STUDY: The quest for better interventions to improve health information systems
In their quest for better interventions to improve health information systems, seven researchers from Africa and Europe conducted a study that aimed to understand maternity care providers’ perceptions of data and how they use it for documentation in health facilities.
The seven researchers – among them Elibariki Mkumbo from Ifakara Health Institute – conducted the study with maternity care providers to understand their interaction with data in two rural hospitals in Southern Tanzania between February and June 2021.
Other researchers who contributed to the study are; Regine Unkels, Fadhlun Alwy Al-Beity, Claudia Hanson and Helle Molsted-Alvesson from Karolinska Institutet, Sweden; Zamoyoni Julius from Aga Khan University, Tanzania; and Andrea Pembe from Muhimbili University of Health and Allied Sciences (MUHAS), Tanzania.
In the study paper, published in the BMJ journal on January 6, 2023, the researchers argued that despite the inadequacy of current health information systems, co-designing interventions to improve data quality is essential.
“Current health information systems may not meet all data demands of maternity care providers or other healthcare workers. Policymakers and health information system specialists need to acknowledge different ways of data use beyond health service planning, with an emphasis on healthcare providers’ data needs for clinical documentation,” they said.
According to the researchers, data on service provision from health facilities is considered vital for health system strengthening. Globally, the data captured by Health Management Information Systems (HMIS), informs national and subnational health system performance monitoring including; monitoring and evaluation, resource planning and service management.
In most low-income and middle-income countries like Tanzania, the HMIS is organized around preprinted registers and forms filled by healthcare providers. In Tanzania, maternity care providers are responsible for HMIS documentation of maternity care using three preprinted registers for antenatal care, labor and delivery and postnatal care, daily tally sheets and monthly summary forms.
However, the system, (of using three preprinted registers) particularly in the case of the two rural hospitals in Southern Tanzania where the study took place, proved not to be effective due to several reasons highlighted in the paper.
One major reason was that it made maternity care providers feel alienated from the numeric nature of health management information system data because it neither fulfilled their need for clinical care, communication and service improvement nor for support and relationship building in a challenging working environment.
Additionally, health personnel had to add informal notes and registers to address their administrative and clinical data needs and appropriated existing data and documentation tools to create accounts of a social reality for example where they kept mothers and babies safe during labor despite workplace challenges.
As a result of these limitations, the researchers recommended re-designing health information systems with an ‘all-data-view’ in mind, taking all users on board, including maternity care providers and their clinically oriented narrative data
“Health data is not neutral, and users assign different meanings to it. Policymakers need to see health information systems as one component of the wider health system where other parts, such as staff and supply availability, should be improved to positively influence MCPs' realities which may then affect data quality and use.”