Barriers and facilitators of the Electronic Community Health Information System (eCHIS) in Ethiopia: Practical Guidance for improved its implementation guided by the Consolidated Framework for Implementation Research (CFIR)

Abstract

Background- Despite the priority given to the electronic Community Health Information System (eCHIS) in Ethiopia, after three years of  its implementation, health extension workers are not yet fully benefited from the system. Household registration remains incomplete,  and service provision is very limited.

Methods- A qualitative case study was conducted from September 2021 to December 2021, enrolling  32 key informants who were purposively selected from diverse stakeholder organizations across four regions of Ethiopia. This  study assessed the key factors facilitating and impeding eCHIS implementation by involving stakeholders ranging from service providers  to policymakers and partner organizations, guided by the comprehensive Consolidated Framework for Implementation Research (CFIR).  

Findings and practical implications- eCHIS offers several promising advantages, including ease of use, reduced  workloads, standardized  services, improved data quality, and enhanced service delivery and referral linkages. Organizational structures such as  Technical Working Groups (TWGs) at all levels and an eCHIS Center of Excellence have the potential to improve and institutionalize eCHIS  implementation in the country. Thus, strengthening the support forum and the regularity and functionality of TWG meetings at all levels  is essential. However due to poor documentation and monitoring mechanisms, as well as the absence of a functional feedback loop,  eCHIS goals are often not acted upon. Activities are not sufficiently followed up, and progress is not checked against feedback.  Insufficient resources to fully support eCHIS represent significant challenges that require further resource mobilization in the future. Additionally, collaborative effort with all key stakeholders and active engagement from leaders are critical to optimizing eCHIS implementation.

Conclusion- eCHIS has demonstrated numerous advantages and a promising future in terms of improving service delivery, data quality,  and utilization. .However, challenges like limited customization, lack of clear guidelines, and insufficient resources hinder its successful  implementation. Addressing these issues, including securing dedicated funding and technical support, is crucial for long-term  sustainability of the program.