The Performance of Health Management Information System Case Study of a District from Central Maharashtra

Abstract

Good governance, transparency and accountability have become the mantra of development, and newline consequently more attention is given to strengthening evidence-based decision-making and newline information systems. The launching of a national portal-based Health Management Information newline Systems (HMIS) by Government of India in 2008 was a bold and innovative step in this regard. State newline government of Maharashtra additionally implemented District Health Information System (DHIS 2) newline application to facilitate use of data for decision making. However, several challenges continue to newline hinder HMIS as an effective tool for planning and monitoring. This study aims to examine the newline performance of HMIS and explore underlying factors that affect it within health systems perspective. newline The research uses realistic evaluation approach and employs case study design. The case here is of newline HMIS for Reproductive and Child Health programme within a district in Central Maharashtra. newline Multistage sampling was used to identify facilities covering all levels of health facilities. The main newline data collection methods were semi-structured interviews of study participants (health workers and newline managers), observation and review of the records (reporting formats, recording registers, reports, newline electronic systems). newline Assessment of HMIS performance reveals that certain aspects such as timeliness and completeness, newline transmission of data have improved considerably and consequently the analysis of data at central level newline has become much easier. However, data accuracy issues and lack of data use persist even in the newline systems with HMIS reforms. The study identifies institutional culture as a prominent reason. The newline traditional top-down approach continues which reinforces role of lower levels as data entry points, newline that of middle levels as data transmission channels and top levels as decision making points. The pre- newline existing and evolving institutional logic shall determine the manner in which technology gets shaped newline and introduced in health system and the way it would operate. It is not only about disconnect between newline most peripheral to most central level but also at each level. HMIS is a fairly designed technologically newline intervention but relevant changes in organisational processes and culture are lagging behind. Hence, newline what is important is to begin with need assessment from most peripheral users. There is need to make newline decentralised data based decision making as the focus and attempts to be made to bring changes in newline institutional systems. This highlights the need to move from information technology to health newline informatics from health systems perspective. newline