Health Systems and Policy Research

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Theoretical Application Assessing Adaptation of District Health Information System (DHIS 2) for HIV/AIDS Surveillance in Uganda

Bwesigye DA,Loneck BM, Sherman BR, Carpenter DO

Background: With support from the United States government, Uganda introduced the District Health Information Software 2 (DHIS2) in 2012 to improve surveillance for better prevention and treatment of HIV/ AIDS. However, districts have yet to fully adopt this system given a 70.2% reporting completeness attained nationally between April-June 2013. To get a deeper understanding of how Uganda has been progressing in the implementation of its DHIS2, this study applied the Boundary Objects and Social Order theories. Methods: The study has one dependent variable: Districts’ reporting completeness and four independent variables. 1) Number of client visits; 2) Number of district health units; 3) Number of NGOs delivering HIV and AIDS services; and 4) Regional location. These data were collected from inpatient, outpatient, and maternal newborn health programs. Findings: Districts reporting the lowest number of client visits (under 2500) attained the highest mean reporting completeness (81.6%), whereas a range of 2501-5000, or over 5001client visits recorded 72.4% and 51.7% respectively. The higher the number of client visits the lower the reporting completeness (p<0.0005). Districts that were receiving support from only one NGO recorded a mere 56.7% whereas those from two recorded 67.2%. Districts supported by over three NGOs had the highest (80.6%) mean reporting completeness score. The number of NGOs was statistically associated with reporting completeness (p<0.0005). The number of health units operated by a district was also significantly associated with reporting completeness (p<0.0005). The regional location of a district was not associated with reporting completeness (p=0.674). Conclusion: Results of this study suggest that districts with higher patient volume for HIV and AIDS services should be identified and targeted with additional NGO support. Newly funded NGOs should be established in districts operating over 40 health units. Incomplete reporting undermines identification of HIV- affected