Dissertations and Theses

Date of Degree


Document Type


Degree Name

Doctor of Philosophy (Ph.D.)


Health Policy and Management


Jim Sherry

Committee Members

Diana Romero

Debrework Zewdie

Subject Categories

Health Information Technology | International Public Health | Public Health


Health Information Systems, Sub-Saharan Africa, Stakeholder Views



Reliable, quality health information is the foundation of measurement and decision making in the health sector. Effective health management information systems can help improve the quality and coverage of health services, aid in policy development, support program implementation, and increase the likelihood that a well-trained health work force with the infrastructure and resources needed to provide appropriate health services will be properly distributed and supplied. There is widespread global agreement that data is a powerful tool. Arming Ministry of Health officials with better access to higher quality data that they know how to use can help improve health services and outcomes. Understanding stakeholder engagement in global norm setting processes and developing new methods to gain the insights of in-country users are important steps in doing so.

The research reported here examined processes through which stakeholder inputs are included in global priority setting and analyzed stakeholder opinions of the health management information systems (HMIS) and strategies for improvement in selected sub-Saharan African countries.


The research strategy involved participant observation of global consultative processes at the World Health Organization (WHO) regarding member states’ development and use of health data. Documents from members states participation in a series of consultative meetings were reviewed. In addition, a sample of in-country HMIS specialists, primarily from Ministries of Health, from Botswana, Eswatini, Kenya, Malawi, Nigeria, Tanzania, Uganda, and Zimbabwe, was surveyed regarding their views of issues currently facing national HMIS in their countries and strategies that can be used to strengthen these systems. The survey also asked which national and global actors should be involved in improvement efforts. The respondents were an influential group of HMIS stakeholders, whose views have not been well documented. To our knowledge, no previous studies have surveyed health information experts from Ministries of Health in the selected countries asking about the overall development and implementation of HMIS.


A large majority of research participants during the WHO global consultative processes and through survey responses emphasized practical barriers that slow, complicate, or compromise the successful implementation of national HMIS. These include such issues as unreliable electricity supply, lack of computer hardware, and intermittent internet connectivity. Other noteworthy barriers to HMIS improvements cited by participants were problems at the health facility level including weak analytical capacity among staff. Proposed interventions to improve HMIS stressed the importance of the use of health data produced by national HMIS. There was the widespread agreement around the need to involve stakeholders from within and outside national health systems to help improve the HMIS. Much of the stakeholders’ analysis and many of the suggested remedial actions closely follow recommendations put forward by WHO and other international organizations concerned with the development of HMIS in low- and middle-income countries.


Findings from this study may lead to the development of new approaches to improve existing efforts to strengthen HMIS thereby encouraging more comprehensive data collection, more thorough analysis, and greater data use, which should lead to better health outcomes. The research also contributes to a better understanding of strategies to regularly and systematically collect inputs from stakeholders in norm setting processes.

The rapidly changing circumstances in low- and middle-income African countries, especially following the emergence of COVID-19, mean that additional research is needed to better understand the shortcomings in existing health information systems and to clearly specify ways such systems can be improved. As a result of this research and in collaboration with USAID’s Health Evaluation and Applied Research Development Project, a revised version of the survey will be employed in a study of health facility mangers implemented in partnership with the East Central Southern Africa Heath Community (ECSA-HC) and the West African Health Organization (WAHO).

Available for download on Wednesday, August 23, 2023