Use of Aggregate Data for Health Decision Making at District Level: Case Study of Ga West Municipality of the Greater Accra Region

Abstract

Background: There is growing interest in the usage of reliable evidence for decision making in the health sector. Quality data from an aggregated system can provide the platform for improving health system performance. The extent of usage of Routine Health Information System (RHIS) data at the lower levels of the health system remain largely unknown. This study examined the level of usage of routine aggregate data for decision making and the extent to which information culture exists at the district and facility levels in the Ga West Municipality of the Greater Accra region. Methods: The study adopted descriptive cross-sectional design and used a quantitative data collection approach. The Organisational, Behavioural Assessment Tool (OBAT) was adapted to measure the level of promotion of information culture which is a key component to the use of routine data for decision making. The tool also contained information on organisational mechanisms, commitment and support for RHIS data use, and self-perception of competence in RHIS data use. A total of 214 healthcare workers (13 upper level managers, 201 other staff) were sampled for the study. Simple random sampling was used to identify the upper level mangers while systematic sampling was used to recruit the other staff in all the seven sub districts. Responses were mainly collected using Likert scale and analysed through composite scoring and Cronbach alpha, which was used to assess the reliability of the tool. Frequencies and relative frequencies were computed in Stata version 15 and Microsoft Excel and presented in tables. The study was approved by the Ethics Review Committee of the Ghana Health Service. Results: A total of 214 healthcare workers participated in the study [Female: 62.1% (133)]. The majority of the respondents (69.6%) had never received formal training in RHIS data use. Fifty percent had worked with RHIS data for 1 – 5 years. As regards to information culture, 69.6% agreed that the basis of healthcare decisions is superior’s directives. Over 50% agreed health care decisions are based on evidence/facts, history and funding directives from higher levels. Fifty-nine of respondents agreed that managers seek input from relevant staff, 56.1% agreed that managers emphasise that data quality be followed at all times. Most staff have positive attitude in promoting information culture by completing RHIS tasks (43.0%), using data for day-to-day decision making (65.0%) and preparing and showing data visuals to monitor progress (51.4%). Forty-two percent of staff agreed that they feel discouraged when information is not used for decision making but 45.3% agreed data collection is tedious. Sixty-seven of health facilities visited had written guidelines on RHIS information display. All the 18 heath facilities had strategic and annual plans, data visuals on their notice boards. Over 80% of the facilities received regular feedback on data quality and service performance. Eighty-three percent of the facilities hold monthly management meetings. Over 50% of the staff had high self-perceived competence in the RHIS tasks. Conclusion: A good culture of information supported by positive staff and management attitude exists in the district. The district has adequate organisational support and commitment which enhances RHIS data use. The level of aggregate data use and the self-perceived competence for RHIS data use are relatively high in the district. However, formal training for staff on RHIS data use is low. The upper level management should train staff on RHIS data analysis and use. Keywords: Health Information, Data, Information Culture, Ga West, Ghana