Yilma Tesfahun Melese, Taddese Asefa, Mamuye Adane, Endehabtu Berhanu Fikadie, Alemayehu Yibeltal, Senay Asaye, Daka Dawit, Abraham Loko, Tadesse Rabeal, Melkamu Gemechis, Wendrad Naod, Kaba Oli, Mohammed Mesoud, Denboba Wubshet, Birhan Dawit, Biru Amanuel, Tilahun Binyam
Department of Health Informatics, Center for Digital Health and Implementation Science, University of Gondar, Gondar, Ethiopia.
Department of Biostatistics and Epidemiology, Center for Digital Health and Implementation Science, University of Gondar, Gondar, Ethiopia.
JMIR Med Inform. 2024 Jul 26;12:e50375. doi: 10.2196/50375.
BACKGROUND: Although Ethiopia has made remarkable progress in the uptake of the District Health Information System version 2 (DHIS2) for national aggregate data reporting, there has been no comprehensive assessment of the maturity level of the system. OBJECTIVE: This study aims to assess the maturity level of DHIS2 implementation in Ethiopia and propose a road map that could guide the progress toward a higher level of maturity. We also aim to assess the current maturity status, implementation gaps, and future directions of DHIS2 implementation in Ethiopia. The assessment focused on digital health system governance, skilled human resources, information and communication technology (ICT) infrastructure, interoperability, and data quality and use. METHODS: A collaborative assessment was conducted with the engagement of key stakeholders through consultative workshops using the Stages of Continuous Improvement tool to measure maturity levels in 5 core domains, 13 components, and 39 subcomponents. A 5-point scale (1=emerging, 2=repeatable, 3=defined, 4=managed, and 5=optimized) was used to measure the DHIS2 implementation maturity level. RESULTS: The national DHIS2 implementation's maturity level is currently at the defined stage (score=2.81) and planned to move to the manageable stage (score=4.09) by 2025. The domain-wise maturity score indicated that except for ICT infrastructure, which is at the repeatable stage (score=2.14), the remaining 4 domains are at the defined stage (score=3). The development of a standardized and basic DHIS2 process at the national level, the development of a 10-year strategic plan to guide the implementation of digital health systems including DHIS2, and the presence of the required competencies at the facility level to accomplish specific DHIS2-related tasks are the major strength of the Ministry of Health of Ethiopia so far. The lack of workforce competency guidelines to support the implementation of DHIS2; the unavailability of core competencies (knowledge, skills, and abilities) required to accomplish DHIS2 tasks at all levels of the health system; and ICT infrastructures such as communication network and internet connectivity at the district, zonal, and regional levels are the major hindrances to effective DHIS2 implementation in the country. CONCLUSIONS: On the basis of the Stages of Continuous Improvement maturity model toolkit, the implementation status of DHIS2 in Ethiopia is at the defined stage, with the ICT infrastructure domain being at the lowest stage as compared to the other 4 domains. By 2025, the maturity status is planned to move from the defined stage to the managed stage by improving the identified gaps. Various action points are suggested to address the identified gaps and reach the stated maturity level. The responsible body, necessary resources, and methods of verification required to reach the specified maturity level are also listed.
背景:尽管埃塞俄比亚在采用地区卫生信息系统2.0版(DHIS2)进行国家汇总数据报告方面取得了显著进展,但尚未对该系统的成熟度水平进行全面评估。 目的:本研究旨在评估埃塞俄比亚DHIS2实施的成熟度水平,并提出一份路线图,以指导向更高成熟度水平迈进。我们还旨在评估埃塞俄比亚DHIS2实施的当前成熟度状况、实施差距和未来方向。评估重点关注数字卫生系统治理、技术熟练的人力资源、信息通信技术(ICT)基础设施、互操作性以及数据质量和使用情况。 方法:通过协商研讨会,与关键利益相关者合作进行评估,使用持续改进阶段工具来衡量5个核心领域、13个组件和39个子组件的成熟度水平。采用5分制(1 = 新兴,2 = 可重复,3 = 已定义,4 = 可管理,5 = 优化)来衡量DHIS2实施的成熟度水平。 结果:国家DHIS2实施的成熟度水平目前处于已定义阶段(得分 = 2.81),计划到2025年提升至可管理阶段(得分 = 4.09)。按领域划分的成熟度得分表明,除处于可重复阶段(得分 = 2.14)的ICT基础设施外,其余4个领域均处于已定义阶段(得分 = 3)。埃塞俄比亚卫生部目前的主要优势在于,在国家层面制定了标准化的基本DHIS2流程,制定了一项为期10年的战略计划以指导包括DHIS2在内的数字卫生系统的实施,并且在机构层面具备完成特定DHIS2相关任务所需的能力。缺乏支持DHIS2实施的劳动力能力指南;卫生系统各级完成DHIS2任务所需的核心能力(知识、技能和能力)缺失;以及地区、州和区域层面的通信网络和互联网连接等ICT基础设施,是该国有效实施DHIS2的主要障碍。 结论:根据持续改进阶段成熟度模型工具包,埃塞俄比亚DHIS2的实施状况处于已定义阶段,与其他4个领域相比,ICT基础设施领域处于最低阶段。计划到2025年,通过弥补已识别的差距,使成熟度状况从已定义阶段提升至可管理阶段。针对已识别的差距并达到规定的成熟度水平,提出了各种行动要点。还列出了达到指定成熟度水平所需的责任主体、必要资源和验证方法。
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