Data use practices and challenges for maternal and child health decision-making in tribal primary health centres in Andhra Pradesh, India

Background: Primary health centres in tribal areas of India collect large volumes of maternal and child health (MCH) data through routine health information systems, yet this data rarely informs local clinical or programmatic decision-making. The gap between data collection and data use in tribal settings, where health disparities are most acute, remains poorly documented from the perspective of frontline decision-makers. Methods: We conducted a qualitative study embedded in the diagnostic phase of an Action Research project in three tribal primary health centres under the Integrated Tribal Development Agency (ITDA), Rampachodavaram, Alluri Sitharama Raju District, Andhra Pradesh. Eight key informant interviews were conducted with medical officers (n=5), a district programme officer (n=1), and data entry operators (n=2). Participant observation at weekly convergence meetings and document review of registers and reports supplemented interview data. Transcripts were independently coded by two analysts using Braun and Clarke's reflexive thematic analysis. Findings: Three interconnected domains emerged. First, local MCH decision-makers needed individual-level, geographically disaggregated, prospective information to plan outreach and follow-up, but formal systems provided only retrospective aggregate statistics. Second, three structural constraints prevented formal systems from meeting these needs: digital infrastructure designed for connected settings, upward data flows with no local feedback, and a single-point- of-access governance vulnerability where one data entry operator's mobile phone controlled portal authentication for all facilities in the jurisdiction. Third, decision-makers constructed four complementary information practices (WhatsApp networks, self-built tracking tools, cross-sectoral convergence meetings, and reliance on intermediary-consolidated reports) to bridge the gap. Interpretation: Complementary information practices are expressions of local ingenuity under structural constraint, not system failures. MCH digital health reform should map and strengthen these practices rather than bypass them. Authentication governance in low- connectivity tribal settings requires urgent policy attention