Towards improving district health information system data consistency, report completeness and timeliness in Neno district, Malawi

Background: Quality data is crucial in making informed decisions regarding health services; However, the literature suggests that in many LMICs including Malawi, it remains of poor quality. Data quality is measured in terms of completeness, timeliness and consistency among other parameters. We describe the Ministry of Health's District Health Information System (DHIS2) report completeness and timeliness at three levels: National, South West Zone (SWZ) and Neno district. Further, describe data consistency following data quality assessments (DQA) in Neno district, Malawi.

Methods: We conducted a descriptive retrospective study by extracting DHIS2 report completeness and timeliness at three levels and used DQA data in Neno district between January 2016 and December 2022. We defined report completeness as the number of reports in DHIS2 against those expected, timeliness as the number of reports entered into DHIS2 before the deadline and consistency as the level of agreement between three sources: register, report and DHIS2 system. We presented the data graphically and calculated yearly median reporting rates for weekly, monthly and quarterly reports against the national target of 85%. We utilized a verification factor (VF) of 0-200% to evaluate consistency between three sources in the Neno district. VF exceeding 100% indicated over-reporting, 100% as a perfect match, and less than 100% as under-reporting, with an acceptable 90-110% range.

Results: During the study period, we found increased trends in weekly, monthly and quarterly report completeness at all three levels but were below 85%. Neno district surpassed the target from 2020 onward for weekly reports and from 2019 onward for monthly reports. Similar increased trends were observed for report timeliness with below threshold of 85% except for Neno district monthly report from 2021 onward. We found inconsistencies in data entry from the report to DHIS2 (VF: >90% - <110%) in Neno district. Similarly, under and over-reporting occurred between the register and the report (VF: <90% and > 110%) were observed. These findings should be considered when using DHIS2 for decision-making.

Conclusion: In general, we found increased completeness and timeliness rates at all three levels, however, less than the set target of 85%. We suggest continued support, including routine DQAs and report monitoring, towards improving DHIS2 data quality.