Strengthening district-based health reporting through the district health management information software system: the Ugandan experience

Abstract

BackgroundUntimely, incomplete and inaccurate data are common challenges in planning, monitoring and evaluation of health sector performance, and health service delivery in many sub-Saharan African settings. We document Uganda’s experience in strengthening routine health data reporting through the roll-out of the District Health Management Information Software System version 2 (DHIS2).MethodsDHIS2 was adopted at the national level in January 2011. The system was initially piloted in 4 districts, before it was rolled out to all the 112 districts by July 2012. As part of the roll-out process, 35 training workshops targeting 972 users were conducted throughout the country. Those trained included Records Assistants (168, 17.3%), District Health Officers (112, 11.5%), Health Management Information System Focal Persons (HMIS-FPs) (112, 11.5%), District Biostatisticians (107, 11%) and other health workers (473, 48.7%). To assess improvements in health reporting, we compared data on completeness and timeliness of outpatient and inpatient reporting for the period before (2011/12) and after (2012/13) the introduction of DHIS2. We reviewed data on the reporting of selected health service coverage indicators as a proxy for improved health reporting, and documented implementation challenges and lessons learned during the DHIS2 roll-out process.ResultsCompleteness of outpatient reporting increased from 36.3% in 2011/12 to 85.3% in 2012/13 while timeliness of outpatient reporting increased from 22.4% to 77.6%. Similarly, completeness of inpatient reporting increased from 20.6% to 57.9% while timeliness of inpatient reporting increased from 22.5% to 75.6%. There was increased reporting on selected health coverage indicators (e.g. the reporting of one-year old children who were immunized with three doses of pentavelent vaccine increased from 57% in 2011/12 to 87% in 2012/13). Implementation challenges included limited access to computers and internet (34%), inadequate technical support (23%) and limited worker force (18%).ConclusionImplementation of DHIS2 resulted in improved timeliness and completeness in reporting of routine outpatient, inpatient and health service usage data from the district to the national level. Continued onsite support supervision and mentorship and additional system/infrastructure enhancements, including internet connectivity, are needed to further enhance the performance of DHIS2.

Ebola Virus Disease Surveillance and Response Preparedness in Northern Ghana

“…These problems range from validity and quality of suspected EVD data; to problems regarding specimen taking, analysis, and confirmation and feedback; to problems of inadequate resources. Though some countries in SSA have shown some improvements in disease surveillance activities with increased potential for rapid dissemination of information (11,14,16,31), findings from the current study in northern Ghana rather revealed that late case detection and delays to provide health care services to suspected Ebola patients at health facilities are common practices leading to preventable deaths. There have been reported cases of clinically diagnosed EVD in northern Ghana.…”

Coverage of routine reporting on malaria parasitological testing in Kenya, 2015–2016

“…DHIS2 has been used previously to capture malaria-related information and has helped improve countries’ understanding of the links between malaria disease burden, use of rapid diagnostic tests, and administration of anti-malarial drugs administered [36,37]. However, similar evaluations of the coverage and completeness of data captured in national DHIS 2.0 systems are few [11–13,38,39]. There have also been several attempts to use routine data in model-based geostatistics using data from Namibia [40], Afghanistan [41] and in Madagascar [42] and these have the potential to form part of new strategies for malaria risk mapping in future [41,43].…”

Using a Structured Approach to Evaluate ICT4D: Healthcare Delivery in Uganda

“…It is important to note that the Ministry of health in Uganda has instituted the management of medical records through a Health Management Information System, (DHIS2) to which all public health facilities nation-wide are required to submit weekly reports (Kiberu et al, 2014).…”

“…They evaluated indicators such as outpatient caseload, user-fee based hospital income and technical efficiency. Kiberu et al (2014) also measured the performance of the District Health Management Information Software System version 2 (DHIS2) in Uganda in terms of completeness and timeliness of outpatient and inpatient reporting between 2011 and 2013. Li (2010) proposed a multi-method longitudinal evaluation process to explore the impact of ICT with an appreciation of the relationship between the social and technical systems within a clinical department.…”