Overcoming legacy system hurdles: a case study on enabling master facility registry interoperability within Ethiopia's national eHealth architecture.

Introduction: Legacy health information systems pose significant barriers to achieving interoperability, which is crucial for strengthening health systems, especially in low- and middle-income countries. Ethiopia, in its pursuit of an 'Information Revolution', faced such challenges while working to establish a robust, interoperable Master Facility Registry (MFR). Method: This case study details a multifaceted approach to overcome these legacy system challenges and integrate the MFR within Ethiopia's national eHealth Architecture. The methods involved strategically designing and developing the MFR, coupled with implementing a dedicated interoperability layer to facilitate data exchange, primarily with the District Health Information Software 2. Key stakeholders were engaged throughout the process, guided by national eHealth governance structures. Result: The results demonstrate the successful deployment of a national MFR and achieved interoperability, leading to improvements in health facility data management and accessibility. Challenges related to disparate data sources, varying standards and the need for system-wide coordination were systematically addressed. Discussion: The successful establishment and integration of a national MFR in Ethiopia, particularly its interoperability with District Health Information Software 2, represents a significant advancement in the country's health information system capabilities. This achievement is noteworthy given the prevalent legacy system hurdles. The findings indicate that strategic vision, targeted technical solutions and sustained stakeholder engagement were pivotal. The MFR now provides a unified, authoritative source of facility information and its seamless integration with District Health Information Software 2 ensures that routine health data is accurately contextualized geographically and organizationally, addressing data inconsistency and limited accessibility. Conclusion: The Ethiopian experience offers valuable lessons regarding the strategic importance of a national eHealth vision, targeted technical solutions for interoperability and the necessity of sustained stakeholder collaboration. This initiative underscores the foundational role of an MFR in enhancing HIS performance and provides actionable insights for other low- and middle-income countries striving to modernize their digital health ecosystems despite prevailing legacy constraints.