Development of a primary health care information system in Ghana: lessons learned

In Ghana, between January 1990 and September 1993, a series of steps were undertaken to review the existing vertical reporting procedures and to develop an integrated Health Management Information System (HMIS) for Primary Health Care (PHC). These steps included a situation analysis of the existing reporting systems; participatory design of tools for planning, data collection, feedback and reporting; field test and revision of the modified system; training of staff at all levels; development of tools for self-assessment and stimulation of routine feedback to lower levels and reporting of analysed indicators to higher levels. There were some notable achievements which included promotion of self-reliance, improved data relevance and accuracy, as well as strengthened supervision and support. However, it was difficult to identify the most appropriate institutional location for the HMIS; over-emphasis on process leads to reduced implementation; reporting was still given greater priority than analysis and use of data, and systems for collection and use were still cumbersome and time consuming. It is also difficult to prove that having better information really improves decision-making, or even coverage and quality of PHC service delivery. These issues, as well as lessons learned, are discussed in the paper.