title: Effects of a health information system data quality intervention on concordance in Mozambique: time-series analyses from 2009-2012.
abstract: BACKGROUND
  We assessed the effects of a three-year national-level, ministry-led health information system (HIS) data quality intervention and identified associated health facility factors.
  
  
  METHODS
  Monthly summary HIS data concordance between a gold standard data quality audit and routine HIS data was assessed in 26 health facilities in Sofala Province, Mozambique across four indicators (outpatient consults, institutional births, first antenatal care visits, and third dose of diphtheria, pertussis, and tetanus vaccination) and five levels of health system data aggregation (daily facility paper registers, monthly paper facility reports, monthly paper district reports, monthly electronic district reports, and monthly electronic provincial reports) through retrospective yearly audits conducted July-August 2010-2013. We used mixed-effects linear models to quantify changes in data quality over time and associated health system determinants.
  
  
  RESULTS
  Median concordance increased from 56.3% during the baseline period (2009-2010) to 87.5% during 2012-2013. Concordance improved by 1.0% (confidence interval [CI]: 0.60, 1.5) per month during the intervention period of 2010-2011 and 1.6% (CI: 0.89, 2.2) per month from 2011-2012. No significant improvements were observed from 2009-2010 (during baseline period) or 2012-2013. Facilities with more technical staff (aβ: 0.71; CI: 0.14, 1.3), more first antenatal care visits (aβ: 3.3; CI: 0.43, 6.2), and fewer clinic beds (aβ: -0.94; CI: -1.7, -0.20) showed more improvements. Compared to facilities with no stock-outs, facilities with five essential drugs stocked out had 51.7% (CI: -64.8 -38.6) lower data concordance.
  
  
  CONCLUSIONS
  A data quality intervention was associated with significant improvements in health information system data concordance across public-sector health facilities in rural and urban Mozambique. Concordance was higher at those facilities with more human resources for health and was associated with fewer clinic-level stock-outs of essential medicines. Increased investments should be made in data audit and feedback activities alongside targeted efforts to improve HIS data in low- and middle-income countries.
authors.affiliation: Department of Epidemiology, University of Washington School of Public Health, 1959 NE Pacific Street, Seattle, WA 98195 USA ; Health Alliance International, Seattle, WA USA.
authors.forename: Bradley H
authors.initials: BH
authors.lastname: Wagenaar
authors.affiliation: Department of Family Child Nursing, University of Washington, Seattle, WA USA ; Health Alliance International, Seattle, WA USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gimbel
authors.affiliation: Health Alliance International, Beira, Mozambique ; Ministry of Health, Beira Operations Research Center, Beira, Mozambique.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Hoek
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA USA ; Health Alliance International, Seattle, WA USA.
authors.forename: James
authors.initials: J
authors.lastname: Pfeiffer
authors.affiliation: Health Alliance International, Beira, Mozambique.
authors.forename: Cathy
authors.initials: C
authors.lastname: Michel
authors.affiliation: Ministry of Health, Beira Operations Research Center, Beira, Mozambique.
authors.forename: João Luis
authors.initials: JL
authors.lastname: Manuel
authors.affiliation: Community Health Department, School of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Fatima
authors.initials: F
authors.lastname: Cuembelo
authors.affiliation: Health Alliance International, Beira, Mozambique ; Ministry of Health, Beira Operations Research Center, Beira, Mozambique.
authors.forename: Titos
authors.initials: T
authors.lastname: Quembo
authors.affiliation: Health Alliance International, Beira, Mozambique ; Ministry of Health, Beira Operations Research Center, Beira, Mozambique.
authors.forename: Pires
authors.initials: P
authors.lastname: Afonso
authors.affiliation: Health Alliance International, Beira, Mozambique ; Ministry of Health, Beira Operations Research Center, Beira, Mozambique.
authors.forename: Victoria
authors.initials: V
authors.lastname: Porthé
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA USA ; Health Alliance International, Seattle, WA USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Gloyd
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA USA ; Health Alliance International, Seattle, WA USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Sherr
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