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Open Access Research article

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

Vincent Micheal Kiberu1*, Joseph KB Matovu1*, Fredrick Makumbi2, Carol Kyozira3, Eddie Mukooyo3 and Rhoda K Wanyenze4

Author Affiliations

1 Makerere University School of Public Health-U.S. Centers for Diseases Control and Prevention (MakSPH-CDC) Fellowship Program, P.O. Box 7072 Kampala, Uganda

2 Department of Biostatistics and Epidemiology, Makerere University School of Public Health, Kampala, Uganda

3 Ministry of Health, Resource Center, Kampala, Uganda

4 Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda

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BMC Medical Informatics and Decision Making 2014, 14:40  doi:10.1186/1472-6947-14-40

Published: 13 May 2014

Abstract

Background

Untimely, 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).

Methods

DHIS2 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.

Results

Completeness 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%).

Conclusion

Implementation 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.

Keywords:
DHIS2; Outpatient; Inpatient; HMIS