Evaluation of the District Health Information System 2 Supported Malaria Reporting System in Solomon Islands

Abstract

BackgroundDistrict Health Information Systems 2 (DHIS2) is used for supporting health information management in 67 countries, including Solomon Islands. However, there have been few published evaluations of the performance of DHIS2-enhanced disease reporting systems, in particular for managing infectious diseases such as malaria. The aim of this study was to evaluate DHIS2 supported malaria reporting in Solomon Islands and to develop recommendations for improving the system.MethodsThe evaluation was conducted in three administrative areas of Solomon Islands: Honoria City Council, and Malaita and Gundacanal Provinces. Records of nine malaria indicators from 1st January to 31st December 2016 were extracted from the DHIS2 database. The indicators permitted assessment in four core areas: availability, completeness, timeliness and reliability. To obtain more detailed information on performance of the malaria case reporting system, focus group discussions (FGD) were conducted with health centre nurses, whilst in-depth interviews (IDI) were conducted with stakeholder representatives from government (province and national) staff and WHO officials who were users of DHIS2. ResultsData were extracted from nine health centres in Honoria City Council and 64 health centres in Malaita Province. Overall, completeness of all nine indicators was 28.2% and 5.1% of health centres submitted reports on time. The most reliable indicator in DHIS2 was ‘clinical malaria’ (i.e. numbers of clinically diagnosed malaria cases) with 62.4% reliability. Challenges to completeness were a lack of supervision, limited feedback, high workload, and a lack of training and refresher courses. Health centres located in geographically remote areas, a lack of regular transport, high workload and too many variables in the reporting forms led to delays in timely reporting. Reliability of reports was impacted by a lack of technical professionals such as statisticians and unavailability of tally sheets and reporting forms. ConclusionThe availability, completeness, timeliness and reliability of nine malaria indicators collected in DHIS2 were variable within the study area, but generally low. Continued onsite support, supervision, feedback and additional enhancements such as electronic reporting will be required to further improve the malaria reporting system.