Transitioning to digital transactional data capture in primary health care facilities: a case report from Ghana's...

Ghana implemented the District Health Information Management System 2 (DHIMS2) in 2012 for aggregate health data management. Later, e-Tracker instances were introduced in response to demand from funders and program implementers for patient-level longitudinal data visibility, and improved patient care and data quality. Digital transactional data capture (electronically recording and storing data generated at the point of service) in health facilities enables real-time data entry and retrieval and has improved data quality, patient care continuity, and health outcomes. Despite multiple e-Tracker implementations, these benefits have not been realized in Ghana. This case report examines digital transactional data capture for maternal and child health (MCH) services in the Savannah Region in 2023 and identifies the enablers and barriers to its uptake in resource-limited settings.

The United States Agency for International Development (USAID)-funded Country Health Information Systems and Data Use (CHISU) program implemented the MCH e-Tracker using a three-stage approach: training health providers and managers on e-Tracker use, providing post-training follow-up and supervision, and holding periodic review meetings to gather feedback. Two hundred and forty-one health facilities and 556 health providers enrolled in the e-Tracker system using 477 provided tablets. Facilities started using e-Tracker in June 2023 but continued using paper-based registers simultaneously for DHIMS2 reporting. Initially, 58.1% (140/241) of facilities used e-Tracker, but this fell to 22.8% (55/241) by December 2023. Although 64.7% (156/241) of facilities used e-Tracker for at least one month, only 16.6% (40/241) consistently used it for all 7 months of implementation. In contrast, 64.3% (155/241) of facilities consistently reported to DHIMS2 using paper-based data. Factors enabling user compliance and adoption of e-Tracker include end user commitment, understanding of system requirements, consistent training and reviews, and strong leadership. Challenges include frequent e-Tracker application updates, parallel use of paper and electronic systems, and internet connectivity issues.

Acceptability and use of e-Tracker in health facilities waned after the first month. Successful transition to electronic data capture requires strong local support systems and reduced staff workload to promote user compliance and ensure high data quality. In Ghana, stakeholders aim to transition at least one district in the region to fully electronic data capture by December 2024 by leveraging these lessons learned.