Comparative Effectiveness of DHIS2 and FAIR Data Approaches for Privacy-Preserving Health Data Analytics in Uganda: A...

Uganda's digital health transformation anchored on District Health Information Software 2 (DHIS2) and the FAIR (Findable, Accessible, Interoperable, Reusable) Data Principles has reshaped health data governance. Nevertheless, systemic constraints in privacy, infrastructure, and human resources threaten sustainability and equity.

To compare DHIS2 and FAIR-based approaches on (i) privacy protection, (ii) interoperability and data usability, and (iii) regulatory/institutional readiness for privacy-preserving health data analytics in Uganda.

Systematic review of 84 peer-reviewed and grey-literature sources (2010-2025) following PRISMA 2020; extracted indicators on reuse, interoperability, privacy, and institutional readiness.

36% of included studies were Uganda-specific; 50% were published in 2020-2024. DHIS2 reached near-national coverage, ~12,000 trained users, and integration across >20 programmes. Persistent gaps include limited rural internet (≈12% of facilities with stable connectivity), high staff turnover (~35%), and low analytics literacy (~25% with intermediate skills). FAIR efforts (since ~2019) remain early: ~10% of institutions with formal policies; low dataset reuse (~22%), machine-readable metadata (~18%), and documented digital consent (<10%). Privacy infrastructure is weak: <30% of facilities with formal privacy frameworks/secure platforms and <10% with Data Protection Officers.

DHIS2 improved reporting and availability, while FAIR initiatives began enabling governed, interoperable reuse. To achieve ethical analytics at scale, priorities are legal enforcement, secure rural ICT, standardized machine-readable metadata/consent, and workforce development.