A Systematic Review of Factors Affecting the Implementation of the District Health Information System Two (Dhis2) in Sub Saharan Africa

Abstract

Background

Health management information systems have been hailed as important tools for health reform, information dissemination and quick decision making. The systems are used to record information on health events and check the quality of services at different levels of health care. Although the beauty and the benefits of these systems are more pronounced, the underlying factors for and against their implementation for example the district health information system version two (DHIS2) are not very clear yet they involve complex processes of modelling and embedding. This systematic review synthesized literature and put together evidence relating to the factors affecting the implementation of DHIS2 and took into consideration the implementation processes.

Objectives

This systematic Review was undertaken to: 1) identify the implementation processes of DHIS2 in Sub Saharan African countries, 2) gather evidence(s) on the factors leading to the successful implementation of the District Health Information version two (DHIS2) among Sub Saharan African Countries that have adopted it and 3) assess the existing policies and legislations in favour of DHIS2 implementation.

Method/Design

The sources searched included studies from: 1) PubMed 2) BASE 3) LILACS 4) Cochrane library 5) TRIP 6) Google scholar 7) Project Muse 8) EBSco host 9) Emerald Insight. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PICO criteria was employed in order to assess the countries (participants), implementation of the system (DHIS2) (intervention), comparator studies and outcome relating to qualitative data on factors that inhibit or promote implementation of DHIS2. The search terms included “DHIS2 implementation”, “DHIS2 enablers”, “DHIS2 inhibitors”, “DHIS2 processes”, “DHIS2 success stories”, generally implementation and adoption of the system among others that yielded the studies included.

Study selection

The studies selected covered the period from 1st January, 2010 to 30th June, 2016. The key filters included PEER REVIEWED articles on implementation factors and processes of implementation of the system (DHIS2) among others were considered and articles published in English language were selected. The key exclusion parameter was non-PEER REVIEWED status of the study.

Findings

Three studies were included for review out of 8,834 studies identified following the inclusion and exclusion criteria. The review showed processes undergone in the implementation of DHIS2. Some enablers and inhibitors of DHIS2 were shown by the review. The Health managers who utilize health information for decision making were shown to be far distant from the implementation and utilization of DHIS2 in the review yet they are decision makers. The policies and legislation guiding the implementation of DHIS2 were found to be lacking. This should be something of serious consideration in Sub Saharan Africa and the World at large as ICT continues to influence day to day work routines in a number of sectors ranging from health to military.

Limitations

The main limitation in this study was the review of PEER REVIEWED articles reported in English language leading to a narrow review. Also looking at only the national roll-out of DHIS2 leaving out test and piloting stages of implementation constricted the studies. Another limitation was the scope of the review which considered only Sub Saharan Africa yet DHIS2 implementation has spread to Asia and Latin America.

Conclusion

The review demonstrated the implementation processes of DHIS2 with enablers and facilitators. Interestingly, no policies were found to have been put in place to govern the implementation of DHIS2 in Sub Sahara Africa.

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