Understanding maternity care providers’ use of data: A qualitative study in Southern Tanzania

Abstract

Introduction Health information management system data is collected for national planning and evaluation but rarely used for health care improvements at the sub-national or facility-level in low-and-middle-income countries. Research suggests that perceived data quality and lack of feedback are contributing factors. We aimed to understand maternity care providers′ perceptions of data and how they use them, with a view to co-design interventions to improve data quality and use. Methods We based our research on constructivist grounded theory. We conducted 14 in-depth interviews, two focus group discussions with maternity care providers and 48 hours of observations in maternity wards of two rural hospitals in Southern Tanzania. Constant comparative data analysis was applied to develop initial and focused codes, sub-categories and categories continuously validated through peer and member checks. Results Maternity care providers appropriated numeric data on service provision to reconcile their professional values and demands from managers and the community with effects of a challenging working environment. They felt controlled by their managers′ data requirements and alienated from service provision data. Providers added informal documentation ways for their own narrative data needs to reflect on and improve service quality. These also assisted them to recreate social relationships with managers, clients and the community. The resulting documentation system led to duplication and increased systemic complexity. Conclusions Data from health information systems does not represent an independent and neutral entity but is embedded into the social realities of different users. Appropriation and use of data reflect these realities and users′ working environment. Interventions to improve data quality and use may need to incorporate the multitude of clinical and administrative documentation and data needs to avoid duplication and inefficiencies.

Feasibility, usability and acceptability of a novel digital hybrid-system for reporting of routine maternal health information in Southern Tanzania: A mixed-methods study

“…The setting's data culture promoted analysis by managers. Lippefeld advocates for managerial role models for a positive data culture [52] but studies from several countries report managerial complacency to data manipulation [43][44][45]. Our participants did not mention this, but managers' emphasis on the summary report may indicate similar complacency.…”

“…Although individuals could be associated to HMIS data previously, our participants did not perceive this as a similar trigger towards data quality. Studies from Tanzania and comparable settings describe HCPs' HMIS data manipulation related to organizational pressure [9,[43][44][45] and report low data accountability for data [24].…”

“…This process improvement did not lead to improved outputs regarding data quality although participants lauded the timely availability of SPT data. Reasons for the reported data discrepancy may be found in i) the health system's organizational culture regarding health PLOS GLOBAL PUBLIC HEALTH data [9,10,45,57], ii) the environment of data collection [47] and iii) duplicate data entry [18].…”