Developing a framework for improved data use in health management at the district level in Malawi health management information system.

The effective use of Health Management Information Systems (HMIS) is critical for strengthening decision-making and resource allocation in healthcare, particularly in low and middle-income countries such as Malawi. Yet, district level data use remains constrained by institutional challenges that undermine the potential of HMIS. This study proposes a framework to enhance data use in health management at the district level, drawing on institutional theory and the dynamics of coercive, normative and mimetic pressures. A qualitative approach was employed, including semi-structured interviews, participant observations, and documents analysis, to examine how these pressures shape data practices within Malawi's health sector. Findings reveal that improved data use depends on key activities such as regulating practices, building human capacity, sustaining efforts, integrating data tools and platforms, coordinating processes and partnerships, motivating contributions, and sharing best practices. By addressing these institutional concerns, the proposed framework offers actionable recommendations for policymakers and practitioners to foster a culture of data use, strengthen health management decision-making, and advance ICT4D scholarship on HMIS effectiveness and health outcomes in low and middle-income settings.