The Impact of Health Information System Interventions on Maternal and Child Health Service Utilizations in Ethiopia: A Quasi-Experimental Study

Abebaw Gebeyehu Worku; Wubshet Denboba Midekssa; Hibret Alemu Tilahun; Hiwot Tadesse Belay; Zeleke Abebaw; Afrah Mohammedsanni; Naod Wendrad; Mesoud Mohammed; Shemsedin Omer Mohammed; Amanuel Biru; Benti Ejeta Futassa

doi:10.9745/GHSP-D-24-00145

Key Findings

A package of interventions was implemented across all regions in Ethiopia to address the technical, behavioral, and organizational determinants of health information system (HIS) performance to improve the use of routine health data for evidence-based decision-making at all health system levels.
To assess the impact of these interventions on HIS performance and maternal care and immunization service utilization, a facility and household survey were conducted at baseline and endline, showing that, compared to control sites, interventions sites showed greater improvements in 27 of 36 HIS performance outcomes, including reporting completeness, timeliness, accuracy, and information use.
Compared to control sites, intervention sites showed greater improvements in 17 of 19 maternal and child health outcomes, including antenatal care, skilled birth attendance, postnatal care, and family planning, as well as immunization service indicators.

Key Implication

Investing in HIS interventions is one of the key strategies to strengthen HIS performance and improve maternal and child health service utilization.

ABSTRACT

Background:

Health information systems (HIS) are vital in supporting all aspects of managing health systems, financing, policymaking, and service delivery. A package of priority HIS interventions was piloted in selected woredas across all regions in Ethiopia. This study examined the impact of HIS interventions on maternal and child health (MCH) service utilization.

Methods:

A 2-arm quasi-experimental study was implemented in intervention and control woredas. Baseline and endline household and health facility surveys were conducted for both arms in 2020 and 2022, respectively. At baseline, 3,016 mothers and 167 health facilities were surveyed. At endline, 3,076 mothers and 160 health facilities were surveyed. The study used modified Performance of Routine Information System Management tools for the facility survey and a structured questionnaire for the household survey. Difference-in-difference (DID) analysis using mixed effect modeling was employed to measure changes and to account for clustering and control for likely confounders.

Results:

Intervention sites showed greater improvements in 75% of key HIS performance indicators. The changes in 90% of the MCH service utilization indicators were higher in the intervention sites. Significant (DID: P<.05) changes were observed in indicators including quality of antenatal care, skilled birth attendance, delivery at a health facility, family planning met need and unmet need, measles and second dose of rotavirus vaccination, and Vitamin A supplementation. BCG vaccination showed significantly higher improvement in the control sites. Other key indicators did not show significant changes.

Conclusions:

In many of the MCH service utilization indicators, the changes in the intervention sites were significantly higher compared to the control sites, but it was not universal. Scale-up of performance monitoring teams is crucial because it is one of the key pathways that links HIS performance with MCH service utilization. Outcome indicators that showed no or lower improvement require in-depth investigation.

Received: May 26, 2024.
Accepted: November 6, 2024.
Published: December 20, 2024.

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