A process evaluation of a pilot community health management information system in Mpongwe district of Zambia: lessons to inform strengthening of health information systems

Background: Increased attention has been put towards developing and implementing Community Health Management Information System (c-HMIS). It is for this reason that in 2012, Ministry of Health (MoH) with the support from Clinton Health Access Initiative (CHAI) developed a Community Health Management Information System (c-HMIS) in Zambia. There is limited data on the implementation, acceptability and use of c-HMIS in community health systems. Guided by the by Atun’s framework on integration of interventions in health systems. We explored the implementation and acceptability of c-HMIS in Mpongwe district. Methodology:Qualitative data collected with 66 respondents namely members of health committees, community health assistants and their supervisors were analysed using thematic analysis. Results: The nature of the problem which included poor quality of data /information due to lack of standardized data collection tools and delayed submission of reports motivated MoH and stakeholders to adopt the c-HMIS. Theattributes of the c-HMIS Intervention such as the provision of improved data collection tools, training stakeholders in using the tools, the perceived simplicity of the system and factors within the adoption system such as some health workers being familiar with c-HMIS, compatibility of the c-HMIS with existing tools, as well as improved collaboration and communication among actors facilitated the adoption process. Further, health system characteristics such as timely availability of data and improved health information feedback processes, improved mapping of key health issues in communities; as well as the broader context such as community engagement promoted community ownership of the c-HMIS. The c-HMIS implementation barriers included challenges with completing some sections in the tools due to missing data, limited gender inclusiveness in the tools, inadequate availability of digital platforms to enter and store data, limited incentives for community health workers, poor phone network/ internet connection as well as the COVID-19 pandemic. Conclusion: Strengthening the implementation and acceptability of c-HMIS may require introducing electronic data capture and transmission using simple digital tools such as android phones. Electronic systems would help address logical challenges related to inadequate data collection tools, data entry challenges, and delayed transmission of data.