Worku Abebaw Gebeyehu, Midekssa Wubshet Denboba, Tilahun Hibret Alemu, Belay Hiwot Tadesse, Abebaw Zeleke, Mohammedsanni Afrah, Wendrad Naod, Mohammed Mesoud, Mohammed Shemsedin Omer, Biru Amanuel, Futassa Benti Ejeta
JSI Research & Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia.
Ethiopia Ministry of Health, Addis Ababa, Ethiopia.
Glob Health Sci Pract. 2024 Dec 20;12(6). doi: 10.9745/GHSP-D-24-00145.
Health information systems (HIS) are vital in supporting all aspects of managing health systems, financing, policymaking, and service delivery. A package of priority HIS interventions was piloted in selected woredas across all regions in Ethiopia. This study examined the impact of HIS interventions on maternal and child health (MCH) service utilization.
A 2-arm quasi-experimental study was implemented in intervention and control woredas. Baseline and endline household and health facility surveys were conducted for both arms in 2020 and 2022, respectively. At baseline, 3,016 mothers and 167 health facilities were surveyed. At endline, 3,076 mothers and 160 health facilities were surveyed. The study used modified Performance of Routine Information System Management tools for the facility survey and a structured questionnaire for the household survey. Difference-in-difference (DID) analysis using mixed effect modeling was employed to measure changes and to account for clustering and control for likely confounders.
Intervention sites showed greater improvements in 75% of key HIS performance indicators. The changes in 90% of the MCH service utilization indicators were higher in the intervention sites. Significant (DID: <.05) changes were observed in indicators including quality of antenatal care, skilled birth attendance, delivery at a health facility, family planning met need and unmet need, measles and second dose of rotavirus vaccination, and Vitamin A supplementation. BCG vaccination showed significantly higher improvement in the control sites. Other key indicators did not show significant changes.
In many of the MCH service utilization indicators, the changes in the intervention sites were significantly higher compared to the control sites, but it was not universal. Scale-up of performance monitoring teams is crucial because it is one of the key pathways that links HIS performance with MCH service utilization. Outcome indicators that showed no or lower improvement require in-depth investigation.
卫生信息系统（HIS）对于支持卫生系统管理、融资、政策制定和服务提供的各个方面至关重要。埃塞俄比亚在所有地区的选定县试点了一套优先的卫生信息系统干预措施。本研究考察了卫生信息系统干预措施对孕产妇和儿童健康（MCH）服务利用的影响。
在干预县和对照县开展了一项双臂准实验研究。分别于2020年和2022年对双臂进行了基线和终线家庭及卫生设施调查。基线时，对3016名母亲和167个卫生设施进行了调查。终线时，对3076名母亲和160个卫生设施进行了调查。该研究使用经修改的常规信息系统管理工具绩效进行设施调查，并使用结构化问卷进行家庭调查。采用混合效应模型的差异-in-差异（DID）分析来衡量变化，并考虑聚类情况以及控制可能的混杂因素。
干预地点在75%的关键卫生信息系统绩效指标上有更大改善。干预地点90%的孕产妇和儿童健康服务利用指标变化更高。在包括产前保健质量、熟练接生、在卫生设施分娩、计划生育满足需求和未满足需求、麻疹和轮状病毒疫苗第二剂接种以及维生素A补充等指标上观察到显著（DID：<.05）变化。卡介苗接种在对照地点显示出显著更高的改善。其他关键指标未显示出显著变化。
在许多孕产妇和儿童健康服务利用指标方面，干预地点的变化与对照地点相比显著更高，但并非普遍如此。扩大绩效监测团队至关重要，因为这是将卫生信息系统绩效与孕产妇和儿童健康服务利用联系起来的关键途径之一。未显示改善或改善较低的结果指标需要深入调查。
