Attitude and Practices of District-level HMIS Managers Towards Malaria Routine Reporting in Uganda: A 2024 Cross-sectional Study

Background Routine surveillance through the health management information system (HMIS), has taken a de facto management structure centered on district leadership, aided by the district health information system for reporting. System performance and credibility has long been derived on the basis of data indicators with little to no consideration of dimensions on human-resources in charge. This study therefore aimed to assess attitudes and practices of HMIS managers at district level. Methods A cross-sectional study was conducted across all 15 malaria endemicity regions of Uganda between January and June 2024. Semi-structured interviews were conducted among HMIS managers in at least one district-level health office per region. The primary outcomes of the study included attitude and practices in malaria routine reporting, particularly data recording, review, reporting, analysis, and use, as well as support supervision. Results were summarized using descriptive statistics and word clouds. Results The 34 participants from 30 districts and cities included biostatisticians (70.6%) and HMIS focal persons (23.5%), overseeing 6 to 1043 actively reporting health facilities. All participants reviewed the reports they received, with 75.8% reporting documenting the mistakes found, though only 31.6% could show their documented queries. By survey date, 81.6% of expected routine reports had been received by the district-level health office, with 25.4% of them received after active follow-up with health facilities. With nearly all data submitted to DHIS-2 by the 15th day of the new month, 93.9% received queries constituting a mean of 4.2 queries per implicated health facility. Whereas ≈ 70% preferred quarterly DHI support supervision visits, 39.4% had received one to two such visits while 51.5% provided support supervision to their facilities, over the past 12 months. Generating mostly summary tables, trend and normal channel plots, key data uses included performance reviews, resource (re)allocation, as well as staffing needs’ assessments. Conclusion Highly capable human resource teams at district-level health offices administered HMIS routine reporting. Teamwork, augmented by collaboration with health facility officials, provides a framework for HMIS strengthening. Gaps remain in: data-query handling and follow-through to ensure data quality; conducting scheduled and/or evidence-driven support supervision; and, confidence of and advanced analytical skills that facilitate improved data use.