Strengthening health systems through improved reliability of health information: An evaluation of the expanded programme on immunisation data management in Eastern Cape, South Africa

Abstract

Background: An initial review of District Health Information System (DHIS) data from Eastern Cape Province, South Africa, collected for the Expanded Programme on Immunisation (EPI), identified wide variations in reported rates of immunisation between sub-districts, with some consistently exceeding 100%. These impossible figures signal significant issues with data quality. To investigate these variations, and identify potential interventions, we designed a mixed-methods evaluation of the accuracy of reported immunisation coverage and challenges in data management.

Methods: The evaluation was carried out in June and July 2012. Data audits and semi-structured interviews with key staff were conducted in 16 purposively selected health facilities and two sub-district offices from two of Eastern Cape’s 24 sub-districts. Selected sub-districts were the ones reporting the lowest and highest coverage rates. The extent of the discrepancy between reported and verified data was calculated for each facilities. Multiple regression analysis identified factors related to these discrepancies. Content theme analysis of interviews was done to pinpoint recurring challenges in data quality assurance.

Results: Reported immunisation coverage for the 24 sub-districts in Eastern Cape Province varied between 46.3% and 133.9%. Five of the sub-districts reported rates exceeding 100%. Results of audits in the two sub-districts reporting the lowest (SD1) and highest (SD2) figures showed that full immunisation was over-reported by 4% in SD1 and 85% in SD 2. When stratified by facility, significant over and under-reporting existed in all facilities, although errors were far larger in SD2. Content analysis of interviews revealed that audit discrepancies related mainly to: availability and use of registers; poor verification processes; inadequate training; and communication issues. These challenges were present in both sub-districts although more frequent in SD2 where greater discrepancies were identified. 

Conclusion: Ensuring data accuracy is a significant problem in Eastern Cape Province. There are some clear steps the Provincial Department of Health can take to reduce errors. Recommendations include a) the central procurement of materials required for data management, b) the formation of Data Audit Teams to verify data, c) integration between Maternal, Child and Women’s Health sub-programmes to improve communication, and d) the provision of training regarding data management processes.