Impact of Health Information System Interventions on Maternal Health Service Utilization in Oromia and Gambella...

To examine the association between Health Information System (HIS) performance and maternal health service (MHS) utilization in the Oromia and Gambella regions, Ethiopia.

A comparative cross-sectional study was conducted (15-25 October 2023) among 840 mothers in catchment areas of health facilities categorized as model (high HIS performance) or candidate (lower HIS performance). HIS performance was evaluated based on infrastructure (30%), data quality (30%), and data use (40%). MHS utilization was measured using a modified composite coverage index (CCI) integrating 10 essential interventions. Multivariable logistic regression (Stata/MP 17.0) identified predictors, reporting adjusted odds ratios (AORs) and 95% confidence intervals (CIs).

MHS utilization was 60.3%, with higher crude odds in model facility areas (COR = 2.03, 95% CI [1.4-3.0]). After adjustment, this association attenuated (AOR = 1.4, 95% CI [0.92-2.15]). Key barriers included poverty (poorest quintile AOR = 0.45, 95% CI [0.30-0.68]) and limited transport access (AOR = 0.21, 95% CI [0.15-0.29]), which were associated with significantly lower MHS utilization. Sensitivity analyses confirmed robustness, and transport access modified the effect of facility type.

HIS performance alone did not independently predict MHS utilization after accounting for structural inequities. Transportation and economic barriers disproportionately hinder access, even in high-performing systems. Integrating HIS strengthening with poverty-sensitive interventions (e.g., transport support, financial protection) is critical to achieving equitable maternal health outcomes.