Barriers and facilitators of the effective use of DHIS2 data to improve program planning and monitoring in Uganda: a sequential mixed methods study.

Uganda adopted the District Health Information Software 2 (DHIS2) in 2012 to monitor public health programs. More than a decade later, the factors that facilitate or hinder the adoption and use of DHIS2 have not been well documented. This study uses a mixed methods design to understand these factors. Ugandan districts were categorized into high, medium and low performance based on weekly reporting, timeliness and completeness into DHIS2. Two districts were selected across each category of high (Yumbe and Maracha), moderate (Kakumiro and Budaka) and low performers (Jinja and Buikwe). In-depth interviews were conducted at national, district, and health facilities with program (immunization, HIV/AIDS, TB, and malaria) managers, district biostatisticians, district health officers, planners, and health facility managers. Data were analyzed thematically. Across the selected districts, the average adoption score (average of all three indicator scores listed above) ranged from 97% for high adopters to 60.3% for low adopters. Enablers of DHIS2 adoption included strong digital infrastructure, adequate and competent human resources, support from implementing partners, and financial incentives. Barriers to DHIS2 adoption were infrastructural challenges and system errors, including a lack of access rights to key cadres and server breakdown. Human resource limitations were also important barriers. Despite DHIS2's role in assessing program performance and real time monitoring of campaigns, data use for decision making remains limited. Findings indicate that the limited investment in its operationalization impedes effective use. This implies improving in-country ownership to routinely upgrade equipment, provide reliable network, and recruit trained personnel.