Assessment of routine health information utilization and its associated factors among Health Professionals in Public Health Centers of Addis Ababa, Ethiopia

AbstractBackground: - A Routine Health Information System (RHIS) is referred to as the interaction between people, processes, and technology to support operations management in delivering information to improve healthcare services. Routine health information is likely to allow public health facility providers to document analyze and use the information to improve coverage, continuity, and quality of health care services. In Ethiopia, information use remains weak among health professionals. Besides, more have to be done on the utilization of routine health information among health professionals to strengthen and improve the health of the community at large. This study aimed to assess the level of routine health information use and identified determinants that affect health information use among health professionals. Method: Facility-based cross-sectional study design was used from March to April 2020 among 408 health professionals within 22 public health centers using a multi-stage sampling technique. Data was collected using a Semi-structure questionnaire and an observational checklist. The data collected were entered into EpiData version 3.1 and transferred into SPSS version 20 for further statistical analysis. Stepwise regression was used to select the variable. Variables with a p-value of less than 0.05 for multiple logistic regression analysis were considered statistically significant factors for the utilization of RHIS. Result: In this study, Routine health information utilization rate among health professionals was 37.3% (95% CI: 32.6%, 42.1%). The findings also showed a significant positive association between routine health information utilization and health professionals who use of Both manual and computer-based files (AOR = 1.474, 95 % CI =1.043-2.082); Organizational rules, values, and practices (AOR = 1.734, 95 % CI =1.212-2.481); Human resource (AOR = 1.494, 95 % CI = 1.056-2.114); Had problem solving skill on HIS tasks (AOR = 2.091, 95 % CI = 1.343-3.256); Professional who believe that routine health information use is important (AOR = .665, 95 % CI = .501- .883); Planning and monitoring practice (AOR = 1.464 95% CI (1.006-2.131)) and Knowing duties and responsibilities (AOR = 1.525, 95 % CI = 1.121-2.073) Conclusion and Recommendations: Good health information utilization status of health professionals in Addis Ababa was low. Use of recording information; Organizational rules, values, and practices; Inadequate Human resource; Problem-solving skill of health professionals on HIS tasks; Professional who believe that routine health information use is important; the Collected information used for planning, monitoring, and evaluation of facility performance; and Staff know their duties and responsibilities in their workplace were found significantly associated with routine health information use. Thus, major improvements must be done in equipping health professionals to utilize the information they have by improving the above key findings/factors in the health care system. And, health professionals have to use routine health information for evidence-based decision-making in health facilities for a better quality of health care system implementation. [Ethiop. J. Health Dev. 2021; 35(SI-1):05-14] Keywords: Routine Health information Utilization, Health centers, Health professionals, Information Use, healthcare dat

Implementing the Urban Community Health Information System in Ethiopia: Lessons from the pilot-tests in Addis Ababa, Bishoftu and Hawassa

Background: The Strengthening Ethiopia’s Urban Health Program (SEUHP), supported by the United States Agency for International Development (USAID), initiated the pilot testing of the Urban Community Health Information System (UCHIS) in three sites (Addis Ababa, Bishoftu and Hawassa) to support the Ethiopian Federal Ministry Health (FMOH) in its efforts to standardize and expand the Health Management Information System (HMIS) to urban areas. This paper aimed to document the lessons learned and the challenges encountered in the implementation process of UCHIS. Methods: UCHIS implementation guidelines, service delivery cards, monitoring tools, registers, data quality assessment, and progress reports were reviewed. To further understand the UCHIS implementation process, five key informant interviews and four focus group discussions were held between March and April 2018. Results and Discussion: The pilot program identified improvements in data quality and use at the urban health extension professional (UHE-p) level for decision-making and for reporting to city/town health offices and health centers. The prioritization of households according to their economic status and health needs helped UHE-ps to target health services and perform activities optimally. The development and standardization of health service cards for various communicable and non-communicable diseases and maternal, neonatal, and child health services enabled UHE-ps to provide health services in a comprehensive manner. Conclusions: The initiation of UCHIS as a pilot test enabled the UHE-ps to collect high-quality data and report to city/town health offices and health centers. Additionally, UCHIS helped UHE-ps to comprehensively focus on the 15 health service packages and target the neediest sections of the population. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):49-53] Keywords: Urban community health, information system, pilot testing

Analisis Faktor yang Mempengaruhi Kualitas Data Sistem Informasi Rumah Sakit (SIRS) Online dengan PRISM Framework

Teknologi informasi memiliki peranan penting untuk meningkatkan efisiensi pelayanan kesehatan khususnya bagi rumah sakit. Satu program pemerintah yang memanfaatkan teknologi informasi yaitu Sistem Informasi Rumah Sakit (SIRS) online. Implementasinya ditujukan bagi semua rumah sakit seluruh Indonesia dengan melaporkan rekapitulasi kegiatan pelayanannya. Data pelaporan harus dilaporkan dengan tenggat waktu, kelengkapan, dan keakuratannya yang baik untuk membantu pembuatan kebijakan, dan bisa dikatakan bahwa data tersebut berkualitas. Terdapat metode untuk mengukur data yang berkualitas salah satunya Performance of Routine Information System Management (PRISM) framework. Beberapa penelitian mengkaji kerangka PRISM, namun peneliti belum menemukan penelitian serupa di Indonesia. Tujuan penelitian ini bermaksud untuk mengetahui faktor yang mempengaruhi kualitas data dengan PRISM framework. Penelitian ini adalah penelitian kuantitatif dengan rancangan cross-sectional. Populasi penelitian yaitu; a) Data sekunder pelaporan SIRS online sebanyak 2798. b) Hasil penyebaran kuesioner sebanyak 100. Sampel diambil dari hasil penggabungan data sekunder dan kuesioner berjumlah 78. Teknik analisis data yang digunakan adalah SEM-PLS dengan model PRISM framework. Berdasarkan pengujian terdapat 3 hipotesis berpengaruh signifikan satu sama lainnya, yaitu; faktor organisasi terhadap faktor perilaku, faktor organisasi terhadap proses SIK rutin, dan proses SIK rutin terhadap kualitas data. Disimpulkan bahwa faktor organisasi merupakan kunci pemanfaatan data SIRS online yang berkualitas.Kata Kunci: Kualitas Data, PRISM Framework, SIRS Online, SIK Rutin Information technology has important role to play in increasing the efficiency of health services, especially for hospitals. One government program that utilizes information technology is online Hospital Information System (HIS). The implementation itself is aimed at all hospitals throughout Indonesia by reporting the recapitulation of their service activities. The Reported data must be reported with due time, completeness and accuracy to assist policy making, and it can be said the data have a good quality. There are methods for measuring quality data, one of which is the Performance of Routine Information System Management (PRISM) framework. Several studies have reviewed based on the PRISM framework, but researchers have not found similar studies in Indonesia. The purpose of this study is to determine the factors that affect data quality using PRISM framework. This research is quantitative study with cross-sectional study design. The research population, which are; a) Reported online HIS secondary data as many as 2798. b) The results of distributing questionnaires as many as 100. Samples were taken from the combination of secondary data and questionnaire data totaling 78. The data analysis technique used is SEM-PLS analysis technique with PRISM framework model. Based on the test of 6 variables, there are 3 hypotheses which significantly influence each other, namely; organizational factors on behavioral factors, organizational factors on RHIS processes, and RHIS processes on data quality. Broadly speaking, it can be said that organizational factors are the keys in utilizing the quality of online HIS data.Keyword: Data Quality, PRISM Framework, Online HIS, RHI

Quality of intrapartum care at health centres of West Gojjam Zone, Amhara Region, Ethiopia

Introduction: Ethiopia is among the top five materal mortality contributors and has high newborn mortality rate and the provision of quality intrapartum care at primary health care units of health centres could reduce maternal and newborn death. Purpose: the purpose of the study was to assess the quality of intrapartum care, providers’ practise of respectful maternity care and clients’ satisfaction with intrapartum care at selected rural health centres and to develop strategies to improve the quality of intrapartum care at health centre level. Method: the researcher selected a convergent parallel mixed methods research design for the study. Twenty-six health centres, 279 labour and delivery clients and 247 post natal women were enrolled to participate. The study was conducted in five strands, namely three quantitative, one qualitative, and a Delphi technique to reach consensus on the strategies developed for quality intrapartum care improvement at health centre level. Result: the study found a 74% overall quality of intrapartum care service provision, 81.4% availability of medical equipment and supplies, and 66.5% quality intrapartum care competency and respectful maternity care, and 74.5% client satisfaction. Challenges included poor cleanliness of labour and delivery rooms and beds; shortage of water; shortage of incinerators; unsafe waste disposal; shortages of equipment, supplies, and drugs; inadequate staffing; inadequate utilisation of partographs; lack of technical competency, and a loose referral system and feedback. Strategy development: Based on the findings, the researcher developed strategies to improve quality intrapartum care service at health centre level. Finally, a Delphi panel of experts reached consensus on the final strategies.Health StudiesD. Litt. et Phil. (Public Health

Inaccessibility and low maintenance of medical data archive in low-middle income countries: Mystery behind public health statistics and measures

Africa bears the largest burden of communicable and non-communicable diseases globally, yet it contributes only about 1 % of global research output, partly because of inaccessibility and low maintenance of medical data. Data is widely recognized as a crucial tool for improvement of population health. Despite the introduction of electronic health data systems in low-and middle-income countries (LMICs) to improve data quality, some LMICs still lack an efficient system to collect and archive data. This study aims to examine the underlying causes of data archive inaccessibility and poor maintenance in LMICS, and to highlight sustainable mitigation measures. Method Authors conducted a comprehensive search on PubMed, Google scholar, organization websites using the search string “data archive” or “medical data” or “public health statistics” AND “challenges” AND “maintenance” AND “Low Middle Income Countries” or “LMIC”. to Identify relevant studies and reports to be included in our review. All articles related data archive in low and middle income countries were considered without restrictions due to scarcity of data. Result Medical data archives in LMICs face challenges impacting data quality. Insufficient training, organizational constraints, and limited infrastructure hinder archive maintenance. To improve, support for public datasets, digital literacy, and technology infrastructure is needed. Standardization, cloud solutions, and advanced technologies can enhance data management, while capacity building and training programs are crucial. Conclusion The creation and maintenance of data archives to facilitate the storage of retrospective datasets is critical to create reliable and consistent data to better equip the development of resilient health systems and surveillance of diseases in LMICs

Improving quality and use of routine health information system data in low- and middle-income countries: A scoping review.

BACKGROUND: A routine health information system is one of the essential components of a health system. Interventions to improve routine health information system data quality and use for decision-making in low- and middle-income countries differ in design, methods, and scope. There have been limited efforts to synthesise the knowledge across the currently available intervention studies. Thus, this scoping review synthesised published results from interventions that aimed at improving data quality and use in routine health information systems in low- and middle-income countries. METHOD: We included articles on intervention studies that aimed to improve data quality and use within routine health information systems in low- and middle-income countries, published in English from January 2008 to February 2020. We searched the literature in the databases Medline/PubMed, Web of Science, Embase, and Global Health. After a meticulous screening, we identified 20 articles on data quality and 16 on data use. We prepared and presented the results as a narrative. RESULTS: Most of the studies were from Sub-Saharan Africa and designed as case studies. Interventions enhancing the quality of data targeted health facilities and staff within districts, and district health managers for improved data use. Combinations of technology enhancement along with capacity building activities, and data quality assessment and feedback system were found useful in improving data quality. Interventions facilitating data availability combined with technology enhancement increased the use of data for planning. CONCLUSION: The studies in this scoping review showed that a combination of interventions, addressing both behavioural and technical factors, improved data quality and use. Interventions addressing organisational factors were non-existent, but these factors were reported to pose challenges to the implementation and performance of reported interventions

On people, data and systems : perspectives on routine health data processing and its digitalization in Tanzania

Background: Facility-based routine health information is captured in health management information systems by health care providers and is the main data source for health system planning and outcome monitoring in Tanzania and other low- and middle-income countries. While this system is fully digitalized in high-income countries, it is still partly paper-based in others. These use i) facility registers, ii) daily tally sheets and iii) monthly summary forms, which are later entered into the District Health Information System-2 software. These hybrid systems are prone to errors related to i) data entry, ii) calculation and iii) data transfer, with negative implications for data completeness and availability. The unavailability of data and lack of trust in its quality may lead to low data use for resource forecasting and planning, especially at subnational and facility levels. Through automatization of data processing, digital technology may be able to address these challenges, making it especially attractive in settings with high disease burdens and few resources. One example of a promising digital solution for low-resource settings is Smart Paper Technology, which produces automated electronic registers and summary reports by scanning bar-coded forms from individual service encounters. Implementation research, however, suggests a complex interplay between the implementation environment and the introduction and sustained institutionalization of technology. The aim of this thesis was to understand the social practices involved in generating and processing routine maternal and newborn health data, using paper-based and digital tools within the health management information system in Tanzania. Smart Paper Technology and the current health management information system with its different digital components are used for evaluation. Study I had the objective of understanding health care providers’ and facility/district managers’ perceptions of Smart Paper Technology and to assess time spent on documentation with the new system. A time-motion study, before and after the introduction of the technology, was applied together with eight focus group discussions with 18 health care providers from three health facilities and 11 in-depth interviews with healthcare managers from one district authority. Quantitative data was analyzed using descriptive statistics and bivariable modelling. Reflexive thematic analysis was used to analyze qualitative data. Findings illustrate challenges to Smart Paper Technology implementation related to pre-existing health system bottlenecks, e.g. lack of human resources, supervision and transport, but also a difference in values assigned to the new system by health care providers and their managers. Health care providers found Smart Paper Technology useful and applicable to their context with perceived benefits for documentation and clinical care. These experiences were confirmed by quantitative data, showing no significant difference between time spent on overall documentation pre- and post-introduction of Smart Paper Technology (27 vs 26 %, adjusted p 0.763) but an increase in time spent on clinical tasks (26.9 vs 37.1%, adjusted p 0.001). Health care managers, in contrast, found it difficult to identify benefits from the new technology for their own work related to national reporting, due to access problems with the digital dashboard and questionable quality of Smart Paper Technology data. They therefore continued to focus managerial efforts on the existing health management information system. Study II’s objective was to assess the quality of Smart Paper Technology data for maternal care services related to i) completeness and timeliness and ii) internal consistency. A cross-sectional survey over 12 months was performed in 13 health facilities using data from the Smart Paper Technology system and District Health Information System-2. Descriptive statistics were produced based on indicators derived from the World Health Organization’s Data Quality Review Toolkit. Results show that data quality of the Smart Paper Technology system was not superior to that of the pre-existing health management information system overall. This may be linked to the effects of duplicate data entry on health care provider performance and consequently on data completeness. Smart Paper Technology performed slightly better in some aspects of internal consistency: Fewer health facilities produced only one or two outliers with Smart Paper Technology in each month of the study period (antenatal care=4, care during labour = 6, postnatal care =4) than with the District Health Information System-2 (antenatal care= 7, care during labour= 9, postnatal care= 6). Smart Paper Technology also yielded higher consistency for the documented postpartum use of oxytocin in relation to the number of documented deliveries with 62% of facilities showing a less than 10% difference between these indicators as opposed to 38% for the District Health Information System-2. However, the pre-existing system demonstrated better data quality in all other quality dimensions, i.e. data completeness, timeliness and consistency of data trends over the study period. Study III: The objective was to improve understanding about the processes involved in health care providers’ data use; which type of information is used together with health management information system data and for what purposes. A constructivist grounded theory-based ethnographic approach was applied, consisting of i) 14 in-depth interviews with health care providers from maternity wards in two hospitals, as well as ii) 48 hours of observation in the maternity wards and ii) two focus group discussions with 11 health care providers from the same hospitals. Findings illustrate how health care providers appropriated numeric data from the official health management information system and narrative data that they had produced for clinical documentation to safeguard social relationships with superiors, patients and the community they served. While they identified themselves as data collectors and not users of the health management information system, they applied narrative clinical documentation systems to service improvement and to protect themselves against litigation or managerial reprimands. Study IV’s objective was to generate knowledge on experiences and perceptions of health care policymakers in Tanzania related to data, data systems and the implementation of digital technology to support health information management. 16 in-depth interviews with healthcare managers from national and subnational levels were conducted and analyzed using reflexive thematic analysis. Results suggest that the health management information system in Tanzania is governed using institutional and discretionary power. Institutional power was mainly used at the national level to conceptualize data collection and processing systems and the scale-up of digitalization. Discretionary power was mainly used for implementation at subnational level. The use of different power practices was influenced by available funding and health care managers’ perception that health care providers, the primary data collectors, lack motivation to perform and are unpredictable in their actions regarding the continuous production of good data quality. Conclusions: Acceptance or rejection of digital technology was influenced to a considerable extent by social practices at all levels of the health system. These included actors’ perceived benefits of maintaining existing social practices. These practices, which are part of an organization’s culture related to data and data processes, require attention during the conceptualization and implementation of health information systems. Numeric and contextual information is used concomitantly at various levels of Tanzania’s health management information system. The health management information system in Tanzania forms a complex adaptive system with inherently high levels of unpredictability, non-linearity, self-organization and adaptation over time. Health care managers’ power practices in the conceptualization and implementation of policies reflect this complexity. Contextual factors affect digital technology integration and have consequences for data quality and use of digital AND paper-based health management information systems. Context may therefore be even more important than the format and technology of data collection and processing

Linking fiscal decentralization and local financial governance: a case of district level decentralization in the Amhara region, Ethiopia

Philosophiae Doctor - PhDThe prime aim of this thesis is to examine the link between fiscal decentralization and local financial governance in fiscally empowered woreda administrations (districts) of the Amhara region in Ethiopia. Local financial governance has been one of the reasons and arguably the crucial one that drives many countries to subscribe to fiscal decentralization. The presumption is that public finance mobilization and spending can be implemented in a more efficient, responsive, transparent and accountable manner at the local government level than at the centre. Nonetheless, empirical studies show that the linkage between fiscal decentralization and these local financial governance benefits is not automatic. Several developing countries that have tried to implement fiscal decentralization have failed to realise the promised financial governance gains largely due to design and implementation flaws. A review of the various theoretical perspectives suggest that local financial governance is not a factor of just devolution of fiscal power but also other intervening forces such as financial management system, citizen voicing mechanisms and the social and political context. It is within the framework of this theoretical argument that this study sought to investigate how the mixed and incomplete efforts of the district level fiscal decentralization program in the Amhara region has impacted on financial governance of woreda administrations. The study assesses the efficacy and role of various initiatives of the district level decentralization program of the Amhara region, such as the fiscal empowerment of woredas; financial management system reforms; citizen voicing mechanisms and political party structures and system in influencing woreda financial governance. To this end, the investigation process largely took the form of an interpretative approach employing a combination of various methods of gathering the required qualitative and quantitative data from respondents and documents in the selected four case woredas or districts. Findings on the assessment of the intergovernmental relations to measure the adequacy of devolution of fiscal power indicate that, despite the constitutional provision that affords the woredas the power to mobilize and spend public finance for the provision of various local public services, several design and implementation shortcomings have constrained woreda administrations from exercising such power effectively. As a result, the district level fiscal decentralization framework of the Amhara region appears to have features of decentralization by de-concentration rather than by devolution. Despite the extensive financial management reforms that have been undertaken, the research findings indicate that the financial management system in woreda administrations faces a range of challenges triggered largely by important design and implementation shortcomings. It is observed that the ‘getting the basics right first’ reforms in various financial management processes of woreda administrations are not only incomplete but also found to be inconsistent with each other and therefore could not serve their purpose. Furthermore, there has not been any other change in the last two decades since the initial implementation of these reforms despite such serious shortcomings. Most importantly, woreda administrations could not properly implement the techniques, methods, procedures and rules that constituted the reform process due to serious implementation problems such as the lack of manpower competency and problems associated with the lack of administrative accountability. The results of the study’s assessment regarding the practice of social accountability show that currently there is no arrangement for citizens to participate in public financial decisions and controls. In general, people have little interest in participating in the meetings organised by woreda government. Formal and informal community based organizations suffer from important capcity constraints, and the lack of strong civil society organizations to support these community based organizations makes such problems more difficult to resolve. However, local communities did indicate that they would be interested in participating in financial and budgeting processes if a number of conditions were satisfied. These included the availability of adequate and relevant information; the introduction of genuine forms of participation in which citizens were empowered; and evidence that popular participation was making a visible impact on financial decisions related to service delivery in their surroundings. The assessment of the ruling party structure and system suggests that the centralized system of the regional ruling party has created a dominant relationship between party organs at various levels so much sothat it has undermined the fiscal discretionary power of woreda administrations; blurred relationship between party and woreda financial management systems; and undermined direct voicing. Consequently, the genuine devolution of fiscal power, the effective implementation of the decentralised financial management systems, and direct participation of citizens are unlikely to be realised within the current ruling party system and structure. Moreover, the study shows that the intergovernmental relations, the implementation of financial management reforms and direct involvement of people influence each other. The evidence suggests that the effective implementation of the financial management reforms is not possible without genuine devolution of fiscal power and arrangements for the activeinvolvement of citizens. Despite these limitations and shortcomings, the research nevertheless reveals that the decentralization process has achieved some positive results, such as the expansion of access to basic services; the economic use of resources for such expansion; the mobilization of resources from local communities; and the streamlining of a number of bureaucratic processes. However, the prevalence of various financial governance challenges such as excessive budget transfers; low budget execution; uneconomical procurement; illicit spending; budget pressure; inadequate revenue collection; poor financial transparency; and compromised accountability in fiscally decentralized woreda administrations means the promised local financial governance benefits of fiscal decentralization are remain largely unrealized. The evidences in the study strongly suggest that the shortcomings in the design and implementation of intergovernmental relations, financial management system reforms, and direct voicing mechanisms areresponsible in combination with each other for these local financial governance challenges. Thus, the study concludes that local financial governance is a result of a complex network of interactions of intergovernmental relations, public financial management arrangements and social accountability mechanisms. The success of initiatives to improve local financial governance is dependent on contextual factors such as the capacity of civil society organizations and the ruling party system and structure. Therefore, while recommending further efforts of genuine devolution of power, in particular through the continuation of the financial management reform processes towards full-fledged reforms, the study contends that opening enough space for the proliferation of civil society organizations and alternative political parties will be the main priority