Data for local decision-making, not a mere reporting requirement: development of an index to measure facility-level use of HMIS data

Well-functioning health management information systems (HMIS) enable decision-making at all health system levels. This study develops an index to measure the use of HMIS data at the facility level. We used two rounds of cross-sectional data collected from 305 health facilities in Ethiopia in 2019 (pre-COVID-19) and 2020 (post-COVID-19). We constructed a summative, 10-item index using exploratory factor analysis and 2019 index development data; and used Cronbach’s alpha to assess reliability. To examine content validity, we mapped items against a previously published conceptual framework and consulted Ethiopian experts. We then employed one-way ANOVA and t-tests comparing the mean index scores overall and by key facility characteristics between 2019 and 2020. The 10-item index loaded on one factor (Cronbach’s alpha=0.74), and the index scores did not differ significantly by facility characteristics in 2019. The mean index score increased from 7.2 in 2019 to 7.9 in 2020 (P<0.01). During this period, more facilities received feedback on HMIS reports from facility leadership (19.3% difference); received actionable recommendations on performance targets and resource allocation (7.5% and 12.3% difference, respectively); and reviewed maternal deaths (15.1% difference); conversely, the proportion of facilities that held participatory performance review meetings monthly or more often decreased by 13.8% (all P <0.05). We propose a facility-level HMIS data use index and document an upward trend in HMIS data use in Ethiopia immediately after the COVID-19 pandemic was declared. Future research should further evaluate and refine the proposed index to support the measurement of HMIS data quality and utilization in Ethiopia and like settings.