An evaluation of the District Health Information System in rural South Africa.

BACKGROUND Since reliable health information is essential for the planning and management of health services, we investigated the functioning of the District Health Information System (DHIS) in 10 rural clinics. DESIGN AND SUBJECTS Semi-structured key informant interviews were conducted with clinic managers, supervisors and district information staff. Data collected over a 12-month period for each clinic were assessed for missing data, data out of minimum and maximum ranges, and validation rule violations. SETTING Our investigation was part of a larger study on improving information systems for primary care in rural KwaZulu-Natal. OUTCOMES We assessed data quality, the utilisation for facility management, perceptions of work burden, and usefulness of the system to clinic staff. RESULTS A high perceived work burden associated with data collection and collation was found. Some data collation tools were not used as intended. There was good understanding of the data collection and collation process but little analysis, interpretation or utilisation of data. Feedback to clinics occurred rarely. In the 10 clinics, 2.5% of data values were missing, and 25% of data were outside expected ranges without an explanation provided. CONCLUSIONS The culture of information use essential to an information system having an impact at the local level is weak in these clinics or at the sub-district level. Further training and support is required for the DHIS to function as intended.