Going digital: added value of electronic data collection in 2018 Afghanistan Health Survey.

Background: Through a nationally representative household survey in Afghanistan, we conducted an operational study in two relatively secure provinces comparing effectiveness of computer-aided personal interviewing (CAPI) with paper-and-pencil interviewing (PAPI).

Methods: In Panjshir and Parwan provinces, household survey data were collected using paper questionnaires in 15 clusters, and OpenDataKit (ODK) software on electronic tablets in 15 other clusters. Added value was evaluated from three perspectives: efficient implementation, data quality, and acceptability. Efficiency was measured through financial expenditures and time stamped data. Data quality was measured by examining completeness. Acceptability was studied through focus group discussions with survey staff.

Results: Survey costs were 68% more expensive in CAPI clusters compared to PAPI clusters, due primarily to the upfront one-time investment for survey programming. Enumerators spent significantly less time administering surveys in CAPI cluster households (248 min survey time) compared to PAPI (289 min), for an average savings of 41 min per household (95% CI 25-55). CAPI offered a savings of 87 days for data management over PAPI. Among 49 tracer variables (meaning responses were required from all respondents), small differences were observed between PAPI and CAPI. 2.2% of the cleaned dataset's tracer data points were missing in CAPI surveys (1216/ 56,073 data points), compared to 3.2% in PAPI surveys (1953/ 60,675 data points). In pre-cleaned datasets, 3.9% of tracer data points were missing in CAPI surveys (2151/ 55,092 data points) compared to 3.2% in PAPI surveys (1924/ 60,113 data points). Enumerators from Panjsher and Parwan preferred CAPI over PAPI due to time savings, user-friendliness, improved data security, and less conspicuity when traveling; however approximately half of enumerators trained from all 34 provinces reported feeling unsafe due to Taliban presence. Community and household respondent skepticism could be resolved by enumerator reassurance. Enumerators shared that in the future, they prefer collecting data using CAPI when possible.

Conclusions: CAPI offers clear gains in efficiency over PAPI for data collection and management time, although costs are relatively comparable even without the programming investment. However, serious field staff concerns around Taliban threats and general insecurity mean that CAPI should only be conducted in relatively secure areas.