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Tilahun H, Abate B, Belay H, Gebeyehu A, Ahmed M, Simanesew A, Ayele W, Mohammedsanni A, Knittel B, Wondarad Y. Drivers and Barriers to Improved Data Quality and Data-Use Practices: An Interpretative Qualitative Study in Addis Ababa, Ethiopia. Glob Health Sci Pract 2022; 10:GHSP-D-21-00689. [PMID: 36109055 PMCID: PMC9476478 DOI: 10.9745/ghsp-d-21-00689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/02/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Hibret Tilahun
- John Snow Research and Training Institute, Inc., Addis Ababa, Ethiopia.
| | - Biruk Abate
- Ethiopian Ministry of Health, Addis Ababa, Ethiopia
| | - Hiwot Belay
- John Snow Research and Training Institute, Inc., Addis Ababa, Ethiopia
| | - Abebaw Gebeyehu
- John Snow Research and Training Institute, Inc., Addis Ababa, Ethiopia
| | | | - Akiliu Simanesew
- Addis Ababa Health Bureau, Regional Health Bureau, Addis Ababa, Ethiopia
| | | | | | - Barbara Knittel
- John Snow Research and Training Institute, Inc., Addis Ababa, Ethiopia
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Worku AG, Tilahun HA, Belay H, Mohammedsanni A, Wendrad N, Abate B, Mohammed M, Ahmed M, Wondarad Y, Abebaw M, Denboba W, Mulugeta F, Oumer S, Biru A. Maternal Service Coverage and Its Relationship To Health Information System Performance: A Linked Facility and Population-Based Survey in Ethiopia. Glob Health Sci Pract 2022; 10:GHSP-D-21-00688. [PMID: 36109058 PMCID: PMC9476483 DOI: 10.9745/ghsp-d-21-00688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/16/2022] [Indexed: 11/23/2022]
Abstract
Coverage for most maternal services showed promising performance. Improving the health information system performance can further improve maternal service uptake and quality. Background: Studies in Ethiopia show an increasing trend in maternal health service use, such as having at least 4 visits of antenatal care (ANC4+) and skilled birth attendance (SBA). Improving the health information system (HIS) is an intervention that can improve service uptake and quality. We conducted a baseline study to measure current maternal service coverage, HIS performance status, and their relationship. Methods: We conducted a linked health facility-level and population-based survey from September 2020 to October 2020. The study covers all regions of Ethiopia. For the population-based survey, 3,016 mothers were included. Overall, 81 health posts, 71 health centers, and 15 hospitals were selected for the facility survey. A two-stage sampling procedure was applied to select target households. The study used modified Performance of Routine Information System Management tools for the facility survey and a structured questionnaire for the household survey. Multilevel logistic regression was employed to account for clustering and control for likely confounders. Results: Maternal service indicators, ANC4+ visits (54.0%), SBA (75.8%), postnatal care (70.6%), and cesarean delivery (9%) showed good service uptake. All data quality and use indicators showed lower performance compared to the national target of 90%. Maternal education and higher levels of wealth index were significantly and positively associated with all selected maternal service indicators. Longer distance from health facilities was significantly and negatively associated with SBA and the maternal care composite indicator. Among HIS-related indicators, availability of electronic HIS tools was significantly associated with maternal care composite indicator and ANC4+. Conclusions: Maternal service indicators showed promising performance. However, current HIS performance is suboptimal. Both service user and HIS-related factors were associated with maternal service uptake. Conducting similar research outside of the project sites will be helpful to have a wider understanding and better coverage.
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Affiliation(s)
- Abebaw Gebeyehu Worku
- JSI Research and Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia.
| | - Hibret Alemu Tilahun
- JSI Research and Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia
| | - Hiwot Belay
- JSI Research and Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia
| | - Afrah Mohammedsanni
- JSI Research and Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia
| | - Naod Wendrad
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Biruk Abate
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | | | | | | | | | - Wubshet Denboba
- JSI Research and Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia
| | - Frehiwot Mulugeta
- JSI Research and Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia
| | - Shemsedin Oumer
- JSI Research and Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia
| | - Amanuel Biru
- JSI Research and Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia
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Adane A, Adege TM, Ahmed MM, Anteneh HA, Ayalew ES, Berhanu D, Berhanu N, Getnet M, Bishaw T, Busza J, Cherinet E, Dereje M, Desta TH, Dibabe A, Firew HS, Gebrehiwot F, Gebreyohannes E, Gella Z, Girma A, Halefom Z, Jama SF, Janson A, Kemal B, Kiflom A, Mazengiya YD, Mekete K, Mengesha M, Nega MW, Otoro IA, Schellenberg J, Taddele T, Tefera G, Teketel A, Tesfaye M, Tsegaye T, Woldesenbet K, Wondarad Y, Yusuf ZM, Zealiyas K, Zeweli MH, Persson LÅ, Lemma S. Exploring data quality and use of the routine health information system in Ethiopia: a mixed-methods study. BMJ Open 2021; 11:e050356. [PMID: 34949613 PMCID: PMC8710857 DOI: 10.1136/bmjopen-2021-050356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE A 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. DESIGN This 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. SETTING This 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. PARTICIPANTS We 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 MEASURES We assessed availability of source documents, completeness, timeliness and accuracy of reporting of routine data, and explored data quality and use perceptions. RESULTS There 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. CONCLUSION We identified important organisational, technical, behavioural and process factors that need further attention to improve the quality and use of RHIS data in Ethiopia.
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Affiliation(s)
- Abyot Adane
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | | | | | | | | | - Della Berhanu
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Misrak Getnet
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Joanna Busza
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Mamo Dereje
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | | | - Abera Dibabe
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Heven S Firew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | - Addis Girma
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | | | - Sorsa F Jama
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Annika Janson
- London School of Hygiene & Tropical Medicine, London, UK
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Binyam Kemal
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Abiy Kiflom
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | - Tefera Taddele
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Gulilat Tefera
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | - Admasu Teketel
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | | | - Tsion Tsegaye
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
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Adane A, Adege TM, Ahmed MM, Anteneh HA, Ayalew ES, Berhanu D, Berhanu N, Beyene MG, Bhattacharya A, Bishaw T, Cherinet E, Dereje M, Desta TH, Dibabe A, Firew HS, Gebrehiwot F, Gebreyohannes E, Gella Z, Girma A, Halefom Z, Jama SF, Kemal B, Kiflom A, Källestål C, Lemma S, Mazengiya YD, Mekete K, Mengesha M, Nega MW, Otoro IA, Schellenberg J, Taddele T, Tefera G, Teketel A, Tesfaye M, Tsegaye T, Woldesenbet K, Wondarad Y, Yosuf ZM, Zealiyas K, Zeweli MH, Persson LÅ, Janson A. Routine health management information system data in Ethiopia: consistency, trends, and challenges. Glob Health Action 2021; 14:1868961. [PMID: 33446081 PMCID: PMC7833046 DOI: 10.1080/16549716.2020.1868961] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/22/2020] [Indexed: 11/02/2022] Open
Abstract
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.
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Affiliation(s)
- Abyot Adane
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | | | | | | | | | - Della Berhanu
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | | | - Heven S. Firew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | - Abyi Kiflom
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | - Carina Källestål
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Seblewengel Lemma
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Tefera Taddele
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Gulilat Tefera
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | - Admasu Teketel
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | | | - Tsion Tsegaye
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Lars Åke Persson
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Annika Janson
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
- Department of Women´s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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