Organisational and management factors and related end-users' perspectives relevant to newborn and stillbirth data at different levels of the health system: findings of the IMPULSE study in Uganda, Ethiopia, Tanzania, and the Central African Republic.

Background: As few studies systematically analysed organisational and management factors related to newborn and stillbirth data quality, we sought to identify specific gaps in these factors to provide evidence for planning tailored actions. Methods: We performed a cross-sectional survey in 12 regions and 4 city administrations in the Central African Republic (CAR), Ethiopia, Tanzania, and Uganda between November 2022 and July 2024, collecting data related to organisational and management factors at different health system levels through the Every Newborn - Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) tools. We reported the results as frequencies/normalised PRISM scores, both on the overall sample and by country, and conducted exploratory subgroup analyses by region. Results: We included 151 sites (56 data offices; 95 facilities) and 108 health/data professional respondents. Availability of written documents describing the routine health information system (RHIS) mission, roles, and responsibilities (71.4% in the CAR to 94.1% in Tanzania; P = 0.380), and designated staff for internal data quality review (83.3% in Ethiopia to 100% in the CAR, Tanzania, or Uganda; P = 0.245) showed high percentages and low heterogeneity across countries at data office level. Most of the other measures explored - i.e. those related to governance, planning, financing, capacity development, relevant guidelines, data quality assurance systems, feedback mechanisms and supportive supervision - showed high heterogeneity across countries, with Ethiopia and Uganda, followed by Tanzania, showing the highest percentages, and the CAR showing the lowest. We observed low percentages in all countries at the data office level in the domains of financing (budget for RHIS supplies: 0% in the CAR to 35.3% in Tanzania; P = 0.079) and capacity development (availability of a report with RHIS training needs: 0% in the CAR to 41.2% in Tanzania; P = 0.333; training schedule: 17.6% in Tanzania to 42.9% in Uganda; P = 0.412). Subgroup analyses suggested high within-country heterogeneity. Needs for improvement in management and organisational factors were reported by most respondents (72.7% in Ethiopia to 100% in the CAR; P = 0.629). Conclusions: Our findings reveal a need for tailored interventions to improve organisational and management aspects at different levels of the health system, to ensure better quality and use of newborn and stillbirth data.