An evaluation of the District Health Information System in rural South Africa

Introduction and objectives Reliable health information is essential for the planning and management of locally responsive health services. The District Health Information System is a national system that collects routine health service utilisation data monthly from all public health care facilities. As part of a larger study on improving information systems for primary care, we aimed to describe the functioning of the DHIS in 10 rural clinics in KwaZulu-Natal; to assess data quality, and utilisation for facility management. Perceptions of work burden and usefulness of the system to clinic staff were also explored. Methods Semi-structured key informant interviews were conducted with clinic managers, supervisors, and district information staff. Data collected over a 12-month period for each clinic were assessed for missing data, data out of minimum and maximum ranges, and validation rule violations. Results The study found a high perceived work burden associated with data collection and collation. Some data collation tools were not being used as intended. While there was good understanding of the data collection and collation process, there was little analysis, interpretation or utilization of data. Feedback to clinics occurred rarely. In the 10 clinics 2.5% of data values were missing, and 25% of data were outside expected ranges without an explanation provided. Conclusions The culture of information use essential to an information system having an impact at the local level is not strong in these clinics or at the sub-district level. Further training and support is required for the DHIS to function as intended