Understanding the challenges associated with the use of data from routine health information systems in low- and middle-income countries: A systematic review

Abstract

Background: 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.

A call for standardised age-disaggregated health data

“…In many cases, these records are not digitised until they reach the district level, at which point the granular, disaggregated data have already been lost. 46 Implementing age-specific recording, aggregation, and reporting (in addition to other important aspects) within current processes would result in exponential demands on the systems' human and information and communications technology capacity. To properly record and report these data, substantial resources are required to expand the use of electronic health records and registries, increase information and communications technology capacity, improve data architecture, digitise data recording, develop reporting processes, and build local capacity.…”

Routine Health Information Systems in the European Context: A Systematic Review of Systematic Reviews

“…The operations of RHISs in low-income countries fall below the globally expected standard due to the production and use of poor quality data, or to not using high-quality data to make informed decisions [ 63 , 64 ]. Despite investment in RHISs in low- and middle-income countries, several problems still persist (technical, organizational, financial), thus preventing proper use of RHIS (incorrect data and nonuse of data already in the system) [ 65 ]. The use of RHISs in various low-income countries in Latin America and in Africa is associated with the most significant local public health problems, such as interventions to improve maternal and newborn health [ 66 ], or to reduce communication delays and improve quality of care via a tuberculosis laboratory information system in Peru [ 67 ].…”

“…Ideally, creating intuitive software is an excellent choice that may even increase user acceptance. The development of tools to improve the results of poor RHIS data has been described in other studies with good results [ 65 ]. These tools could even allow data availability and usability to be improved (by both uploading new data and reviewing data that is already available), possibly by using cloud storage services to enable easy access from anywhere and by having a common standard that allows for interoperability of systems in different locations.…”

“…This can be resolved through educational interventions to show the benefits of RHISs and by training staff to use them properly. These actions have been shown to improve staff members’ abilities to use data [ 65 ]. Here, a leadership figure is very important for the purpose of providing guidance during project rollout.…”

Optimizing Pandemic Preparedness and Response Through Health Information Systems: Lessons Learned From Ebola to COVID-19

“…Furthermore, integrated national roll out of the District Health Information Software 2 (DHIS2)-a free, open source, and locally customizable health management data platform used by over 50 countries-could provide real-time data that governments can leverage to better inform aligned outbreak responses. 1,16 Promoting efficient and useful HIS solutions, including incorporating epidemic information systems into existing local DHIS2 and IDSR systems rather than running them in parallel, could avert future failures in policy coordination. To improve governance during public health crises, ministries of health should take ownership of and integrate routine and emergency HIS through cohesive governance of data sharing mechanisms and digital risk communication strategies.…”