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Background: The Capacity Building and Mentorship Program (CBMP) has been implemented in Amhara Region to enhance data use for decisions. Though the intervention is effectively improving the routine health data use for decision-making, knowledge on the facilitators and barriers in implementing the CBMP is scarce. Therefore, this study sought to explore the facilitators and barriers that affect the implementation of the CBMP in improving evidence-based decision-making in the Amhara National Regional State of Ethiopia.Methods: A hermeneutical phenomenology qualitative study was done in five districts of the Amhara region from 5th June to 30th July/ 2020. The study recruited 25 key informants working at different health system levels using a heterogeneous purposive sampling method. Codes were developed and assigned to the data, ideas of patterns were searched, and themes and subthemes were identified using abductive thematic analysis.Results: The overarching thematic areas spanning were 1) The need for Capacity Building and Mentorship Program (CBMP), 2) the Effectiveness of CBMP in Routine Health Information System (RHIS) Performances, 3) Implementation Facilitators, and 4) Implementation Barriers. The implementation facilitators and barriers subthemes were human-related, technical, organizational, and socio-economic context-related. Human-related (a favorable attitude towards recommendations for mentors, staff motivation, and leaders’ commitment), technical (skill in data management and use, and the capacity for conducting the performance monitoring team meeting), organizational (access to information, data availability, and resource supply), and contextual (policy support and government concern) were positive attributes. Human-related constraints include resistance to accepting the intervention at the early stage of the intervention period and lack of knowledge on the National Classification of Disease; technical barriers: lack of intra-facility information communication skills and inadequate training; organizational barriers: trained staff turnover, and lack of technology for intra-facility data sharing; and contextual barriers (the onset of the COVID19 and security issues.Conclusion: Human, technical, organizational, and contextual attributes played massive roles in facilitating the implementation. However, strengthening the capacity of health workers, supporting health workers for good use of NCOD, installing intra-facility level data sharing mechanisms, and continuous re-assessment of the context in implementing the CBMP is required.

Background: Ethiopia utilises the district health information system for health information management. However, the lower level health structure seems inaccurate in comparison to the parallel reporting system, with limited evidence on its effect on data quality and information use. Therefore, the present study aimed to assess the influence of a parallel reporting system on data quality and information use at the lower level structures of the Amhara region, Northwest Ethiopia.Methods: The study was conducted in five districts of the Amhara region using an explanatory case study design. Twenty respondents were interviewed from the 1st – 30th April 2021, using a semi-structured key informant interview (KII) guide with multiple probes to explore relevant information. The data was transcribed into English and transferred to the Open-Code 4.02 software for analysis. Textual data were coded, and themes were identified from the synthesis. Inductive thematic analysis was applied to identify the relationships among the emerging themes in order to draw a relevant conclusion.Results: Five themes were emerged from the analysis, including the current practice of parallel reporting, a program area of parallel reporting, the influence of parallel reporting, reasons for parallel reporting, and means to avoid parallel reporting. Likewise, parallel reporting was done at the district level and at the point of service delivery. The respondents described maternal and child health programs often using parallel reporting. Parallel reporting was described as having undesirable impacts on routinely collected health data quality and use. Moreover, it increases the work burden; and affects service quality, the the satisfaction levels of clients and staff, and the overall efficiency. The main reasons for practicing parallel reporting were: missing important data elements in DHIS2, single language, varying stakeholders’ interests, and lack of conducting a partner forum.Conclusion and implication: Against the national health information system’s guiding principles and vision, parallel reporting is practiced at the lower health system levels for various programs. Therefore, a corrective measure should be taken to achieve the country’s information revolution (IR) agenda. To avoid parallel reporting mechanisms, it is recommended that regular partner forums at the district level must be strengthened, important data elements should be incorporated into the DHIS 2, and additional language platforms should be be included in the DHIS2 system.

Supplementary Material 1

Background The government of Ethiopia has envisioned digitalizing primary healthcare units through the electronic community health information system (eCHIS) program as a re-engineering strategy aiming to improve healthcare data quality, use, and service provision. The eCHIS is intended as a community-wide initiative to integrate lower health structure with higher administrative health and service delivery unit with the ultimate goal of improving community health. However, the success or failure of the program depends on the level of identifying enablers and barriers of the implementation. Therefore, this study aimed to explore individual and contextual-level enablers and barriers determining eCHIS implementation. Method We conducted an exploratory study to determine the enablers and barriers to successfully implementing eCHIS in rural Wogera district, northwest Ethiopia. In-depth interviews and key informant interviews were applied at participants from multiple sites. A thematic content analysis was conducted based on the key themes reported. We applied the five components of consolidated framework for implementation research to interpret the findings. Results First, based on the intervention's characteristics, implementers valued the eCHIS program. However, its implementation was impacted by the heavy workload, limited or absent network and electricity. Outer-setting challenges were staff turnover, presence of competing projects, and lack of incentive mechanisms. In terms of the inner setting, lack of institutionalization and ownership were mentioned as barriers to the implementation. Resource allocation, community mobilization, leaders’ engagement, and availability of help desk need emphasis for a better achievement. With regard to characteristics of the individuals, limited digital literacy, older age, lack of peer-to-peer support, and limited self-expectancy posed challenges to the implementation. Finally, the importance of mentoring and engaging community and religious leaders, volunteers, having defined plan and regular meetings were identified elements of the implementation process and need emphasis. Conclusion The findings underlined the potential enablers and barriers of eCHIS program for quality health data generation, use, and service provision and highlighted areas that require emphasis for further scale-up. The success and sustainability of the eCHIS require ongoing government commitment, sufficient resource allocation, institutionalization, capacity building, communication, planning, monitoring, and evaluation.