Use of DHIS2 Immunization Program Data to Identify Health Facilities with Data Quality and Program Performance Gaps

This abstract has been accepted at the 2024 DHIS2 Annual Conference

Use of DHIS2 Immunization Program Data to Identify Health Facilities with Data Quality and Program Performance Gaps

In Uganda, a paper-based system is used to collect routine immunization (RI) data, and then reported through the Health Management Information System (HMIS) and entered into DHIS2. Country and global stakeholders have noted that data quality issues are introduced through this reporting process, resulting in low-quality data, which hinders effective decision-making. To identify gaps in the immunization program at the health facility (HF) level to inform action, Uganda Expanded Program on Immunization (UNEPI) and Division of Health Information (DHI) initiated a project through the US CDC’s Growing E-Health Expertise Knowledge and Skills (GEEKS) program to develop a dashboard visualizing quantifiable data quality and program issues. With UNEPI support, the GEEKS team developed a dashboard using R software for 4 immunization program indicators: number of missing reports, negative DPT1-DPT3 dropout rate, negative DPT vial wastage rate, and the difference between DTP3 and PCV3 vaccinations. In February 2024, the dashboard was piloted at the national level and in four districts: Kagadi, Hoima City, Nakaseke, and Nakasongola. Data from paper records at fourteen HFs were collected and compared to the dashboard’s data to evaluate the dashboard’s accuracy in mirroring real-world conditions. The dashboard highlighted eighteen areas of poor data quality at fourteen pilot HFs. The HFs generally had poor documentation within the child health registers and vaccine utilization forms and 6 of the HFs reported using more vaccines than available in stock, resulting in a negative DPT vial wastage rate. The GEEKS team provided recommendations to the HF staff and conducted capacity-building exercises to improve the HFs’ immunisation data collection activities and reporting. Following its pilot, program managers utilized the dashboard to identify areas of underperformance. It was found that the negative DPT1 to DTP3 dropout rate and negative DTP vial wastage rate were consistently the worst performing indicators across the country. The GEEKS data quality dashboard has reliably underscored areas of poor data quality in DHIS2 data across the Ugandan health system. It is necessary to address these areas of concern to meet national and global immunization goals, including the Immunization Agenda 2030 and GAVI 5.0. Full-scale expansion of this dashboard will inform key stakeholders where to allocate resources best to facilitate interventions to improve data quality and overall RI program performance, leading to a reduction of zero-dose and under-immunized children.

Primary Author: Robinson Amanyiraho

Immunization, Uganda, data quality, Data use, GEEKS, R