Measuring health system quality with routine health information systems in Rwanda

BackgroundGrowing evidence suggests that achieving the Sustainable Development Goal (SDG) 3 will require high-quality health systems in low and middle-income countries. The objective of this study was to assess whether routine health information systems in Rwanda capture relevant health system quality measurements to facilitate the effective tracking of the Rwandan health system performance. MethodsI systematically reviewed the Rwanda health management information systems (Rwanda HMIS)--one of the six core building blocks of health systems--to identify health system performance indicators corresponding to processes of care quality and quality impact dimensions of high-quality health systems proposed by the Lancet Global Health Commission on High-Quality Health Systems in the SDG Era. Using a cross-sectional study design and descriptive statistics, I summarized available quality indicators by domains of the high-quality health system framework. ResultsOverall, less than 30% of the indicators collected in the Rwanda HMIS are processes of care quality and / or quality impact indicators. Health outcome measures were captured across health center and hospital HMIS reporting forms. However, there were gaps in the measurement of relevant quality impact measures such as confidence in health systems and economic benefit, and processes of care quality measures such as user (patient) experience, safety, continuity, and integration of care. Measurements about competent care and systems care were rarely available outside maternal, newborn, and child health. ConclusionThe current routine health information systems in Rwanda would benefit from capturing additional healthcare quality metrics, including for noncommunicable diseases, to allow the effective tracking of the health system performance and to identify new potential efficiencies to maximize the impact of the Rwandan health system.