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An analysis of roles and decision making structures to facilitate routine health information system (RHIS) implementation and use in public health facilities in South Africa identified a wide range of stakeholders in these processes. Two broad categories of RHIS 'special people' are analysed, i.e. leaders (administrative and/or clinical) and bridgers/support staff. In addition to health system personnel with specific responsibility for RHIS, users with an interest in effective use of RHIS and RHIS outputs, and staff of external system and/or service providers, can play significant roles in RHIS implementation and use.

A recurring theme in published studies is the need for the appropriate human and other resources to support routine health information system (RHIS) implementation. While training in the use of specific RHIS and the availability of the required resources for implementation are essential for all users, other factors such as managers' understanding of the role of RHIS in supporting health services; the ability to interpret RHIS data; and a focus on data quality are further requirements for effective RHIS implementation.

Evaluations that have looked at the people aspect of the health information system in South Africa have only focused on the availability of human resources and not on competence or other behavioural factors. Using the Performance of Routine Information System Management (PRISM) tool that assumes relationships between technical, behavioural and organizational determinants of the routine information processes and performance, this paper highlights some behavioural factors affecting the quality of routinely collected data in South Africa. In the context of monitoring maternal and child health programmes, data were collected from 161 health information personnel in 58 health facilities and 2 district offices from 2 conveniently sampled health districts. A self-administered questionnaire was used to assess confidence and competence levels of routine health information system (RHIS) tasks, problem solving anddata quality checking skills, and motivation. The findings suggest that 64% of the respondents have poor numerical skills and limited statistical and data quality checking skills. While the average confidence levels at performing RHIS tasks is 69%, only 22% actually displayed competence above 50%. Personnel appear to be reasonably motivated but there is considerable deficiency in their competency to interpret and use data. This may undermine the quality and utility of the RHIS.