Integrating community health management information system into the community and district health system in Mpongwe, Zambia

Introduction: Considerable attention has been directed towards implementing and strengthening community health management information systems (c-HMIS) in low-and middle-income countries. In 2012, the Zambian Ministry of Health with the support from the Clinton Health Access Initiative developed a c-HMIS. Guided by the by Atun’s framework for integrating interventions in health systems, we explored the acceptability and adoption of the c-HMIS in the community and district health system in Mpongwe District, Zambia. Methods: A qualitative case-study design was used to examine the integration process of the c-HMIS. Data were collected through phone-based in-depth interviews with 66 purposively selected participants from the community, facility, district, provincial, and national levels (including Neighborhood Health Committees leaders, community-based volunteers, community health assistants (CHAs), CHA supervisors, and Ministry of Health officials). Data were analyzed using thematic analysis. Results: The nature of the problem, which included the persistent issue of data quality deficiency motivated the Ministry of Health and stakeholders to adopt the c-HMIS. The attributes of the c-HMIS intervention such as the provision of data collection tools, training stakeholders in using these tools and the perceived simplicity of the c-HMIS facilitated the adoption process. Further, health system characteristics such as timely availability of data and improved health information feedback processes; as well as the broader adopting context such as community participation promoted community ownership of the c-HMIS. The c-HMIS implementation barriers included challenges with data collection tools and digital platforms. Conclusion: Overall, our findings indicate that while the c-HMIS has substantial potential to strengthen health information management systems, its sustained integration within the community and district health systems depends on leveraging some of the identified enablers and carefully addressing systemic, health system, and contextual barriers.