Utilization of Routine Health Information from Health Management Information System and Associated Factors Among Health Workers at Health Centers in Oromia Special Zone, Ethiopia: A Multilevel Analysis

Health management information system utilization and associated factors in public and private health facilities of Mogadishu, Somalia

Background

The World Health Organization has identified health information systems as part of the six building blocks of a health system. A health management information system (HMIS) is part of a health information system, and it is critical in evidence-based decision-making when planning, implementing, and evaluating health programs.

Objective

The objective of this study is to determine HMIS utilization and associated factors in public and private health facilities of Somalia's Mogadishu in 2022.

Methods

A quantitative cross-sectional study was conducted from 08 May 2022 to 11 September 2022 on 411 healthcare workers in public and private healthcare facilities in Mogadishu. After obtaining consent, data were collected using self-administrated and standardized questionnaires. Collected data were then analyzed using SPSS version 26. A logistic regression model was computed to measure the factors associated with HMIS utilization. A p-value of 0.05 with a 95% CI was used as a cutoff to indicate the level of statistical significance.

Results

The study found that 237 (57.7%) (95% CI: 1.53-1.62) of the 411 respondents had good HMIS utilization practices. Healthcare workers who had not received HMIS training were 60.9% less likely to use HMIS (AOR = 0.391, 95% CI: 0.200-0.764) compared to those who had received HMIS training. Health workers who did not receive regular supportive supervision were 69.5% less likely to use HMIS (AOR = 0.432, 95% CI: 0.218-0.856) than those who did receive regular supportive supervision. Those with the skills needed to use HMIS data for decision-making were 91.1% less likely to use HMIS (AOR = 0.089; 95% CI: 0.042-0.185) compared to their nonskilled counterparts.

Conclusion

The result of this study shows that the magnitude of HMIS utilization among health workers in public and private health facilities in Mogadishu is low-237 (57.7%)-compared to its use from similar studies. The study found that skills training on HIS/HMIS and support from managers have a significant correlation with HMIS utilization. Given this, all concerned bodies should work hard to bridge the gaps identified in this study.

Implementation status of maternal death surveillance and response system in Ethiopia: Evidence from a national-level system evaluation

BACKGROUND

In Ethiopia, Maternal Death Surveillance and Response (MDSR) was integrated into the existing Integrated Disease Surveillance and Response (IDSR) system in 2014. Despite providing valuable evidence to inform policies and actions, system implementation has not been evaluated. Thus, a national-level evaluation was conducted to assess the level and status of system implementation.

METHODS

A national cross-sectional study was conducted using a multi-stage sampling approach in 2020. A total of 629 health facilities were included in the study. A modified tool, adapted from the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), was employed to assess each functional component of the system, encompassing structure, core, supportive, and system attributes. The score for each component was based on Ethiopian Public Health Institute's mid-term evaluation metrics. To objectively evaluate the implementation status, a composite score of the Maternal Death Surveillance and Response Performance Index (MDSRPI) was calculated based on five performance indicators. Descriptive statistics, independent t-tests, and one-way analysis of variance (ANOVA) with Bonferroni correction were used to examine the variations in scores among the different characteristics.

RESULTS

Of the total sample size, 82.5% (519/629) of health facilities were assessed. Among the assessed health facilities, 77.0% (400/519) fulfilled the criteria for final analysis. Accordingly, the overall readiness score was 44.9% (95% CI: 43.9% to 45.9%), which is rated as less functional. The structures of the system were rated at 51.7% (95% CI: 49.9% to 53.4%), and the system attributes were rated at 69.6% (95% CI: 68.0% to 71.2%), which were considered fairly functional. In contrast, the core functions were rated at 20.0% (95% CI: 18.9% to 21.1%), and the supportive functions were rated at 38.4% (95% CI: 36.4% to 40.4%), which were categorized as not functioning and less functional, respectively. Regionally, Tigray's overall readiness score (54.8%, 95% CI: 50.4-59.1%) was significantly higher than Oromia (41.6%, 95% CI: 40.2-43.0%, P = 0.0001), Amhara (47.7%, 95% CI: 43.9-45.9%, P = 0.05), and SNNPR (42.3%, 95% CI: 39.3-45.3, P = 0.0001). Additionally, Amhara's score was significantly higher than Oromia and SNNPR. Secondary-level healthcare facilities (49.6%, 95% CI: 45.7-53.7, P = 0.029) had a significantly higher readiness score compared to primary health facilities (44.6%, 95% CI: 43.5-45.6). The overall score for the Maternal Death Surveillance and Response Performance Index (MDSPI) was 33.9%.

CONCLUSION

Despite the noticeable regional variation, the overall system readiness and status to implement MDSR were suboptimal, characterized by low representativeness, completeness, and community engagement. Efforts should be directed toward improving community surveillance and enhancing all components of the system to address regional variations and improve overall performance through triangulation and integration with various data sources.

Practice of district health information data for decision making and associated factors among performance monitoring team at Hadiya Zone Public Health Facilities SNNPR, Ethiopia

BACKGROUND

Evidence based practice is a key tool to increase effectiveness and efficiency of healthcare providers worldwide and using health facility data at all levels is vital. But, it is poorly practiced in developing countries including Ethiopia. As a result, the purpose of this study was to evaluate the level of practice of District Health Information for decision making and associated factors among performance monitoring teams in Hadiya Zone public health facilities, South Nation Nationality People Republic, Ethiopia, in 2022.

METHODS

A facility based-cross sectional study was employed from May 3 to June 3, 2022. To obtain data, a pre-tested structured questionnaire with qualitative was employed. A multistage random sampling technique was employed to select performance monitoring team from public health facilities. Data was entered into a computer using Epi data version 4.6, and analyzed using SPSS version 25. Bivariable and multivariable analyses were used to identify determinants related to practice of district health information. For the qualitative section, thematic analysis was used.

RESULTS

The practice of district health information for decision making among performance monitoring team in this study was 48% (95% CI: [42.3, 54.1]). having standard sets of indicators [AOR = 4.055; 95% CI: (1.67, 9.86)], Being trained [AOR = 3.12; 95%CI: (1.385, 7.023)], having internet access [AOR = 3.23; 95% CI: (1.52, 6.9)], having positive attitudes [AOR = 2.667; 95% CI: (1.28, 5.56)], having low motivation [AOR = 0.202; 95% CI: (0.081, 0.504)], Sufficient skill [AOR = 3.239: 95%CI; (1.328, 8.164)] and having knowledge [AOR = 6.227; 95% CI: (2.12, 12.8)] were significantly associated with practice of District health information for decision making.

CONCLUSION

In general, this study found that the performance monitoring team at health facilities poorly practiced district health information. It requires major improvement to provide a consistent set of indicators, training, internet access, user attitudes, motivation, and necessary skills and knowledge, as well as to raise users' confidence in DHIS2.

District health information system 2 data utilization among health professionals in Amara region private hospitals, Ethiopia

Background

Globally, health information systems have been improved by District Health Information System Version 2 (DHIS2), which promotes consistency and integrity in collecting data, processing, and utilization. This success has been attributed to its user-friendly interface and incorporation of advanced data analysis and validation features.

Objective

This study aimed to assess DHIS2 data utilization among health professionals working at private hospitals in the Amara region.

Methods

An Institution-based cross-sectional study design was conducted from 9 May to 30 June 2022. A simple random sampling technique was used to select participants, with a total of 395 health professionals participating. Data was collected using a self-administered paper-based questionnaire. Data entry was performed using the Kobo Collect tool, and data analysis was conducted using STATA version 14.0. Bivariable and multivariable logistic regression analyses were used and p < .05 with a 95% CI was considered to measure statistically significant variables.

Result

Out of 395 participants, about 37.72% of the participants had good DHIS2 data utilization. Had good data analysis skills (adjusted odds ratio (AOR) = 6.5, 95% CI [3.1-13.8]), regular supportive supervision and feedback (AOR = 5.2, 95% CI [2.8-9.5]), monthly salary > 5000 ETB (AOR = 2.0, 95% CI [1.1-3.7]), ease of use (AOR = 5.4, 95% CI [2.8-10.2]), and district health information system training (AOR = 4.2, 95% CI [2.2-7.3]) were enabling factors for utilization of DHIS2 data.

Conclusion

Private healthcare providers had limited utilization of DHIS2 data. It is highly recommended to provide DHIS2 training, supervision, and feedback focused on private health facilities. Additionally, enhancing data analysis skills and prioritizing ease of use are crucial to improving DHIS2 data utilization.

Utilization of health data and associated factors among department heads in public health facilities in Eastern Ethiopia: A cross-sectional study in Harari region

INTRODUCTION

Even though the information generated by routine health information systems is an essential element in the process of transforming the health sector, the information is systematically under-utilized by the health workers. Hence, this study was aimed to assess the utilization level and associated factors of routine health information system data among department heads in Eastern Ethiopia.

METHODS

The cross-sectional study design was conducted among heads of departments in the health facilities of Harari region. The source populations and the study populations were all department heads. The data were collected by standardized tools through interviews, observations, and document reviews. The data were entered into Epi Data version 3.1 and then exported to SPSS version 25 for analysis. Multivariable logistic regression was performed to identify the associated factors and P-value < 0.05 was used to declare the statistically significant association.

RESULT

Of the respondents, 51.8 % live in urban, 82.4 % participated in performance review meeting, 61.7 % received feedback, 80.6 % engage in HIS, and 91 % feel responsible to HIS. Routine health information system data utilization among department heads was 177 (79.7 %); 95 % CI: [73.8 %, 84.8 %] in the Harari region. Factors associated with data utilization were urban residence (AOR = 2.891; 95 %CI: 1.147-7.286), getting feedback (AOR = 3.136; 95 %CI: 1.311-7.499), active engagement in health information system activities (AOR = 2.560; 95 %CI: 1.010-6.490), participation in performance review meeting (AOR = 3.847; 95 %CI: 1.563-9.464), and feeling responsibility (AOR = 3.727; 95 %CI: 1.071-12.961).

CONCLUSION

Level of data use in this study was higher than the one in other studies in Ethiopia. Residence, feedback, level of engagement in health information system activities, sense of responsibility towards health information system, and performance review meeting were the determinants of data utilization. Important attention should be given by the officials at various levels to expand the information communication technology infrastructures and strengthen the feedback system.

Refining the Performance of Routine Information System Management (PRISM) framework for data use at the local level: An integrative review

INTRODUCTION

Foundational to a well-functioning health system is a strong routine health information system (RHIS) that informs decisions and actions at all levels of the health system. In the context of decentralization across low- and middle-income countries, RHIS has the promise of supporting sub-national health staff to take data-informed actions to improve health system performance. However, there is wide variation in how "RHIS data use" is defined and measured in the literature, impeding the development and evaluation of interventions that effectively promote RHIS data use.

METHODS

An integrative review methodology was used to: (1) synthesize the state of the literature on how RHIS data use in low- and middle-income countries is conceptualized and measured; (2) propose a refined RHIS data use framework and develop a common definition for RHIS data use; and (3) propose improved approaches to measure RHIS data use. Four electronic databases were searched for peer-reviewed articles published between 2009 and 2021 investigating RHIS data use.

RESULTS

A total of 45 articles, including 24 articles measuring RHIS data use, met the inclusion criteria. Less than half of included articles (42%) explicitly defined RHIS data use. There were differences across the literature whether RHIS data tasks such as data analysis preceded or were a part of RHIS data use; there was broad consensus that data-informed decisions and actions were essential steps within the RHIS data use process. Based on the synthesis, the Performance of Routine Information System Management (PRISM) framework was refined to specify the steps of the RHIS data use process.

CONCLUSION

Conceptualizing RHIS data use as a process that includes data-informed actions emphasizes the importance of actions in improving health system performance. Future studies and implementation strategies should be designed with consideration for the different support needs for each step of the RHIS data use process.

Routine health information use among healthcare providers in Ethiopia: a systematic review and meta-analysis

INTRODUCTION

Healthcare policy formulation, programme planning, monitoring and evaluation, and healthcare service delivery as a whole are dependent on routinely generated health information in a healthcare setting. Several individual research articles on the utilisation of routine health information exist in Ethiopia; however, each of them revealed inconsistent findings.

OBJECTIVE

The main aim of this review was to combine the magnitude of routine health information use and its determinants among healthcare providers in Ethiopia.

METHODS

Databases and repositories such as PubMed, Global Health, Scopus, Embase, African journal online, Advanced Google Search and Google Scholar were searched from 20 to 26 August 2022.

RESULT

A total of 890 articles were searched but only 23 articles were included. A total of 8662 (96.3%) participants were included in the studies. The pooled prevalence of routine health information use was found to be 53.7% with 95% CI (47.45% to 59.95%). Training (adjusted OR (AOR)=1.56, 95% CI (1.12 to 2.18)), competency related to data management (AOR=1.94, 95% CI (1.35 to 2.8)), availability of standard guideline (AOR=1.66, 95% CI (1.38 to 1.99)), supportive supervision (AOR=2.07, 95% CI (1.55 to 2.76)) and feedback (AOR=2.20, 95% CI (1.30 to 3.71)) were significantly associated with routine health information use among healthcare providers at p value≤0.05 with 95% CI.

CONCLUSION

The use of routinely generated health information for evidence-based decision-making remains one of the most difficult problems in the health information system. The study's reviewers suggested that the appropriate health authorities in Ethiopia invest in enhancing the skills in using routinely generated health information.

PROSPERO REGISTRATION NUMBER

CRD42022352647.

How do medication errors occur in the nursing communication process? Investigating the relationship between error types and error factors

BACKGROUND

Human error types and error factors are two important elements of error analysis. Understanding the relationship between them can contribute to new case analyses, the tendency of error occurrence statistics, error factor identification, and prevention of error recurrence.

OBJECTIVE

To provide evidence and guidance for the prevention and improvement of medication communication errors by quantitatively exploring the relationship between error types and error factors.

METHODS

Data were collected on self-reported errors in the medication administration process by nurses in all departments of three cooperative medical institutions, and an error sheet of specified style was adopted. Error types were determined by the systematic human error reduction and prediction approach method and human cognition processes. Error factors were extracted using the root cause analysis combined with Berlo's communication model, and the relationship between error types and error factors was quantitatively studied using the partial least-squares regression method.

RESULTS

After a one-by-one analysis of 303 error cases, the communication errors occurring in the nursing medication process could be explained by six error types and 12 error factors. In addition, 20 correlation patterns between the error types and error factors were quantitatively obtained, and their path coefficient distributions ranged from 0.088 to 0.467.

CONCLUSION

The results of this study may provide reference to understand errors and establish countermeasures from the statistics of error occurrence trends, extract error factors related to error types and determine key error factors.

Level of implementation of district health information system 2 at public health facilities in Eastern Ethiopia

Objective

The major aim of this study was to assess the level of District health information system 2 (DHIS 2) implementation in the public health facilities (HFs) in Dire Dawa City Administration.

Methods

This study was employed both quantitative (cross-sectional) and qualitative (phenomenological) study designs. All public HFs found in Dire Dawa City Administration and health workers were participated in the study. Quantitative data were collected using a pre-tested, structured, self-administered questionnaire. The collected data were entered into Epi-Data and analyzed using STATA version 14 software. A descriptive summary was computed using proportion and frequencies. Qualitative data were collected from in-depth interview with key informants (KIs), and the results were then analyzed thematically.

Results

The overall implementation level of DHIS 2 was 80%, which shows good implementation. The main difficulties encountered in implementing DHIS 2 were a lack of power backup (64.3%), unreliable internet connectivity (43%), and a lack of training (34.6%). According to an in-depth interview with a 32-year-old professional, "…there is offline and online DHIS 2 software for data collection and reporting that is an opportunity for the health center, but there is a challenge of interruption of electricity lost unsaved data and hinder data to enter and view for making a decision…."

Conclusion

The level of DHIS 2 implementation in this study was good compared to other studies in Ethiopia. However, more than half of the HFs require infrastructure maintenance and support.

Health workers' use of routine health information and related factors at public health institutions in Illubabor Zone, Western Ethiopia

Background

Proper utilization of health data has paramount importance for health service management. However, it is less practiced in developing countries, including Ethiopia. Therefore, this study aimed to assess routine health information utilization and identify factors associated with it among health workers in the Illubabor zone, Western Ethiopia.

Methods

A facility based cross-sectional study was conducted from March to June 2021 with a total of 423 randomly selected health workers. Data were collected using an interviewer-administered questionnaire that was developed based on the performance of routine information system management (PRISM) framework. We created composite variables for health workers' knowledge, attitude, abilities, and information utilization based on existing data. Multivariate logistic regression analysis was performed and the statistical association between the outcome and independent variables was declared using 95% CI and a P < 0.05.

Results

About two-thirds or 279 health workers (66.0%, 95% CI 61.3, 70.4) had good health information utilization. Two-thirds of health workers think organizational decision-making culture (67.1%, 95% CI 62.6, 71.5) and facility managers' or supervisors' promotion of information use (65.5%, 95% CI 60.9, 69.9) are positive. Over half of health workers (57.0%, 95% CI 52.2, 61.6) have a positive attitude toward data management, and the majority (85.8%, 95% CI 82.2, 88.9) believe they are competent of performing routine data analysis and interpretation activities. Only about two-thirds of health workers (65.5%, 95% CI 60.9, 69.9) were proficient in data analysis and interpretation.

Conclusions

The use of routine health information was lower than the national target and data from other literatures. Unacceptably large number of health personnel did not use information. As a result, efforts should be made to increase health workers' data management knowledge and skills, as well as the organizational culture of data utilization.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-01881-y.

Utilisation of health management information and its determinant factors among health professionals working at public health facilities in North Wollo Zone, Northeast Ethiopia: a cross-sectional study

OBJECTIVE

The study aimed to assess health management information utilisation and associated factors among health professionals working at public health facilities in North Wollo Zone, Northeast Ethiopia.

SETTING

The study was conducted at public health facilities in the North Wollo Zone, Northeast Ethiopia.

PARTICIPANTS

A total of 664 (56.3% male and 43.7% female) health professionals participated in the study. All health professionals permanently working in North Wollo Zone were included in this study. However, health professionals who were not present during the data collection period by any means and who had less than 6 months of experience were not included in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

The main outcome measure was health management information utilisation.

RESULT

About 58.4% (n=388) (95% CI: 54.4% to 62.0%) of the study participants use health management information. The multivariable logistic regression model indicated that participants who had managerial positions are more likely to use health management information with an adjusted OR (AOR) of 3.11 and 95% CI 1.84 to 5.24. Similarly, having a good motivation level (AOR=4.42 (95% CI: 2.82 to 6.93)), perceived good culture of health information (AOR=6.17 (95% CI: 3.35 to 11.36)), a standard set of indicators (AOR=4.11 (95% CI: 2.65 to 6.38)), having good governance of health information system (AOR=1.75 (95% CI:1.13 to 2.72)) and health management information system (HMIS) training (AOR=3.10 (95% CI: 1.89 to 5.07)) were the predictors positively associated with higher utilisation of health management information.

CONCLUSION

This study revealed that utilisation of health management information was still inadequate. Enhancing motivation, building a culture of information use, having standardised indicators, strengthening the governance of health information systems and comprehensive HMIS training were measures to be taken to improve utilisation of health management information in this study setting.

'The false reporter will get a praise and the one who reported truth will be discouraged': a qualitative study on intentional data falsification by frontline maternal and newborn healthcare workers in two regions in Ethiopia

INTRODUCTION

Health Management Information Systems (HMIS) are vital to ensure accountability and for making decisions including for tracking the Sustainable Development Goals. The Ethiopia Health Sector Transformation Plan II includes preventing data falsification as a major strategic initiative and our study aimed to explore the reasons why healthcare providers intentionally falsify maternal and newborn health (MNH) data in two regions of Ethiopia.

METHODS

We conducted a qualitative study in two hospitals, four health centres and their associated health posts in Oromia and Amhara regions. We conducted 45 in-depth interviews with health facility managers, quality improvement (QI) focal persons, health information technicians, MNH care providers, Health Extension Workers and QI mentors. Data were collected in local languages and transcribed in English. During analysis we repeatedly read the transcripts, coded them inductively using NVivo V.12, and categorised the codes into themes.

RESULTS

Participants were hesitant to report personal data falsification but many reported that falsification is common and that they had experienced it in other facilities or had been told about it by other health workers. Falsification was mostly inflating the number of services provided (such as deliveries). Decreasing the number of deaths or reclassifying neonatal death into stillbirths was also reported. An overarching theme was that the health system focuses on, and rewards, the number of services provided over any other metric. This focus led to both system and individual level incentives for falsification and disincentives for accurate reporting.

CONCLUSION

Our finding suggests that to reduce facility level data falsification policy makers might consider disentangling reward and punishments from the performance reports based on the routine HMIS data. Further studies examining the high-level drivers of falsification at regional, national and global levels and effective interventions to address the drivers of data falsification are needed.

Utilisation of district health information system and its associated factors among health professionals working at public health facilities of the southwest of Ethiopia: cross-sectional survey

OBJECTIVES

To assess utilisation of district health information system and its associated factors among health professionals in the southwest of Ethiopia, 2020.

SETTING

Public health facilities in the southwest of Ethiopia.

PARTICIPANTS

A facility-based cross-sectional study was conducted among a sample of 260 participants.

MAIN OUTCOME MEASURES

The main outcome measure was utilisation of the district health information system.

RESULTS

Overall, 149 (57.3%) of study participants had good utilisation of district health information systems (95% CI 50 to 64.2). Sufficient skills (Adjusted Odds Ratio (AOR) 3.83, 95% CI 1.92 to 7.64), being trained (AOR 3.90, 95% CI 1.95 to 7.79), high motivation (AOR 3.93, 95% CI 1.99 to 7.76), feedback provided (AOR 2.93, 95% CI 1.53 to 5.77) and regular supervision (AOR 3.06, 95% CI 1.56 to 6.01) were associated with utilisation of district health information systems.

CONCLUSIONS

In general, more than half of the respondents had good utilisation of district health information systems. Providing regular supportive supervision and feedback, having good skills on district health information system use, high motivation and being trained on district health information system will help to bring good utilisation of district health information system for decision making.