The Health Information Management System and HIV/Aids Monitoring: Insights From Ethiopia
Résumé
Abstract Background A well-performing Health Information System (HIS) provides timely, complete, accurate and easily retrievable data. It also reflects the impact of guidelines and policies on the functioning of the health system. However, an HIS in Low- and Middle-Income Countries (LMIC), including Ethiopia, is highly complex and influenced by pressures from donors, politics and technical factors. Hence, these countries experience persistent challenges in producing quality data and difficulties using HMIS data from their HISs. This study aimed to evaluate how HMIS was perceived and utilized in HIV/AIDS monitoring in Ethiopia, and views regarding the influence of technical, organizational factors and behavioural factors on the use of HMIS. Methods A qualitative evaluative case study using focus group discussions (8) with data producers and users was conducted in selected public hospitals and health centres in Addis Ababa. A purposive critical case sampling was used to recruit participants. Data were collected from 64 participants made up of data clerks, HMIS heads, health information technicians, voluntary counselling and testing (VCT), Prevention of Mother to Child Transmission (PMTCT) and Antiretroviral Treatment (ART) heads, medical directors and disease prevention heads. Qualitative analytical techniques using ATLAS.ti Version 8 were used for data analysis, and codes, categories, and themes were validated with the participants. Result Key findings revealed that HIV/AIDS-specific indicators, ICT and other related resources were critical barriers to the successful use of the HMIS. Participants believed these technical issues impacted the quality of data adversely and, subsequently, the conversion of that data to information and using it to monitor the HIV/AIDS programme’s performance. Ethiopian guidelines emphasize the benefits of DHIS2 in ensuring the production of good-quality data. However, the system will not produce useful data without clear and meaningful indicators. Timely reporting was hampered by parallel reporting systems such as DHIS2 and SmartCare, a lack of interoperability between these systems, and a hybrid system consisting of paper documents and electronic data. Conclusion Technical factors such as data collection tools, the HMIS design, computer software, and reporting formats are all strategic decisions taken by the organization, which in turn influence the behavior of users and the use of HMIS. The health facilities did not process information as expected. However, staff performed the HMIS tasks with the tools available as they tried to make sense of data coming out of the HMIS. Challenges, such as a lack of human resources, specialized skills, and support, could be improved to effectively use the HMIS for generating useful information for HIV monitoring.
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