Strengthening Data Use in Routine Immunization: �A Mid-Evaluation of DHIS2 EPI Dashboard Enhancements in Uganda

Omiel Patrick Okecho ¹ , Vittoria Crispino² ,  Nakibuuka Joan ¹ , Tumusiime Besigye Albert³ and Biroma Godfrey³  and Dr. Prosper Behumbiize ¹

 1) HISP Uganda, 2) University of Oslo, HISP Centre, 3) Ministry of Health, Uganda

DHIS2 Annual Conference 2024

Background and context

• HISP Centre, WHO, and partners develop DHIS2 health toolkits.
• Over 70 countries have implemented in the national DHIS2 instances
• HISP Uganda has supported MOH to implement these toolkit since 2018
• The goal was to enhance data analysis and data use.
• BUT limited use of these toolkits was observed
• In 2022, a participatory approach was adopted to revamp the dashboard
• Baseline assessment was conducted October 2022
• Mid-term assessment in November 2023.
• This presentation is to disseminate key findings of the mid-term assessment.

Project activities

This is the broader support of the GAVI's Targeted Country Assistance (GAVI TCA). Specific activities include;

• Stakeholder engagement and requirements gathering
• Joint program indicator reviews and alignment to the national EPI program
• Redesign of the visualisations and the dashboard
• Dashboard demonstration to stakeholders and solicitation of feedback
• End-user training at national, district and facility levels:
• Evaluating the use of the dashboard

Objectives of the mid-term assessment

Scope and Methodology

• Prospective and non-experimental design, with baseline, mid-term and endline assessments
• Purposely and conveniently sampled district and facility users who meet the eligibility criteria
• Assessment tool with both structured and open-end questions, administered via Google Forms
• 216 and 94 respondents at mid-term and baseline assessments respectively
• 62 of 216 respondents at mid-term participated in both and were used for comparative analysis

Both (n): 62

Key findings - Profiles of respondents

• 55 of 146 districts, non-response from Kigezi and Kampala regions
• Majority of the participants were Facility EPI focal person and District Biostatisticians

Key findings –Appropriateness and comprehensiveness

• Agreement = strongly agree+agree
• At mid-term, for 216 respondents assessed;
• Coverage and dropout were the highest, both at 87%
• followed by stock and wastage monitoring at 78%, and cold chain management at 76%.

• Mid-term Vs baseline results; 62 and 94 respondents respectively;
• Notable improvement of user perceptions across all the areas.
• Cold chain and AEFI, in particular, showed substantial positive shifts compared to the parameters.

Key findings - Accessibility and Ease of Use

• Mid-term Vs baseline results; 62 and 94 respondents respectively;
• Notable improvement across all the areas.
• User manual showed a substantial increase in availability
• Ease of navigation was the least improvement.
• Training materials developed and utilized during the training sessions could have improved the perception on user manual

Key findings - Training and capacity building

• Mid-term Vs baseline results; 62 and 94 respondents respectively;

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• Decrease from 65% to 47% of respondents trained on the dashboard.
• At baseline, it was on general DHIS2 training, not dashboard
• Training adequacy at mid-term increased potentially due to the improved quality of training materials.�

Key findings – Dashboard views

Based on the DHIS2 usage analytics;

• Threefold growth
• 78 views per month at baseline
• 225 views per month by December 2023
• Improvement is notable but still falls short of the expected considering the number of users at health facility, district, and partners

Key findings – Challenges

Internet - Lack of institutional internet, slow speed with poor coverage, low budget support for data and devices.

Training - First time training on the dashboard, need for general DHIS2 training, more training at district and less at facility level.

Data quality - Lack of facility-level targets or catchment population data. Missing reporting tools for new antigens

System access - Lack user accounts or insufficient rights, infrequent access and unavailability of devices like computers.

Design improvement - Not user-friendly for some people, missing indicators like for the surveillance.

System performance - Occasional downtimes, failures during analysis, freezing, slow response times.

Recommendations

Recommendations (ctd..)

Acknowledgement

• Respondents
• EPI focal persons at facility and district
• District Biostatisticians
• Ministry of Health - UNEPI
• Ministry of Health - DHIM
• African Field Epidemiology Network (AFENET)
• WHO Uganda
• HISP Uganda and HISP Centre UiO