Improving Data Use and Participatory Action and Design to Support Data Use: The Case of DHIS2 in Rwanda

TL;DR

This paper describes an action research project in Rwanda aimed at enhancing data use practices and the DHIS2 health information platform through participatory design, addressing user preferences and system shortcomings.

Contribution

It introduces a participatory design approach to improve DHIS2 data use in Rwanda, involving multiple stakeholders and addressing practical challenges.

Findings

Data was routinely used in meetings but dashboards were underutilized.

Users preferred Excel over DHIS2 analytical tools.

Design improvements involved multi-level stakeholder participation.

Abstract

This article reports from an ongoing 'evaluation for improvement' action research and participatory design project in Rwanda, where the aim is to improve data use practices and the capabilities of the District Health Information Software 2 (DHIS2), an open source health information management platform, to support data use. The study of data use at health facility and district level showed that while data was used routinely at, for example, monthly coordination meetings, the DHIS2 dashboards and other analytical tools were in limited use because users preferred to use Microsoft Excel for data analysis and use. Given such findings, a major focus of the project has been directed towards identifying shortcomings in data use practices and in the software platform and to suggest, design and eventually implement changes. While the practical work on implementing improvements have been slow due to the COVID-19 pandemic, the suggested design improvements involve many levels of system design and participation, from the global core DHIS2 software team, the country DHIS2 team and local app development, the Rwanda Ministry of Health, and health workers at local level.