Health Data Reporting Challenges in the Age of DHIS2: a Mixed-Methods Review in the Teso Sub-Region of Uganda

In Uganda, the complete and timely reporting of priority disease data by health centers is critical for detecting outbreaks. However, health centers face significant reporting challenges, which compromise data fidelity and public health. To assess the efficacy of existing systems, we aimed to (1) compare reporting performance among districts in the Teso region of Eastern Uganda, (2) ascertain the association between volume of outpatient department (OPD) visits and reporting rates at facilities, and (3) characterize reporting challenges. We queried Ugandas Electronic Health Management Information System database, DHIS2, regarding the completeness (reporting rate) and timeliness (reporting rate on time) of priority disease data submission within Teso from January-April 2024. We selected the 3 lowest-performing districts in both metrics and assessed reporting at all health centers within these districts. We used linear regression to determine the relationship between the aggregate number of outpatient visits per health facility and their mean reporting rates. At 7 health facilities across the 3 districts, we interviewed staff to enumerate reporting challenges. Of all 11 districts in Teso, 7 (64%) scored >80% for completeness and 2 (18%) scored >80% for submission timeliness across health facilities. The median (IQR) scores for completeness and timeliness were 83% (75-93%) and 69% (55-75%), respectively. The 3 lowest performing districts in both metrics were Soroti City, Soroti district, and Ngora district. In Soroti City, increasing number of OPD visits was associated with higher reporting rate percentages (b [slope]=0.005, p=0.01). The main reasons given for low reporting rates included limited staff trained on data entry protocols, competing responsibilities among reporting personnel, and lack of reliable internet access. The implementation of DHIS2 has improved public health and disease surveillance in Uganda, but institutional-level data reporting challenges continue to impair disease tracking. Targeted interventions to relieve such barriers is possible.