Strengthening district-based health reporting through the district health management information software system: the Ugandan experience.

BACKGROUND: Untimely- incomplete and inaccurate data are common challenges in planning- monitoring and evaluation of health sector performance- and health service delivery in many sub-Saharan African settings. We document Uganda\'s experience in strengthening routine health data reporting through the roll-out of the District Health Management Information Software System version 2 (DHIS2). METHODS: DHIS2 was adopted at the national level in January 2011. The system was initially piloted in 4 districts- before it was rolled out to all the 112 districts by July 2012. As part of the roll-out process- 35 training workshops targeting 972 users were conducted throughout the country. Those trained included Records Assistants (168- 17.3%)- District Health Officers (112- 11.5%)- Health Management Information System Focal Persons (HMIS-FPs) (112- 11.5%)- District Biostatisticians (107- 11%) and other health workers (473- 48.7%). To assess improvements in health reporting- we compared data on completeness and timeliness of outpatient and inpatient reporting for the period before (2011/12) and after (2012/13) the introduction of DHIS2. We reviewed data on the reporting of selected health service coverage indicators as a proxy for improved health reporting- and documented implementation challenges and lessons learned during the DHIS2 roll-out process. RESULTS: Completeness of outpatient reporting increased from 36.3% in 2011/12 to 85.3% in 2012/13 while timeliness of outpatient reporting increased from 22.4% to 77.6%. Similarly- completeness of inpatient reporting increased from 20.6% to 57.9% while timeliness of inpatient reporting increased from 22.5% to 75.6%. There was increased reporting on selected health coverage indicators (e.g. the reporting of one-year old children who were immunized with three doses of pentavelent vaccine increased from 57% in 2011/12 to 87% in 2012/13). Implementation challenges included limited access to computers and internet (34%)- inadequate technical support (23%) and limited worker force (18%). CONCLUSION: Implementation of DHIS2 resulted in improved timeliness and completeness in reporting of routine outpatient- inpatient and health service usage data from the district to the national level. Continued onsite support supervision and mentorship and additional system/infrastructure enhancements- including internet connectivity- are needed to further enhance the performance of DHIS2.