A Story of Transformation: Revitalizing the Health Information System in Shebedino District, Ethiopia

Tesfaye Beyene, Shebedino District Health Office head. Photo: Benti Ejeta/JSI

From 2019 to 2024, Shebedino was one of the three districts that JSI’s Ethiopia Data Use Partnership (DUP), in collaboration with Hawassa University and the Sidama Regional Health Bureau (RHB), helped implement the Ministry of Health’s (MOH) Information Revolution (IR) initiative.

If anyone can tell the dramatic story of Shebedino District’s health information system (HIS) transformation, it is Tesfaye Beyene, Shebedino Health Office head. Tesfaye has been at the heart of the transformation since Ethiopia’s IR activities began in 2019. Starting as a team lead, he rose to his current position overseeing six health centers and 23 health posts. Over these years, he has watched the IR unfold and witnessed its effects on staff and service quality.

Before DUP, Hawassa University, and Sidama RHB support began, health systems across the district were struggling. Many health institutions had inadequate human, technological, and infrastructural capacities to generate, manage, and use high-quality data. The lack of skilled personnel, in particular, hindered health management information system (HMIS) implementation and maintenance.

“We lacked skilled HMIS and cardroom human resources. The medical recording units were very small and overcrowded with misplaced records,” said Tesfaye. Despite having established standards and guidelines, staff were also regularly inconsistent when conducting HMIS activities.

“LQAS [lot quality assurance sampling] and PMT [performance monitoring team] meetings were irregular and haphazard. And despite their findings, no corrective actions were ever taken,” said Shimelis Shibiru, head of the Health Development and Planning Department at the district health office, echoing Tesfaye’s concerns.

The rollout of digital solutions like DHIS2, designed to improve data accessibility nationwide, was delayed and the electronic community health information system (eCHIS) encountered obstacles that were exacerbated by inadequate infrastructure. Non-functioning information communication technology, frequent power interruptions, and limited internet connectivity disrupted operations, hindering data quality and effective use of information.

Tesfaye and Shimelis said that medical record documentation was another problem. They noted a significant shortage of essential health information recording tools and widespread unawareness of proper documentation practices. A prevalent misconception about the importance of improving data quality had led to improper documentation, with health care workers often resorting to makeshift solutions like writing on scraps of paper when proper recording tools were unavailable. This contributed substantially to the overall deterioration in data quality.

The Turning Point

DUP’s support to the district, facilitated through a supplementary grant from the Doris Duke Charitable Foundation (DDCF), was instrumental in overcoming operational challenges, said Tesfaye. In 2019, DUP partnered with Hawassa University, one of six local universities involved in the DDCF project, to transform health information management in the district. This included robust support to build institutional and human capacity to facilitate technological, procedural, and behavioral changes within the HIS sector.

Hawassa University, DUP, and the Sidama RHB implemented capacity building activities using a practice-based learning approach. This ensured integration of theory into daily operations, with each theoretical training session at the facility level immediately followed by hands-on exercises. Seble Mekuria, planning officer at the district health office, emphasized the effectiveness of this approach. “Training sessions are conducted in the morning, and we implement those principles in practice in the afternoon.” This approach has been replicated in various health facilities across the district, also yielding significant and tangible results.

The Results

Tesfaye, Shimelis, and Seble have seen the IR initiatives enhance HIS performance. Many health workers have gained skills that enable them to contribute to HIS functionality. The district has undergone a profound transformation by adopting digital health solutions, an information-use culture, and evidence-based decision-making.

There is now consensus among stakeholders on the importance of adhering to HIS standards. Health service units have adopted practices such as using LQAS to ensure data quality. The district’s PMT conducts regular management meetings that are action-oriented, driving continuous improvement.

Most importantly, these advancements improved services across the district’s health systems. For example, antenatal care visits (ANC 4) have surged from 85 percent in July 2019 to 95 percent in May 2024 and skilled birth attendance (SBA) rose from 80 percent to 97 percent over the same period. Data consistency in registers and medical records has improved significantly from 25 percent to 95 percent.

Shebedino has emerged as a model district for successfully implementing IR initiatives. The MOH and RHB officially recognized it as an IR model district, distinguished by its robust monitoring and evaluation tools and HIS infrastructure that facilitates enhanced information exchange through offline and online channels.

The future looks bright as Tesfaye and his team continue to strengthen digitization and the information-use culture, aiming to improve access to health care services for the residents of Shebedino. “What has been achieved is our own. We have been integral to the entire intervention process. It no longer belongs exclusively to DUP or anyone else.”