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Background Policymakers need regular high-quality coverage data on care around the time of birth to accelerate progress for ending preventable maternal and newborn deaths and stillbirths. With increasing facility births, routine Health Management Information System (HMIS) data have potential to track coverage. Identifying barriers and enablers faced by frontline health workers recording HMIS source data in registers is important to improve data for use. Methods The EN-BIRTH study was a mixed-methods observational study in five hospitals in Bangladesh, Nepal and Tanzania to assess measurement validity for selected Every Newborn coverage indicators. We described data elements required in labour ward registers to track these indicators. To evaluate barriers and enablers for correct recording of data in registers, we designed three interview tools: a) semi-structured in-depth interview (IDI) guide b) semi-structured focus group discussion (FGD) guide, and c) checklist assessing care-to-documentation. We interviewed two groups of respondents (January 2018–March 2019): hospital nurse-midwives and doctors who fill ward registers after birth (n = 40 IDI and n = 5 FGD); and data collectors (n = 65). Qualitative data were analysed thematically by categorising pre-identified codes. Common emerging themes of barriers or enablers across all five hospitals were identified relating to three conceptual framework categories. Results Similar themes emerged as both barriers and enablers. First, register design was recognised as crucial, yet perceived as complex, and not always standardised for necessary data elements. Second, register filling was performed by over-stretched nurse-midwives with variable training, limited supervision, and availability of logistical resources. Documentation complexity across parallel documents was time-consuming and delayed because of low staff numbers. Complete data were valued more than correct data. Third, use of register data included clinical handover and monthly reporting, but little feedback was given from data users. Conclusion Health workers invest major time recording register data for maternal and newborn core health indicators. Improving data quality requires standardised register designs streamlined to capture only necessary data elements. Consistent implementation processes are also needed. Two-way feedback between HMIS levels is critical to improve performance and accurately track progress towards agreed health goals.

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Background In regard to health service planning and delivery, the use of information at different levels in the health system is vital, ranging from the influencing of policy to the programming of action to the ensuring of evidence-informed practices. However, neither ownership of, nor access to, good quality data guarantees actual use of these data. For information to be used, relevant data need to be collected, processed and analysed in an accessible format. This problem of underused data, and indeed the absence of data use entirely, is widespread and has been evident for decades. The DHIS2 software platform supports routine health management for an estimated 2.4 billion people, in over 70 countries worldwide. It is by far the largest and most widespread software for this purpose and adopts a holistic, socio-technical approach to development and implementation. Given this approach, and the rapid and extensive scaling of DHIS2, we questioned whether or not there has been a parallel increase in the scaling of improved information use. To date, there has been no rigorous review of the documentation on how exactly DHIS2 data is routinely being used for decision-making and subsequent programming of action. This scoping review addresses this review gap. Methods The five-stage approach of Arksey and O’Malley progressed by Levac et al. and Peters was followed. Three databases (PubMed, Web of Science and Embase) were searched, along with relevant conference proceedings and postgraduate theses. In total, over 500 documents were reviewed and data from 19 documents were extracted. Results Overall, DHIS2 data are being used but there are few detailed descriptions of this usage in peer reviewed or grey literature. We find that, commonly, there exists a centralised versus decentralised pattern of use in terms of access to data and the reporting of data ‘up’ in the system. We also find that the different conceptualisations of data use and how data use is conceptualised are not made explicit. Conclusions We conclude with some suggestions for a way forward, namely: i) the need to document in more detail and share how data are being used, ii) the need to investigate how data were created and who uses such data, iii) the need to design systems based on work practices, and in tandem develop and promote forums in which ‘conversations’ around data can take place.

The purpose of this paper is to explore tensions in global public goods (GPG), based on the case of digital platforms for innovation. GPG designs promise normative ideals of nonrivalry and non-exclusivity, which in practice are challenged in reality and fraught with tensions. This paper draws on theory of contradictions to illustrate some of these tensions, which confronts simplistic and linear views that implementing GPG health management platforms will translate unproblematically to efficiency gains. The paper explores field data collected by the authors in the Health Information Systems (HISP) research programme around a digital platform (DHIS2) installed in over 80 countries globally, primarily in the health sector. Episodes are taken from action research undertaken by the authors drawn from experiences of multiple implementations in various countries. This paper furthers the theoretical understanding of contradictions arising from the espoused ideals of GPGs and the realities of their implementation and use. The implications focus on the need to move away from simple deterministic visions of GPG towards acknowledging the contested nature of their outcomes.

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League tables are used to compare the performance of different entities in the health systems in developing countries. The aim of this paper is to study the implementation process and its effects related to a computerized league table application in Malawi. Focusing on the health district and using a field experiment research approach, the focus is on the implementation process and how it improves information transparency for health managers. Based on routine health data recording in the health management information system DHIS2, the introduced league table was used by the district health management teams in the pilot districts to rank and compare performance among their health facilities. While the introduction of the league tables was challenging, it also showed its potential through effects including improved visibility of information and accessibility for managers, better understanding of indicators, the identification of data quality issues, skills acquisition in computing and information use and improved communication and collaboration among stakeholders.