Perceptions and experiences with District Health Information System software to collect and utilize health data in Bangladesh: A qualitative exploratory study

Abstract

Background: Accurate and high-quality data are important for improving program effectiveness and informing policy. Bangladesh’s health management information system adopted the District Health Information Software, Version 2 (DHIS2) in 2009 to capture real-time health service utilization data. However, routinely collected data are being underused because of poor data quality. We aimed to understand the facilitators and barriers of implementing DHIS2 as a way to retrieve meaningful and accurate data for reproductive, maternal and child health (RMCAH) services. Methods: This qualitative study was conducted in two districts of Bangladesh from September 2017 to 2018. Data collection included key informant interviews (n=11), in-depth interviews (n=23), and focus group discussions (n=2). The study participants were individuals involved with DHIS2 implementation from the community level to the national level. The data were analyzed thematically. Results: DHIS2 could improve the timeliness and completeness of data reporting over time. The reported facilitating factors were strong government commitment, extensive donor support, and positive attitudes toward the technology among staffs. Quality checks and feedback loops at multiple levels of data gathering points were helpful to minimize data errors. Introducing a dashboard makes DHIS2 compatible to use as monitoring tool. However, the barriers to effective DHIS2 implementation were lack of human resources, slow Internet connectivity, frequent changes to of DHIS2 versions, and maintaining both manual and electronic system side-by-side. Data in DHIS2 remains incomplete because it does not capture data from private health facilities. Having two parallel management information systems reporting the same RMNCAH indicators threatens data quality and increases the reporting workload. Conclusion: The overall insights from this study are expected to contribute to the development of effective strategies for successful DHIS2 implementation and building responsive health management information system. Focused strategic direction is needed to sustain the achievements of digital data culture. Periodic refresher trainings, incentives for increased performance, and an automated single reporting system for multiple stakeholders could make the system more user-friendly. A national electronic health strategy and implementation framework can facilitate creating a culture of DHIS2 use for planning, setting priorities, and decision making among stakeholder groups.

Evaluation of the malaria reporting system supported by the District Health Information System 2 in Solomon Islands

“…However, uptake of technology-based recording and reporting is hampered by a lack of awareness and organizational support [ 34 , 43 ]. Other barriers include inadequate internet coverage [ 31 , 44 ], telecommunications network coverage [ 42 ] and electricity [ 45 ], limited budgets for system introduction, maintenance and repair of devices [ 46 – 48 ] and limited training of personnel in their use [ 49 , 50 ]. The expansion of computerized recording and reporting in Solomon Islands need to address these barriers for expanding it to the health centres.…”

“…A mixed-methods approach using quantitative and qualitative methods was used for this study. Mixed methods research can help address complex, multifaceted issues in health care delivery [ 31 – 34 ]. A qualitative study using focus group discussions (FGD) and in-depth interviews (IDI) was undertaken to elucidate the underlying reasons for the quantitative findings using a triangulation [ 35 , 36 ].…”

Evaluation of the District Health Information System 2 supported malaria reporting system in Solomon Islands

“…However, uptake of technology-based recording and reporting is hampered by a lack of awareness and organizational support [34,43]. Other barriers include inadequate internet coverage [31,44], telecommunications network coverage [42] and electricity [45], limited budgets for system introduction, maintenance and repair of devices [46][47][48] and limited training of personnel in their use [49,50]. The expansion of computerised recording and reporting in Solomon Islands need to address these barriers for expanding it to the health centres.…”

“…The details of the indicators are outlined in Table 2. A mixed-methods approach using quantitative and qualitative methods was used for this study. Mixed methods research can help address complex, multifaceted issues in health care delivery [31][32][33][34]. A qualitative study using focus group discussions (FGD) and in-depth interviews (IDI) was undertaken to elucidate the underlying reasons for the quantitative ndings using a triangulation [35,36].…”

Evaluation of the malaria reporting system supported by the District Health Information System 2 in Solomon Islands

“…A mixed-methods approach using quantitative and qualitative methods was used for this study. Mixed methods research can help address complex, multifaceted issues in health care delivery [31][32][33][34]. A qualitative study using focus group discussions (FGD) and in-depth interviews (IDI) was undertaken to elucidate the underlying reasons for the quantitative ndings using a triangulation [35,36].…”