Organizational Factors Influencing the Adoption of the District Health Information System 2 in Uasin Gishu Sub County Hospitals, Kenya

Abstract

Sound and reliable information is the foundation of decision making across all health system building blocks that include: service delivery; health workforce; health information; medical products, vaccines and technology; financing; leadership and governance. This study is built on the health information system pillar. The aim of this study was to assess the use of District Health Information System data in decision making in Uasin Gishu Sub County Hospitals. The specific objectives were to determine the level of knowledge, organizational, technical and behavioral factors that influence the use of DHIS2 data in Uasin Gishu Sub County Hospitals. The study was conducted in Uasin Gishu Sub County Hospitals. The study employed both quantitative and qualitative approaches using cross-sectional research design. A questionnaire was used to collect quantitative data from 283 health workers who were selected randomly while 10 key informants were selected purposefully from this sample for in-depth interviews. The quantitative data was coded and analyzed using R Software for descriptive, bivariate and multivariate logistic regression. Thematic analysis was used to analyze qualitative data using Qualitative Data Analysis (QDA) software. Bivariate association between the independent variables and the dependent variable was assessed using Pearson‘s Chi Square test and fishers exact test where chi square assumptions were violated. Multivariate analysis was done using logistic regression to assess for predictors. A P value of 0.05 was considered as significant. The results of the quantitative data were presented in the form of graphs, tables and charts, while the results for qualitative data were presented in the form of themes. Approval to conduct the study was obtained from the KeMU Scientific Ethics Research Committee (SERC) and from National Commission for Science, Technology and Innovation (NACOSTI). Consent was sought from participants for the study. The study found that 68.4% of the participants reported good, very good or excellent competence levels in data management using DHIS2 while use of information in DHIS2 to inform policy and operational decision making was reported as good, very good, and excellent by only 37.3%, 18.9%, and 8.0% respectively. A half of the participants (50.0%) acknowledged that there are adequate finances to run DHIS2, the main champions promoting use of DHIS2, information for decision making in the County were county health records and information officers (56.2%). Moreover, 61.7% of the participants agreed or strongly agreed that age influences the way health workers adopt and use DHIS2 in the hospitals while 65.4% of the participants were dissatisfied with the IT support received from the Ministry of Health. Although 80.9% of the participants had log in credentials, only 24.2% had difficulty with logging into the DHIS2. Furthermore, 79.5% had low or moderate level of training in DHIS2 but 15.0% had never trained and this could be the reason why only a third of the participants had some confidence in handling a task using DHIS2. The study concludes that the level of knowledge regarding the use of DHIS2 information is fair across the six Sub County Hospitals in Uasin Gishu County but utilization of DHIS2 information by county health managers for decision making is low. It also concludes that the main funder of the DHIS2 system is the County Government while support from National Government is minimal, while age influences the way health workers adopt and use DHIS2 data in Uasin Gishu Sub County Hospitals. Lastly, the level of training on DHIS2 is generally low while utilization of information on DHIS2 in facilitating evidence-based decision making in the Sub County Hospitals range from moderate to low. Consequently, the study recommends that the County scales up utilization of DHIS2 information and generates policy measures to ensure utilization of DHIS2 information to facilitate decision making at the County.