A Strategy That Improves the Culture of Information Use at Primary Health Care Units in Ethiopia
Abstract Background: Health systems require high-quality data production for health service delivery and program improvement. Ethiopia’s health sector was challenged with lack of quality data from its routine health information system which is an essential element of evidence-based decision making. To overcome this, the Ethiopian Ministry of Health introduced a health information system (HIS) performance monitoring tool named the connected woreda strategy (CWS). This study aims to assess the effectiveness of the CWS to improve culture of information use at primary health care entities. Methods: The study employed a repeated cross-sectional study design through pre and post testing of district health offices using connected woreda assessment tools. A total of 78 districts were enrolled in this study to assess their performance on the implementation of the CWS. The CWS assessment checklist is comprised of 54 questions, all of which were assigned numeric number response types and categorized into HIS capacity (30%), data quality (30%), and administrative data use (40%) and further categorized as districts that meet the highest standards, (>90% of common set of criteria) i.e. ‘model woredas’, districts that meet medium standards, (between 65% to 90% score of common set criteria) i.e. ‘candidate woredas’ and districts that meet lowest standards (<65 of common set of criteria) i.e. ‘emerging woredas’. Finally, the data were analyzed using the SPSS-version 25 software. Results: A total of 78 districts were employed and described and a paired sample t-test was used to measure the performance of districts on CWS implementation. Due to CWS implementation, 10% of districts were ‘models’ in HIS performance; ‘candidate’ districts increased from 40% to 73%; and ‘emerging’ districts decreased from 60% to 17%. Finally, overall CWS scores showed significant improvements after the intervention with 73.4 ± 10.48 SD compared to before intervention 60.4±13.69 SD, with t (77) =-7.18 and p=0.001. Conclusions: This study has revealed that the CWS implementation has a positive effect towards cultural transformation of use of data for decision making at primary health care entities. Thus, scaling up the connected woreda implementation is recommended at the national level to improve the performance of primary health care entities.