Towards acceptable health information systems quality in low-resource settings: still simple and practical approach?

April 23rd, 2012

I  enjoy reading the publication of Mphatswe et al[1] reporting superb effort to improve health information management practice in a low-resource setting. They claim to perform a simple and practical solution to increase data completeness (from 26% to 64%) and accuracy (from 37% to 65%) applied in prevention of mother-to-child transmission (PMTCT) program in health facilities of Kwazulu-Natal, South Africa.

Even though the quality is much improved, the authors admitted that it was still below the acceptable standard of health information system. We assume that, this great achievement was occurred due to the very poor baseline health information management practice[2]. Once this improvement achieved, the critical point is that do we believe that similar simple and practical recipe will work in the later stage?

This question was driven by two hidden facts in the paper. First, authors did not explain the improvement by the sites of health facilities: urban, semi urban and rural areas. In many low-resource settings, gap of infrastructure, facilities and level of accessibility usually exist. Second, intervention for completeness appeared to be more successful in the delivery wards (increased from 28% to 86%) than in the antenatal clinics (increased from 25% to 63%). In terms of accuracy, virtually no difference existed by the types of services. The final data audit showed that both services reached 65%, started by from 37% in the antenatal care and from 41% in the delivery ward. If explored further, whether this relates to higher number of data element to record in the antenatal care (nearly 1000) than in delivery ward (only 50)? Maybe it is related to the duplication of reporting forms or registries? Or even high load of patients, HIV and non HIV, visiting the antenatal care compared to on duty health professionals?

I believe the uniqueness of changing practical behavior of health professionals in low-resource settings. The case will be more complicated if it involves health information technology and cultivate the culture of information. Sittig and Singh introduced 8 dimensions to be considered in such situation[3]. To ensure good quality data, lesson from Malawi recommend considering rewards and incentives[4]. On contrary, there is limited evidence that financial incentive could change health professionals practice[5]. Whatever the solution to continuously increase and then keep sustain the quality of health information systems, I  support the work of the authors which will be harder and more complicated.

Lastly, Indonesia receives support from Global Fund Round 10 Cross Cutting Health Systems Strengthening to improve health information. One of the main activities is to conduct of data quality assessment at primary health center, hospital and district health offices which will be implemented in 2013. Therefore, further dialogues and experiences to disclose best practices of health information systems quality in low-resource settings are well-appreciated.


  1. Mphatswe W, Mate K, Bennett B, et al. Improving public health information: a data quality intervention in KwaZulu-Natal, South Africa. Bull World Health Organ. Mar 1 2012;90(3):176-182.
  2. Mate KS, Bennett B, Mphatswe W, Barker P, Rollins N. Challenges for routine health system data management in a large public programme to prevent mother-to-child HIV transmission in South Africa. PLoS One. 2009;4(5):e5483.
  3. Sittig DF, Singh H. A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Qual Saf Health Care. Oct 2010;19 Suppl 3:i68-74.
  4. Makombe SD, Hochgesang M, Jahn A, et al. Assessing the quality of data aggregated by antiretroviral treatment clinics in Malawi. Bull World Health Organ. Apr 2008;86(4):310-314.
  5. Flodgren G, Eccles MP, Shepperd S, Scott A, Parmelli E, Beyer FR. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database Syst Rev. 2011(7):CD009255.

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