Perceptions and experiences with District Health Information System software to collect and utilize health data in Bangladesh: A qualitative exploratory study
Abstract Background: Accurate and high-quality data are important for improving program effectiveness and informing policy. Bangladesh Health Management information System (HMIS) has adopted District Health Information software 2 (DHIS) in 2009 to capture real-time health service utilization data. However, routinely collected data are being underused because of poor data quality. We aim to understand the facilitators and barriers on implementing DHIS2 as a way to retrieve meaningful and accurate data for the Reproductive, Maternal and Child Health (RMCAH) services. Methods: This qualitative study was done among two districts of Bangladesh from September 2017 to 2018. Data collection method were key informant interview (n=11); in-depth interview (n=23); focus group discussion (n=2). Study participants were individuals involved with DHIS2 implementation from the community level to the national level. The data were analyzed thematically. Results: DHIS 2could improve the timeliness and completeness of data reporting over time. The reported facilitating factors were strong government commitment, extensive donor support and positive attitude of staffs. Quality checks and feedback loops at multiple levels of data gathering points was helpful to minimize data errors. Introducing dashboard makes the DHIS2 compatible to use as monitoring tool. However, the barriers to DHIS 2 implementation were lack of human resources, slow Internet connectivity, and frequent change of DHIS 2 versions, maintaining both manual and electronic system side by side. The collected data remains incomplete as private health facilities are not covered. The parallel presence of two MISs to report same RMNCAH indicators is a threat to achieve quality data and increases workload. Conclusion: The overall insights from this study are expected to contribute to the development of effective strategies for successful DHIS 2 implementation and building responsive HMIS. To sustain the achievements of digital data culture, focused strategic direction is needed. Periodic refresher trainings, incentives for increased performance, automated single reporting system for multiple stakeholders could make the system more user friendly. A national electronic health strategy and implementation framework can facilitate creating a culture of DHIS 2 use for planning, setting priorities, and decision making among stakeholder groups