JMIR Publications

ABSTRACT

Background:

Although Ethiopia has made remarkable progress in the uptake of the District Health Information System (DHIS2) for national aggregate data reporting, there has been no comprehensive assessment of the maturity level of the system. This research aimed to assess the current maturity status, implementation gaps, and future direction of DHIS2 implementation in Ethiopia. The assessment focused on digital health system governance, skilled human resources, ICT infrastructure, interoperability, and data quality and use.

Objective:

This paper aims to assess the maturity level of DHIS2 implementation in Ethiopia and propose a roadmap that could guide the progress toward a higher level of maturity.

Methods:

A collaborative assessment was conducted with the engagement of key stakeholders through consultative workshops using the Stages of Continuous Improvement (SOCI) tool to measure maturity levels in 5 core domains, 13 components, and 39 subcomponents.

Results:

The national DHIS2 implementation's current maturity level was at the defined stage, scoring 2.81, and planned to move to the manageable stage (4.09) by 2025. Domain-wise maturity score indicated that except for ICT infrastructure which was at the repeatable stage (2.14), the remaining four domains are at the defined stage (3.0). The development of a standardized and basic DHIS2 process at the national level, the development of a ten-year strategic plan to guide the implementation of the digital health system including DHIS2, and the presence of required competencies at a facility level to accomplish specific DHIS2-related tasks are the major strengths that the MOH of Ethiopia works so far. The lack of workforce competency guidelines to support the implementation of DHIS2, the unavailability of core competencies (knowledge, skills, and abilities) required to accomplish DHIS2 tasks at all levels of the health system, and ICT infrastructures like network and Internet connectivity fixed at the district, zonal, and regional levels are the major hindrances of effective DHIS2 implementation in the country.

Conclusions:

Based on the SOCI maturity model toolkit, the implementation status of DHIS2 in Ethiopia was at the “Defined” stage with the ICT infrastructure domain having the least level of stages as compared to the other four domains. By 2025, the current status of maturity is planned to move to the “Managed” stage by improving the identified gaps. In order to reach the stated maturity level, various action points are suggested to address the identified gaps. The responsible body, necessary resources, and methods of verification are also listed to reach the specified maturity level.