Users' capabilities related to the electronic RHIS for newborn and stillbirth indicators: quantitative and qualitative findings of the IMPULSE study across 151 sites in the Central African Republic, Ethiopia, Tanzania, and Uganda.

Background: The electronic routine health information system (eRHIS) is crucial for policy and planning. However, its effectiveness depends on end-users' capabilities in utilising it. Using a mixed-methods approach, we evaluated end-users' data in the Central African Republic (CAR), Ethiopia, Tanzania, and Uganda in one of the first standardised cross-country assessment of eRHIS users' capabilities focussed on newborn and stillbirth indicators. Methods: We collected data in 12 regions and 3 city administrations between November 2022 and July 2024 using the Every Newborn-Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) Performance of Routine Information System Management (PRISM) tools. All data but staff opinions were collected through direct observation. We analysed quantitative questions and reported them as frequencies/normalised PRISM scores, both on the overall sample and by country. We analysed qualitative data using thematic analysis. Results: We included end-users of the eRHIS from 151 sites (56 data offices, 95 facilities). Their capabilities in utilising the eRHIS varied and were mainly higher in Uganda, followed by Tanzania, Ethiopia, and the CAR. End-users' capabilities also varied by type of abilities, being in general higher for track report completeness (with Tanzania, Uganda, Ethiopia, and CAR having 6/10, 5/10, 4/10, and 2/10 indicators at >80%, respectively), compared to skills in data analysis and visualisation (with only Uganda showing 2/6 indicators >80% for both domains and the other countries having no indicators at >80%). Practical skills scores were low in all countries, particularly on plotting, problem-solving, and use of information. 'Champion/good performer' emerged in each country, with staff at higher health system levels showing the highest capabilities. End-users' suggestions to improve the eRHIS (n = 127) were focussed on technical/software improvements (n = 73, 57.5%) and functionalities for data quality checks and data analysis (n = 36, 28.3%). Conclusions: Our findings suggest several common gaps in end-users' capabilities in utilising the eRHIS, particularly in the CAR, and in all countries at facility levels.