfaction with services is low to medium and the major concerns of livestock keepers appears to be availability and accessibility of services. Based on our findings, we recommend an integrated, multi-sectoral involvement to improve the veterinary service delivery through improved veterinary infrastructure, public-private partnership, and animal health information system across the various livestock production systems.

ObjectiveA routine health information system (RHIS) enables decision making in the healthcare system. We aimed to analyse data quality at the district and regional level and explore factors and perceptions affecting the quality and use of routine data.DesignThis was a mixed-methods study. We used the WHO toolkit for analysing data quality and interviewed staff at the point of data generation and along with the flow of data. Data were analysed using the Performance of Routine Information System Management framework.SettingThis study was performed in eight districts in four regions of Ethiopia. The study was nested within a 2-year programme of the Operational Research and Coaching for government Analysts.ParticipantsWe visited 45 health posts, 1 district hospital, 16 health centres and 8 district offices for analysis of routine RHIS data and interviewed 117 staff members for the qualitative assessment.Outcome measuresWe assessed availability of source documents, completeness, timeliness and accuracy of reporting of routine data, and explored data quality and use perceptions.ResultsThere was variable quality of both indicator and data element. Data on maternal health and immunisation were of higher quality than data on child nutrition. Issues ranged from simple organisational factors, such as availability of register books, to intricate technical issues, like complexity of indicators and choice of denominators based on population estimates. Respondents showed knowledge of the reporting procedures, but also demonstrated limited skills, lack of supportive supervision and reporting to please the next level. We saw limited examples of the use of data by the staff who were responsible for data reporting.ConclusionWe identified important organisational, technical, behavioural and process factors that need further attention to improve the quality and use of RHIS data in Ethiopia.