title: Toward utilization of data for program management and evaluation: quality assessment of five years of health management information system data in Rwanda.
abstract: BACKGROUND
  Health data can be useful for effective service delivery, decision making, and evaluating existing programs in order to maintain high quality of healthcare. Studies have shown variability in data quality from national health management information systems (HMISs) in sub-Saharan Africa which threatens utility of these data as a tool to improve health systems. The purpose of this study is to assess the quality of Rwanda's HMIS data over a 5-year period.
  
  
  METHODS
  The World Health Organization (WHO) data quality report card framework was used to assess the quality of HMIS data captured from 2008 to 2012 and is a census of all 495 publicly funded health facilities in Rwanda. Factors assessed included completeness and internal consistency of 10 indicators selected based on WHO recommendations and priority areas for the Rwanda national health sector. Completeness was measured as percentage of non-missing reports. Consistency was measured as the absence of extreme outliers, internal consistency between related indicators, and consistency of indicators over time. These assessments were done at the district and national level.
  
  
  RESULTS
  Nationally, the average monthly district reporting completeness rate was 98% across 10 key indicators from 2008 to 2012. Completeness of indicator data increased over time: 2008, 88%; 2009, 91%; 2010, 89%; 2011, 90%; and 2012, 95% (p<0.0001). Comparing 2011 and 2012 health events to the mean of the three preceding years, service output increased from 3% (2011) to 9% (2012). Eighty-three percent of districts reported ratios between related indicators (ANC/DTP1, DTP1/DTP3) consistent with HMIS national ratios. Conclusion and policy implications: Our findings suggest that HMIS data quality in Rwanda has been improving over time. We recommend maintaining these assessments to identify remaining gaps in data quality and that results are shared publicly to support increased use of HMIS data.
authors.affiliation: Research Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; ni2mariepaul@gmail.com.
authors.forename: Marie Paul
authors.initials: MP
authors.lastname: Nisingizwe
authors.affiliation: Research Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Hari S
authors.initials: HS
authors.lastname: Iyer
authors.affiliation: HMIS Department, Ministry of Health, Kigali, Rwanda.
authors.forename: Modeste
authors.initials: M
authors.lastname: Gashayija
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA; Partners In Health, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Hirschhorn
authors.affiliation: Research Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Amoroso
authors.affiliation: HMIS Department, Ministry of Health, Kigali, Rwanda; Integrated Health Systems Support Project, Management Sciences for Health, Kigali, Rwanda.
authors.forename: Randy
authors.initials: R
authors.lastname: Wilson
authors.affiliation: HMIS Department, Ministry of Health, Kigali, Rwanda.
authors.forename: Eric
authors.initials: E
authors.lastname: Rubyutsa
authors.affiliation: HMIS Department, Ministry of Health, Kigali, Rwanda.
authors.forename: Eric
authors.initials: E
authors.lastname: Gaju
authors.affiliation: Integrated Delivery, Bill and Melinda Gates Foundation, Seattle, WA, USA.
authors.forename: Paulin
authors.initials: P
authors.lastname: Basinga
authors.affiliation: HMIS Department, Ministry of Health, Kigali, Rwanda.
authors.forename: Andrew
authors.initials: A
authors.lastname: Muhire
authors.affiliation: HMIS Department, Ministry of Health, Kigali, Rwanda; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
authors.forename: Agnès
authors.initials: A
authors.lastname: Binagwaho
authors.affiliation: Research Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
authors.forename: Bethany
authors.initials: B
authors.lastname: Hedt-Gauthier
mesh_terms: D063005:Health Information Systems; D006801:Humans; D019984:Quality Indicators, Health Care; D012107:Research Design; D012432:Rwanda
keywords: Rwanda; data quality; data use; global health; health management information system; quality improvement