Status and Barriers of the Community Health Information System (CHIS) Implementation in Tiro Afata Woreda, Southwest Ethiopia

Abstract

Abstract
Background: Quality data and appropriate information utilization are vital for the effective management of community-level health programs and interventions. In Ethiopia, the Community Health Information System (CHIS) has been implemented since 2012. However, little evidence exists regarding its implementation status. In Tiro Afata Woreda, southwest Ethiopia, this study sought to examine the factors that contribute to and hinder the adoption of a community health information system.
Methods: A mixed-methods design was used to conduct the study from March to April 2021 in 19 health posts (HPs), where key informant interviews were undertaken with 21 purposefully selected health extension workers. Based on the Performance of Routine Information System Management (PRISM) concept, a quantitative questionnaire was created. Descriptive statistics were used to analyze quantitative data, and an index was computed for the implementation status of CHIS. Thematic analysis was performed on qualitative data.
Results: A family folder was available in 13/19 HPs, integrated maternal and child health care in 15/19 HPs, and a family health card in 14/19 HPs. Overall, 6/19 HPs had folders, health cards, a field book, and a master family index, and 3/19 HPs had all the recommended tally sheets and CHIS tools. Fifteen out of nineteen HPs had shelves, 16/19 had tickler file boxes, and 14/19 had at least one trained health worker on data management and use. One out of nineteen HPs had properly practiced data quality reviews, and only two of the examined indicators (measles <1 year’s coverage and under-five pneumonia cases diagnosed) out of five have met an accuracy target (verification factor: 0.9–1.1). Sixteen out of nineteen HPs have submitted reports on time. None of the HPs has practiced performance reviews, and only three out of the 19 HPs have prepared recommended data visualizations. Moreover, only 6/19 HPs have used routine data for planning. A shortage of health workers, overburdened tasks, a lack of supportive supervision and supply of tools, and language barriers (English) in completing tools are hurdles in implementing CHIS.
Conclusions: The performance of the CHIS was generally low. Data quality and information utilization were below the national target. Therefore, it is required that data management tools be supplied, supportive supervision must be strengthened, and data management tools must be produced in local languages for user convenience. [Ethiop. J. Health Dev. 2022;36 (SI-2)]
Keywords: Implementation, Barriers, Community Health Information System, District, Ethiopia.