Quality and Use of Routine Healthcare Data in Selected Districts of Eastern Province of Rwanda
Strengthening of Health Management Information System (HMIS) is becoming an unavoidable task for most health systems in the World. As part of the strengthening (of HMIS), it is imperative that stakeholders undertake periodic studies on HMIS-data quality so as to gain insight into the level of quality and cause corrective action. This study evaluated the quality of HMIS, factors influencing quality (of HMIS), use of data generated from HMIS and factors influencing use of data in 3 districts of Eastern Province of Rwanda. We employed a descriptive cross-sectional study design focusing on 9 months from 1st July 2012 to 31st March 2013. To achieve this we conducted HMIS data quality assessment through checking of presence of selected registers and client/patients’ cards, deviations between reported patient statistics and those in the appropriate registers, reports with at least 95% of the data fields well filled, expected reports received at the receiving hospitals, reports received by due date and evidence of data use from a set of criteria. We further conducted key informants interviews with the health facility managers and records officers on factors influencing the observed data quality; use of data and associated factors. We found that though every ‘register of interest’ was available in all the health facilities, client/patients’ cards experienced severely stock out over the months under study. Low proportion of health facilities attained the a priori for availability of ANC cards (58.0%), Partograms (56.8%), Child Health Cards (59.5%), Family Planning user cards (78.1%) and Outpatient medical forms (57.4%). High proportion of health facilities had good quality of (accurate) health facility reports (73.3%) and those in the electronic data base (70.6%). Similarly, high proportion of health facilities met the quality standard for content completeness (97.6%) in addition to high proportion of expected reports received at the receiving hospitals (97.7%). The overall timeliness of reporting of HMIS monthly reports stood at 93.8%. Data were rarely used in the health facilities and this was majorly enhanced by the top-down approach to setting of targets and planning. We concluded that levels of data accuracy, completeness and timeliness in the situation of Rwanda did not match the rhetoric that data quality in health systems in developing countries is poor. The few lapses identified could have been associated with factors we did not statistically verify. Use of data in our study health facilities was inadequate and the self-reported use (of data) could not be backed by evidence from our observations. The top-down nature of planning greatly prevented the operational-level managers from using data.
Quality, Healthcare Data, Routine HMIS, Selected Districts of Eastern Province, Rwanda
Drobac et al. 2013. Comprehensive and integrated district health systems strengthening: the Rwanda Population Health Implementation and Training (PHIT) Partnership, BMC Health Services Research 2013, 13(Suppl 2): S5 http://www.biomedcentral.com/1472-6963/13/S2/S5
UNICEF. Committing to survival: a promise renewed progress report. New York: UNICEF, 2014.
United Nations Inter-agency Group for Child Mortality Estimation. Levels and trends in child mortality. New York: UNICEF, 2014.
National Health Service. United Kingdom: The Stationery Office Limited, 2010.
Opit LJ. How should information on health care be generated and used? World Health Forum, 1987; 8: 409-417.
Lippeveld T. Sauerborn R & Bodart C. Design and implementation of health information systems. Geneva: World Health Organization, 2000.
Nabyonga-Orem J & Mijumbi R. Evidence for informing health policy development in low-income countries (LICs): perspectives of policy actors in Uganda. International Journal of Health Policy and Management, 2015; 4(5): 285-293.
Lippeveld T Sauerborn R & Bodart C. Design and implementation of health information systems. Geneva: World Health Organization, 2000.
Kabagambe G, Nganwa A & Matte R. (2008). ASSESSMENT OF THE FUNCTIONALITY OF HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS), UGANDA. Unpublished report. Wind Consult.
Republic of Kenya, Health Sector (2008). REPORT FOR ASSESSMENT OF THE HEALTH INFORMATION SYSTEM OF KENYA. Un-published report. Ministry of Health, Kenya.
Kumwenda B, Jimmy-Gama D, Manyonga V, Semu-Kamwendo N, Nindi-Mtotha B & Chirwa M. Factors Affecting Data Quality in the Malawian Health Management Information System. ACTA Press, 2014; DOI: 10.2316/P.2014.815-028.
Michael KV, Matovu JKB, Makumbi F, Kyozira C, Mukooyo E & Wanyenze RK. Strengthening district-based reporting through the district health management information software system: the Ugandan experience. BMC, 2014; 14:40.
Health Information Systems Knowledge Hub, School of Population Health, The University of Queensland &Institute for Health Metrics and Evaluation, University of Washington. Theme: Building health information systems. Improving the quality and use of health information systems: essential strategic issues. Working paper series. Herston-Australia: Health Information Systems Knowledge Hub 2009.
Paul NM, Iyer HS, Gashayija M, Hirschhorn LR, Amoroso C, Wilson R, Rubyutsa E, Gaju E, Basinga P, Muhire A, Binagwaho A & Hedt-Gauthier B. Toward utilization of data for program management and evaluation: quality assessment of five years of health management information system data in Rwanda. Global Health Action, 2014; 7: 25829.
Ministry of Health, Zambia (2007). ASSESSMENT OF THE HEALTH INFORMATION SYSTEM IN ZAMBIA. Unpublished report. Ministry of Health, Zambia.
The World Health Organization, Regional Office for Western Pacific. Developing health management information systems: a practical guide for developing countries. Geneva: World Health Organization, 2004.
Kintu P, Nanyunja M, NzabanitaA & Magoola R. Development of HMIS in poor countries: Uganda as a case study. Health Policy and Development, 2005; 3(1): 46-53.
Health Information Systems Knowledge Hub, School of Population Health, The University of Queensland. Improving the quality and use of health information systems: essential strategic issues. Herston: The University of Queensland, 2009.
Ash J, Berg M and Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system related errors. Journal of the American Medical Information Association, 2004; 11:104–112.