Strengthening Tanzania's Routine Health Information System: Incorporating Family Planning Quality Assessment Indicators

Author(s): Donald Kasongi, Hadija Malimusi, and George Kwilasa

Year: 2018

Abstract:

Background: Universal access to family planning (FP) services significantly improves maternal health outcomes by ensuring that those who need but cannot access FP services, most of whom are poor and marginalized women, will receive them. In Tanzania’s Lake Zone area, even with the increase of FP interventions by the public and nongovernmental organization sectors, there are great disparities in FP outreach between urban and rural areas. The team explored the benefits of incorporating FP quality assessment indicators in a decentralized routine health information system (RHIS) in rural districts in the Lake Zone. The overall question was, what are the benefits of incorporating indicators related to FP quality assessment in a decentralized RHIS in rural farming districts around Lake Victoria?

Methods: The study was conducted in Magu District, Mwanza Region, using mixed methods. The study collected quantitative and qualitative data through questionnaire-guided individual interviews, key informant interviews, and focus group discussions. Data sets from primary and secondary sources were analyzed to demonstrate the potential for integration of FP indicators in the RHIS and DHIS 2, the district’s software platform for health information.

Findings: Most respondents (66%) considered RHIS to be a highly effective resource in decision making for improving FP services; 28 percent asserted that RHIS was a moderately effective tool. About a quarter (24%) of all respondents mentioned the absence and inadequacy of FP-related services at health facilities and the low demand for and uptake of FP at health facilities as a constraint to assessing the quality of FP services in an RHIS. Respondents mentioned low data literacy among service providers assigned to the RHIS (22%), delays in data transmission to the RHIS (16%), and inadequate financial and human resources for providing comprehensive FP services (14%) as critical gaps in the current RHIS’ ability to assess the quality of FP services. Close to half (40%) of the respondents asserted that incorporating FP quality assessment indicators into the RHIS would trigger use of FP.

Although the RHIS-DHIS 2 infrastructure has been established in Magu District, evidence of the system’s functionality is limited, as exhibited by the gaps we identified in the completeness, timeliness, representation, and accuracy of the data captured in the system. The lack of FP-related services and commodities at health facilities limits the information system’s effectiveness. Limited training opportunities were mentioned as causes of low data literacy among service providers, while inadequate financial and human resource for providing comprehensive FP services hinders the effectiveness of the RHIS.

Most facility-based service providers and community health workers affirmed that incorporating explicit assessment indicators of FP quality in routine data collection would likely stimulate demand at the facility level and trigger local government action through council health management teams (CHMTs) regarding human and financial resources as well as technical materials.  

Recommendations: The information system needs review to incorporate explicit and stand-alone indicators for capturing FP patterns and trends that can be presented to a CHMT without additional technical analysis. To improve FP uptake, health service providers and community health workers should be incentivized, particularly with periodic in-service trainings to upgrade knowledge and skills. There is a need to explore and invest in technology options for data transmission that are appropriate and cost-effective for rural settings. Guaranteeing a steady supply of FP commodities and appropriate counseling space would motivate and engage clients effectively, ensuring health facility readiness. CHMTs should receive regular trainings to enhance evidence-based decision making and focus on outcomes.

Conclusion: The ministry emphasis on strengthening the RHIS by incorporating explicit and stand-alone FP quality assessment indicators at the health facility level seeks to promote  health system accountability within a decentralized governance system. Despite the heterogeneity and challenges of technology and infrastructure, local government authorities have opportunities to improve the basic determinants of an effective RHIS that can inform the DHIS 2 in a timely and accurate manner.