Comparison of DHIS 2 structure and use in six African countries: a case study of MEASURE Evaluation's building and scaling-up of the electronic health information system software

MEASURE Evaluation has used the DHIS2 to build and/or strengthen health information systems in many parts of the world, notably in six sub-Saharan African countries. MEASURE's work demonstrates comfort with the DHIS2 technology, stakeholder engagement and ownership, contributions to capacity building, and a strong example of how to use a standard tool to solve the problems that arise in different settings by identifying approaches for context-specific solutions. Successful deployment of the same software has occurred in six countries with different objectives and approaches, but with success across the board. Whereas the DHIS2 has remained true to its original format in Burundi and Madagascar, it has contributed to expanding both countries' electronic health information system (in Burundi, DHIS 2 is now present in all hospitals and in 80% of facilities and in Madagascar, reporting completeness has improved by 50% in 4 years). In Burkina Faso, the DHIS2 supports an innovative One Health electronic platform, tracking over 60 human, animal, and environmental diseases across three Ministries. In Cote d'Ivoire, DHIS2 is integrating and connecting existing local software focused on HIV/AIDS, logistics, and orphans and vulnerable children (OVC) and adolescent girls and young women (AGYW) data, and is actively used in 100% of regions, districts, and hospitals. In Mali, where 100% of regions, districts, and hospitals (and 98% of community health facilities) are reporting into DHIS 2 (all in less than 16 months of implementation), it has become a one-stop shop, whether it be for patient-level data collection or notification of stock-outs. Finally, in Guinea, DHIS2 was used to build a health information system from the ground up, introducing Guinea's very first electronic system (deployed to 100% of districts and hospitals), and linking it to a MEASURE-created master facility list using DHIS2 to power a facility registry. When MEASURE's work began in Guinea, there was no electronic health information system to speak of. Today, data completeness in DHIS2 continues to improve and reaches 98% for health centers and 94% for hospitals. Although setting up the same software, MEASURE Evaluation's experience of implementing DHIS2 in six African countries illustrates the context-specificity and complexity of using a global good and successfully adapting it to the country needs and priorities.