Electronic community health information system in Ethiopia: current maturity status, opportunities and improvement pathways.

Abstract

Background: Assessing the maturity level of digital solutions and the ability of digital systems to meet the changing needs and demands related to their purposes is essential. Despite Ethiopia's significant efforts in expanding the electronic Community Health Information System (eCHIS), the results have been below expectations, varying by location and hindered by several issues. This research aimed to evaluate the current maturity status, identify implementation gaps and propose future directions for improving eCHIS in Ethiopia.

Methods: Through a consultative workshop, a collaborative assessment was carried out with the participation of key stakeholders and experts. The Stages of Continuous Improvement (SOCI) tool was used to measure maturity levels in 39 subcomponents, 13 components and 5 core domains. The evaluation focussed on the leadership and governance of the digital health system, human resources, information and communication technology (ICT) infrastructure, interoperability and data quality and use. The measurement scales used were Emerging, Repeatable, Defined, Managed and Optimized.

Results: The current maturity status of eCHIS is rated as repeatable (2.24/5) and aims to improve to the defined state (3.75/5) by 2025. Comparatively, the leadership and governance domain had the highest level of maturity (2.67/5), followed by the standards and interoperability domain (2.47/5) and the data quality and use domain (2.28/5). The ICT infrastructure (1.67/5) and management and workforce (2.09/5) domains have the lowest level of maturity. Strengths include the presence of a comprehensive HIS strategic plan, updated standard guidelines and operational manuals, a defined organizational structure and processes for eCHIS, defined data management, reporting and use procedures, monitoring and evaluation (M&E) mechanisms for eCHIS and central eCHIS infrastructure capacity. Areas of improvement in the digital solution included the absence of certain aspects such as a standard eCHIS training curriculum (both pre-service and in-service), reliable power supply and connectivity at health facilities, robust business continuity plans, a multiyear budget and a skilled workforce. Furthermore, weaknesses were also found in the enforcement of existing laws, regulations and policies, as well as leadership and coordination within the eCHIS program at lower levels.

Conclusions: The implementation status of eCHIS in Ethiopia was at the repeatable stage, with the ICT infrastructure domain having the lowest level of maturity compared with the other four domains. By 2025, the current maturity status was planned to advance to the defined stage by addressing the identified gaps. To achieve this maturity level, various action points are suggested.