Revisiting Strategies: A Hybrid Study on the Effective Implementation of the Electronic Community Health Information System for Enhanced Data Quality and Service Provision

Abstract

Background: Implementing an Electronic Community Health Information System (eCHIS) is a high-priority initiative of the Ethiopian  Ministry of Health (MOH). Beyond serving as data capturing and reporting tool, it acts as a job aid for Health Extension Workers (HEWs)  and enhances the provision of health services at the community level. However, the current implementation process is causing delays in  household profiling, and the service provision through eCHIS is limited. This implementation research was planned to evaluate the  effectiveness of eCHIS implementation strategies, skill-oriented training, and regular mentorshipof HEWs.

Methods: A hybrid study design, evaluating the effectiveness of both intervention and implementation strategies, was applied in a  phase-based and iterative approach from January, 2021- December, 2022. Fourteen health posts from 2 woredas, Dangla zuria and  Welmera, were included in the study, with all HEWs in the selected health posts as the target populations. Four rounds of survey- baseline  and three rounds of mentorship- were conducted to measure changes over time. Consequently, the analysis was focused on the  changes in output and outcome indicators. 

Results: After implementation of the selected strategies, HEWs skill in App  initialization,managing the digital family folder, using the reproductive, maternal, newborn and child health (RMNCH) module, referral  and communication, and utilizing eCHIS app were significantly improved. Significant improvement (P<0.001) were also observed in all  indicators of service provision scores, including ANC packages (from 44% to 56.8%), ANC counseling score (from 37% to 59.6%), PNC  counseling score from (36% to 47.9%) and ANC service quality score (from 38% to 58.2%) Completeness of data elements at health posts  significantly improved whencomparing endline with baseline data. The average lag time, for all forms, form completion on the HEWs  tablets to submission to eCHIS server reduced from 11.5 days at baseline to 4.1 daysat the end of the follow up period (last round of  survey). Among the reasons for incompleteness, “not understanding data elements” was the most significant. Both over and under-  reporting weremajor data accuracy issues. 

Conclusion: Implementation of eCHIS showed significant improvement in service provision  and data quality. Combining skill-oriented training and regular mentorship for HEWs proves to be effective eCHIS implementation strategies.