Restricted accessReview articleFirst published online 2022-9
Understanding the challenges associated with the use of data from routine health information systems in low- and middle-income countries: A systematic review
Routine health information systems (RHISs) are crucial to informing decision-making at all levels of the health system. However, the use of RHIS data in low- and middle-income countries (LMICs) is limited due to concerns regarding quality, accuracy, timeliness, completeness and representativeness.
Objective:
This study systematically reviewed technical, behavioural and organisational/environmental challenges that hinder the use of RHIS data in LMICs and strategies implemented to overcome these challenges.
Method:
Four electronic databases were searched for studies describing challenges associated with the use of RHIS data and/or strategies implemented to circumvent these challenges in LMICs. Identified articles were screened against inclusion and exclusion criteria by two independent reviewers.
Results:
Sixty studies met the inclusion criteria and were included in this review, 55 of which described challenges in using RHIS data and 20 of which focused on strategies to address these challenges. Identified challenges and strategies were organised by their technical, behavioural and organisational/environmental determinants and by the core steps of the data process. Organisational/environmental challenges were the most commonly reported barriers to data use, while technical challenges were the most commonly addressed with strategies.
Conclusion:
Despite the known benefits of RHIS data for health system strengthening, numerous challenges continue to impede their use in practice.
Implications:
Additional research is needed to identify effective strategies for addressing the determinants of RHIS use, particularly given the disconnect identified between the type of challenge most commonly described in the literature and the type of challenge most commonly targeted for interventions.
AbajebelSJiraCBeyeneW (2011) Utilization of health information system at district level in Jimma Zone Oromia Regional State, South West Ethiopia. Ethiopian Journal of Health Science21: 65–76.
2.
AbouZahrCBoermaT (2005) Health information systems: the foundations of public health. Bulletin of the World Health Organisation83(8): 578–583.
3.
AhsanKZTahsinaTIqbalA, et al. (2017) Production and use of estimates for monitoring progress in the health sector: the case of Bangladesh. Global Health Action10(1): 29–38.
4.
AqilALippeveldTHozumiD (2009) PRISM framework : a paradigm shift for designing, strengthening and evaluating routine health information systems. Health Policy and Planning24: 217–228.
5.
AsahFNNielsenPSæbøJI (2017) Challenges for health indicators in developing countries: misconceptions and lack of population data. In: ChoudrieJ, et al. (eds) Information and Communication Technologies for Development. Cham: Springer International Publishing, pp. 593–604.
6.
AshtonRABennettAYukichJ, et al. (2017) Methodological considerations for use of routine health information system data to evaluate malaria program impact in an era of declining malaria transmission. American Journal of Tropical Medicine and Hygiene97(Suppl 3): 46–57.
7.
AskarAArdakaniMMajdzadeR (2017) Bridging gaps in health information systems: a case study from Somaliland, Somalia. Eastern Mediterranean Health Journal23(11): 764–773.
8.
Awoonor-WilliamsJKBawahAANyonatorFK, et al. (2013) The Ghana essential health interventions program: a plausibility trial of the impact of health systems strengthening on maternal & child survival. BMC Health Services Research13(Suppl 2): S3.
9.
BernardiR (2017) Health information systems and accountability in Kenya: a structuration theory perspective. Journal of the Association for Information Systems18(12): 931–958.
10.
BraaJSahayS (2012) Improving quality and use of data through data-use workshops: Zanzibar, United Republic of Tanzania. Bulletin of the World Health Organisation90: 379–384.
11.
ChikumbaPARasmussenSL (2016) Management and use of health information in Malawi and Burkina Faso: the role of technology. In: CunninghamPCunninghamM (eds) IST-Africa Week Conference, Durban, South Africa, 11–13 May 2016, pp. 1–9.
12.
CibulskisREHiawalyerG (2002) Information systems for health sector monitoring in Papua New Guinea. Bulletin of the World Health Organisation80(9): 752–758.
13.
CibulskisREPosonaiEKarelSG (1995) Initial experience of using a knowledge based system for monitoring immunization services in Papua New Guinea. Journal of Tropical Medicine and Hygiene98: 107–113.
14.
Covidence systematic review software (2013) Veritas Health Innovation, Melbourne, Australia. Available at: www.covidence.org (accessed 20 February 2019).
15.
DagnewEWoretaSAShiferawAM (2018) Routine health information utilization and associated factors among health care professionals working at public health institution in North Gondar, Northwest Ethiopia. BMC Health Service Research18: 685.
16.
DehnaviehRHaghdoostAKhosraviA, et al. (2018) The district health information system (DHIS2): a literature review and meta-synthesis of its strengths and operational challenges based on the experiences of 11 countries. Health Information Management Journal48(2): 62–75.
17.
DehuryRChatterjeeS (2018) Assessment of health management information system for monitoring of maternal health in Jaleswar Block of Balasore district, Odisha, India. Indian Journal of Public Health62(4): 259–264.
18.
DriessenJSettleDPotenzianiD, et al. (2015) Understanding and valuing the broader health system benefits of Uganda’s national human resources for health information system investment. Human Resources for Health13(49): 1–9.
19.
EtamesorSOttihCNdalami SalihuI, et al. (2018) Data for decision making: using a dashboard to strengthen routine immunisation in Nigeria. BMJ Global Health3: 1–7.
20.
FieldEUsurupJNathanS, et al. (2018) Contextual factors and health service performance from the perspective of the provincial health administrators in Papua New Guinea. Rural and Remote Health18(4): 4484.
21.
GimbelSMwanzaMNisingizweMP, et al. (2017) Improving data quality across 3 sub-Saharan African countries using the consolidated framework for implementation research (CFIR): results from the African health initiative. BMC Health Services Research17(Suppl 3): 828.
22.
HotchkissDDianaMForeitK (2012) How Can Routine Health Information Systems Improve Health Systems Functioning in Low-Resource Settings? Assessing the Evidence Base. MEASURE Evaluation Special Report. Available at: https://www.measureevaluation.org/resources/publications/sr-11-65(accessed 20 February 2019).
23.
Iguiñiz-RomeroRPalominoN (2012) Data do count! collection and use of maternal mortality data in Peru, 1990–2005, and improvements since 2005. Reproductive Health Matters20(39): 174–184.
24.
JaniJVJaniIVAraújoC, et al. (2006) Assessment of routine surveillance data as a tool to investigate measles outbreaks in Mozambique. BMC Infectious Diseases6(1): 29.
25.
KimaroHCTwaakyondoHM (2005) Analysing the hindrance to the use of information and technology for improving efficiency of health care delivery system in Tanzania. Tanzania Health Research Bulletin7: 189–197.
26.
KoivuAMavengereNRuohonenMJ, et al. (2016) Exploring the information and ICT skills of health professionals in low- and middle-income countries. In: BrindaT et al. (eds) Stakeholders and Information Technology in Education. SaITE 2016. IFIP Advances in Information and Communication Technology, Cham: Springer, 493, pp. 152–162.
27.
KumarMGotzDNutleyT, et al. (2018) Research gaps in routine health information system design barriers to data quality and use in low- and middle-income countries: a literature review. International Journal of Health Planning Management33: 1–9.
28.
LatifovMASahayS (2013) Challenges in moving to “health information for action”: an infrastructural perspective from a case study in Tajikistan. Information Technology for Development19(3): 215–229.
29.
LedikweJHReasonLLBurnettSM, et al. (2013) Establishing a health information workforce: innovation for low- and middle-income countries. Human Resources for Health11: 35.
30.
LeonNBradyLKwamieA, et al. (2015) Routine health information system (RHIS) interventions to improve health systems management. Cochrane Database of Systematic Reviews12: 1–18.
31.
LippeveldTSauerbornRBodartC (2000) Design and Implementation of Health Information Systems. Geneva: World Health Organization.
32.
MboeraLEGRumishaSFMayalaBK, et al. (2017) Malaria surveillance and use of evidence in planning and decision making in Kilosa district, Tanzania. Tanzania Journal of Health Research19(3): 1–10.
MengeshaWSteegeRZerihun KeaA, et al. (2018) Can mHealth improve timeliness and quality of health data collected and used by health extension workers in rural Southern Ethiopia?Journal of Public Health40(2): 74–86.
35.
MoherDLiberatiATetzlaffJ, et al. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Medicine6(7): e1000097.
36.
MosseELSahayS (2003) Counter networks, communication and health information systems: a case study from Mozambique. IFIP Advances in Information and Communication Technology126: 35–51.
37.
MoyoCKaasbøllJNielsenP, et al. (2016) The information transparency effects of introducing league tables in the health system in Malawi. The Electronic Journal of Information Systems in Developing Countries75(2): 1–16.
38.
MpofuMSemoB-WGrignonJ, et al. (2014) Strengthening monitoring and evaluation (M&E) and building sustainable health information systems in resource limited countries: lessons learned from an M&E task-shifting initiative in Botswana. BMC Public Health14: 1032.
39.
MutaleWChintuNAmorosoC, et al. (2013) Improving health information systems for decision making across five sub-Saharan African countries: implementation strategies from the African health initiative. BMC Health Services Research13(Suppl 2): S9.
40.
MutemwaRI (2006) HMIS and decision-making in Zambia: re-thinking information solutions for district health management in decentralized health systems. Health Policy and Planning21(1): 40–52.
41.
NdabaroraEChippsJAUysL2014Systematic review of health data quality management and best practices at community and district levels in LMIC. Information Development30(2): 103–120.
42.
NecocheaETripathiVKimY-M, et al. (2015) Implementation of the standards-based management and recognition approach to quality improvement in maternal, newborn, and child health programs in low-resource countries. International Journal of Gynecology and Obstetrics130: S17–S24.
43.
NemserBAungKMushambaM, et al. (2018) Data-informed decision-making for life-saving commodities investments in Malawi: a qualitative case study. Malaria Medical Journal30: 111–119.
44.
NicolEBradshawDUwimana-NicolJ, et al. (2017) Perceptions about data-informed decisions: an assessment of information-use in high HIV-prevalence settings in South Africa. BMC Health Services Research17(Suppl 2): 765.
45.
NjugunaJKamauNMurukaC (2017) Impact of free delivery policy on utilization of maternal health services in county referral hospitals in Kenya. BMC Health Services Research17: 1–6.
46.
NutleyTGnassouLTraoreM, et al. (2014) Moving data off the shelf and into action: an intervention to improve data-informed decision making in Cote d’Ivoire. Global Health Action7: 1–10.
47.
NutleyTMcnabbSSalentineS (2013) Impact of a decision-support tool on decision making at the district level in Kenya. Health Research Policy and Systems11(34): 1–8.
48.
NwankwoBSamboMN (2018) Can training of health care workers improve data management practice in health management information systems: a case study of primary health care facilities in Kaduna state, Nigeria. Pan African Medical Journal30(289): 1–8.
49.
Odhiambo-otienoG (2005) Evaluation of existing district health management information systems: a case study of the district health systems in Kenya. International Journal of Medical Informatics74: 733–744.
50.
OmarMAPintoACharimariL (1994) The district health information system and its potential in the management of district and rural hospitals. World Hospital30(3): 15–20.
51.
OtienoFCKasejeMKasejeD (2017) Perspectives on utilization of community based health information systems in Western Kenya. Pan African Medical Journal27: 1–9.
52.
PinchoffJLarsenDARennS, et al. (2016) Targeting indoor residual spraying for malaria using epidemiological data: a case study of the Zambia experience. Malaria Journal15(11): 1–6.
53.
PintoLFSoares de FreitasMPSant’Anna de FigueiredoAW (2018) National information and population survey systems: selected contributions from the ministry of health and the IBGE for analysis of Brazilian state capitals over the past 30 years. Ciencia & Saude Coletiva23(6): 1859–1870.
54.
QaziMSAliM (2009) Pakistan’s health management information system: health managers’ perspectives. Journal of Pakistan Medical Association59(1): 10–14.
55.
QaziMSAliM (2011) Health management information system utilization in Pakistan: challenges, pitfalls and the way forward. BioScience Trends5(6): 245–254.
56.
QaziMSAliMKuroiwaC (2008) The health management information system of Pakistan under devolution: health managers’ perceptions. BioScience Trends2(2): 75–80.
57.
RadinAKAbutuAAOkweroMA, et al. (2017) Confronting challenges in monitoring & evaluation: innovation in the context of the global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. HHS Public Access75(Suppl 1): 1–18.
58.
RanasingheKIChanTYaralagaddaP (2012) Information support for health management in regional Sri Lanka: health managers’ perspectives. Health Information Management Journal41(3): 20–26.
59.
RasmussenSL (2018) Plans and “off-plan activities”: exploring the roles of data and situated action in health planning in Burkina Faso. Electronic Journal of Information Systems in Developing Countries84(5): 1–9.
60.
ScottCClarkeKGrevendonkJ, et al. (2017) Country immunization information system assessments (IISAs), in Kenya (2015) and Ghana (2016). Weekly Epidemiological Record66(44): 1226–1229.
61.
ScottVGilsonL (2017) Exploring how different modes of governance act across health system levels to influence primary healthcare facility managers’ use of information in decision-making: experience from cape town, South Africa. International Journal for Equity in Health16(159): 1–15.
62.
Seitio-KgokgweOMashallaYSeloilweE, et al. (2016) Utilization of the district health information software (DHIS) in Botswana: from paper to electronic based system. In: IST-Africa Week Conference, Durban, South Africa, 11–13 May 2016, pp. 1–10. IIMC.
63.
Seitio-KgokgweOGauldRDCHillPC, et al. (2015) Development of the national health information systems in Botswana: pitfalls, prospects and lessons. Online Journal of Public Health Informatics7(2): e210.
64.
ShiferawAMZegeyeDTAssefaS, et al. (2017) Routine health information system utilization and factors associated thereof among health workers at government health institutions in East Gojjam Zone, Northwest Ethiopia. BMC Medical Informatics and Decision Making17(1): 116.
65.
SoeungSGrundyJKamaraL, et al. (2007) Developments in immunization planning in Cambodia – rethinking the culture and organisation of national program planning. Rural and Remote Health7(2): 630.
66.
ThomasJBarryMA (2018) PRISM: performance of routine information system management series. Chapel Hill: MEASURE Evaluation.
67.
ThomasJCSilvestreESalentineS, et al. (2016) What systems are essential to achieving the sustainable development goals and what will it take to marshal them?Health Policy and Planning31(10): 1445–1447.
68.
TiwariVKKumarKSherinSR, et al. (2016) Standards, frameworks and practices in health management information and evaluation systems (HMIES) in Australia and India: lessons for future transition in India?Journal of Health Management18(1): 70–83.
69.
TshimangaMPetersonDEDlodloRA (1997) The health information system in the city of Bulawayo, Zimbabwe: how good is it?Central African Journal of Medicine43(7): 195–199.
70.
VidorACFisherPDBordinR (2011) Use of health information systems in small municipalities in Southern Brazil. Reve Saude Publica45(1): 1–7.
71.
WagenaarBHGimbelSHoekR, et al. (2015) Effects of a health information system data quality intervention on concordance in Mozambique: time-series analyses from 2009–2012. Population Health Metrics13: 9.
72.
WagenaarBHSherrKFernandesQ, et al. (2016) Using routine health information systems for well-designed health evaluations in low- and middle-income countries. Health Policy and Planning31(1): 129–135.
73.
WardKMugenyiKBenkeA, et al. (2017) Enhancing workforce capacity to improve vaccination data quality, Uganda. Emerging Infectious Diseases23(13): 85–93.
74.
WickremasingheDHashmiIESchellenbergJ, et al. (2016) District decision-making for health in low-income settings: a systematic literature review. Health Policy and Planning31 (Suppl 2): 12–24.
Yazdi-FeyzabadiVEmamiMMehrolhassaniMH (2015) Health information system in primary health care: the challenges and barriers from local providers’ perspective of an area in Iran. International Journal of Preventive Medicine6: 57.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
