Quality of routine facility data for monitoring priority maternal and newborn indicators in DHIS2: A case study from Gombe State, Nigeria

Abstract

Introduction: Routine health information systems are critical for monitoring service delivery. District Heath Information System, version 2 (DHIS2) is an open source software platform used in more than 60 countries, on which global initiatives increasingly rely for such monitoring. We used facility-reported data in DHIS2 for Gombe State, north-eastern Nigeria, to present a case study of data quality to monitor priority maternal and neonatal health indicators.

Methods: For all health facilities in DHIS2 offering antenatal and postnatal care services (n = 497) and labor and delivery services (n = 486), we assessed the quality of data for July 2016-June 2017 according to the World Health Organization data quality review guidance. Using data from DHIS2 as well as external facility-level and population-level household surveys, we reviewed three data quality dimensions-completeness and timeliness, internal consistency, and external consistency-and considered the opportunities for improvement.

Results: Of 14 priority maternal and neonatal health indicators that could be tracked through facility-based data, 12 were included in Gombe's DHIS2. During July 2016-June 2017, facility-reported data in DHIS2 were incomplete at least 40% of the time, under-reported 10%-60% of the events documented in facility registers, and showed inconsistencies over time, between related indicators, and with an external data source. The best quality data elements were those that aligned with Gombe's health program priorities, particularly older health programs, and those that reflected contact indicators rather than indicators related to the provision of commodities or content of care.

Conclusion: This case study from Gombe State, Nigeria, demonstrates the high potential for effective monitoring of maternal and neonatal health using DHIS2. However, coordinated action at multiple levels of the health system is needed to maximize reporting of existing data; rationalize data flow; routinize data quality review, feedback, and supervision; and ensure ongoing maintenance of DHIS2.

Fig 1. Antenatal care: Completeness of facility reporting and indicator data in Gombe State, Nigeria, July 2016-June 2017.

Notes: ANC = antenatal care; HIV = human immunodeficiency virus; IPT = intermittent preventive treatment of malaria in pregnancy.

Fig 2. Labor, delivery and postnatal care: Completeness of facility reporting and indicator data in Gombe State, Nigeria, July 2016-June 2017.

Fig 3. Consistency between related indicators: Facility-reported indicators for antenatal care in Gombe State, Nigeria, July 2016-June 2017, for 471 primary facilities and 26 referral facilities.

Fig 4. Consistency between related indicators: Facility-reported indicators for labor and delivery services in Gombe State, Nigeria, July 2016-June 2017, for 460 primary facilities and 26 referral facilities.

Fig 5. Consistency of data between original facility registers and reported data in DHIS2, January-June 2017.

Notes: According to WHO guidance, ratios <0.9 or >1.1 indicate that reported data in DHIS2 were inconsistent with data extracted from the original facility register. For the 97 primary facilities where facility surveys and data extraction took place, five facilities offering antenatal and postnatal care services and seven facilities offering labor and delivery services were excluded as the facility registers were unavailable at the time of the survey.

Fig 6. External consistency of priority MNH indicators, comparing DHIS2 data for July 2016-June 2017 with matched facility-clusters of a household survey in Gombe State, Nigeria (n = 79 facilities).

Notes: ANC = antenatal care. Household survey denominator for (i) four or more ANC visits, (ii) anemia testing during ANC, and (iii) proteinuria testing during ANC: number of women who had received at least one ANC visit while pregnant during the one year prior to the survey (n = 377 women). Household survey denominator for deliveries by skilled birth attendant: number of women who had given birth in a facility during the one year prior to the survey (n = 588 women).