Study on external consistency of health management information system data at district level across India

The WHO has provided toolkit for data quality review of Health Management Information System (HMIS) data, with external consistency of coverage rate being one dimension.

To assess the level of external consistency of HMIS data compared with National Family Health Survey-5 (NFHS-5) data at district level across India.

We used secondary data on health service delivery indicators across districts at meso-level collected from HMIS and NFHS-5 website. We collected data on 7 indicators: Mothers registered within trimester I, mothers with at least 4 antenatal visits, mothers last birth protected against tetanus, institutional births, births delivered by Caesarean section, sex ratio at birth, and pregnant women aged 15-49 years who are anaemic. We evaluated the agreement between HMIS and NFHS data for the above indicators using Pearson's correlation co-efficient, intraclass correlation coefficient, and Bland-Altman plot.

Data were available from both HMIS and NFHS-5 for 695 districts for the above indicators, except for pregnant women with anaemia, for whom data were available for 564 districts. Pearson corelation co-efficient showed a strong correlation between the two datasets for institutional births and delivery by caesarean section, while weak to moderate correlations were observed for the other indicators. Intraclass correlation coefficient showed discordance between the two datasets, and poor agreement was observed between the data for sex ratio at birth and mothers with at least 4 antenatal visits in Bland-Altman plot.

Poor agreement was observed between HMIS and NFHS data for certain indicators, and steps can be taken to improve the quality of HMIS data for these indicators.