Improving Data Quality and Information Use through Capacity Building and Mentorship Program in Ethiopia: Best Practices and Lessons Learned

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Recently, the FMOH declared that some CBMP implementations woredas are models. Therefore, assessing the best practices and lessons learned among the model woredas is essential for the success and scalability of the program. This study explores the best practices and lessons learned and their implications for creating a learning health system. Methods: - A descriptive exploratory case-study design was conducted in four verified model woredas and one town administration across three regions: Amhara, Sidama, and Benishangul-Gumuz of Ethiopia. The study involved interviewing forty-two informants who were purposively selected from the model districts. A semi-structured interview guide was used to explore information on the Performance Monitoring Team (PMT), data management, analysis, visualization and use, capacity building, and infrastructure. The data collected was analyzed thematically using Atlas ti. 8 software. Results: - Six themes were explored in this study: technical, behavioral, organizational intervention, health information system performance improvement, sustainability, and challenges. Need-based and practical capacity-building training, local resource mobilization, leadership engagement, HIS task audit, HIS accountability framework, reward, and recognition were some of the critical best experiences and lessons to be shared. Besides data visualization and dissemination, the Performance Monitoring Team (PMT) functionality and quality improvement project using strategic problem-solving approaches enhanced the intervention implementation. This study asserted local resource mobilization, leadership engagement, and institutional capacity building as critical factors for the sustainability of existing achievements. However, staff shortage and turnovers, job evaluation grading complaints, and low competency of medical record unit staff were existing challenges affecting the sustainability and scalability of the best experiences and lessons. Conclusion and recommendation: - Numerous best experiences and lessons are identified among model districts. Need-based and practical HIS capacity-building training, leadership engagement, local resource mobilization, and HIS accountability framework were scalable and replicable best experiences and lessons. However, staff shortage and turnover, local Health Information Technician complaints, and contextual factors must be considered while scaling up to other areas. CBMP HIS Best experience Lessons learned Ethiopia Figures Figure 1 Background Health Information System (HIS) is an essential part of the six essential building blocks of a health system functioning to improve healthcare quality ( 1 ). The health information system is fundamental for planning, monitoring, and evaluating healthcare services, controlling epidemics, tracking disease trends, and managing healthcare resources. ( 2 , 3 ). Ethiopia's health sector has made significant progress by adopting and implementing a Health Management Information System (HMIS) ( 4 , 5 ). Despite the achievements in HIS implementation, health data quality production and use culture persisted as a major gap characterized by untimely, incomplete, poor data production and use culture ( 6 – 10 ). The Federal Ministry of Health in Ethiopia has recognized the importance of Health Management Information Systems (HMIS) and has made it a priority in their Health Sector Transformation Plan (HSTP). As part of this plan, they have designed an Information Revolution (IR) to transform the production of quality data, the culture of data use, the digitization of health information systems, and governance towards universal coverage( 11 , 12 ). Furthermore, the FMOH is attempting to improve HIS implementation by engaging with Higher Education Institutions (HEIs) in their respective areas, through the design of a Capacity Building and Mentorship Program (CBMP)( 13 ). Evidence suggests that the involvement of higher education institutions has a significant impact on capacity building, technology transfer, training, and collaborative research( 13 , 14 ). CBMP is a collaborative initiative with the federal ministry of health, regional health bureaus, and selected universities. The universities were selected to geographically cover all the national administrative regions of Ethiopia. "They were actively involved in technical capacity-building activities, which included mentorship, training, and supervision. Additionally, they worked towards harmonizing and expanding the pre-service programs for the development of Health Information Systems (HIS) professionals and evidence generation. The Federal Ministry of Health (FMOH) collaborates with other partners to finance and oversee the Capacity Building and Mentorship Program (CBMP)"( 15 – 17 ). CBMP’s primary objectives include ( 1 ) improving health data quality and information utilization, ( 2 ) improving the capacity of health workers and health managers to prepare, analyze, and use quality health information for evidence-based decision-making, ( 3 ) building the capacity of health workers and health managers at all levels ( 4 ) implementing DHIS 2 at facilities and district health offices and, ( 5 ), undertaking embedded implementation science research that helps to improve HIS implementation. The CBMP program aimed to create model woredas by achieving the objectives mentioned above( 18 ). The Connected Woreda Strategy (CWS) is a district-level tool that monitors HIS performance, improves HIS capacity, data quality, and information use culture at the point of data production( 19 , 20 ). The Comprehensive Health Services (CWS) utilizes assessment tools to evaluate the status of primary healthcare units. The Federal Ministry of Health (FMOH) declares model woreda and health facilities based on a predetermined set of criteria and assessment checklist dashboard. The assessment is based on three domains of performance: HIS infrastructure, data quality, and administrative data usage. HIS infrastructure and data quality are given a weightage of 30% each, while administrative data usage is given a weightage of 40%( 21 ). Woredas are classified into three categories based on their scores: emerging, candidate, and model when they score below 65%, between 65–90%, and above 90%, respectively. To declare the performance status, a multi-stage assessment process is required where the facility conducts a self-assessment, followed by verification from the CBMP-Implementing University, and final verification by the FMOH. Empirical evidences documented the effectiveness and implementation status of the CBMP program and the woreda’s performance status ( 22 , 23 ). It has been observed that the best practices and lessons learned from the model woredas were not adequately studied and recorded. Documenting the best experiences and lessons from the model woredas in a scientific manner can be an efficient and effective approach to scale up to other settings and create a learning health system. Therefore, the objective of this study is to explore the best practices and lessons learned from model health facilities and their implications for a learning health system in Ethiopia. Methods Study setting and period This study was conducted between March and June 2022 in four woredas and one town administration located in the Amhara, Sidama, and Benishangul Gumuz regional states of Ethiopia. The study included two model woredas, namely Awobel and Wogera Woredas from the Amhara region, Assosa town administration from the Benishangul-Gumuz region, and Shebedino and Hawella Woredas from the Sidama region. Study design A descriptive exploratory case study design involves a comprehensive examination of the complexity and uniqueness of a specific "initiative, policy, institution, program or system in a real-life" setting from various perspectives was employed( 24 ). The study used the exploration of the best practices and lessons learned during the CBMP intervention period. The research team adopted the Performance of Routine Information System Management (PRISM) framework to illustrate the information explored by the participants. Study population The study population includes purposively selected University CBMP, program leaders and coordinators, Regional Health Bureau directors, Health Centre, Hospital, and Woreda Health Office (WoHo) heads, Case team/HMIS/program/plan officers, or focal persons. Moreover, program and policy documents, published and unpublished articles, and program implementation documents are also included to supplement the participant’s responses Sampling and data collection procedure Forty-two key informants were purposefully selected and included in the study. In addition, policy and program documents were reviewed to supplement the qualitative findings. A semi-structured questionnaire was initially developed in English to gather information on PMT, data management, analysis, visualization and use, capacity building, and infrastructure. Each section explored the interventions implemented, the role of the intervention in data quality assurance, dissemination and use, best practices, lessons learned, challenges, and recommendations. A data extraction tool was developed and used to map available evidence and extract necessary information. Four data collectors conducted the qualitative interviews, and the availability and convenient times of all key informants were pre-arranged. To maintain the quality of the data, three days of training were provided to the data collectors. The training covered general guidelines on data-collection methods, sampling and data-collection procedures, and discussions on the content of each question. Data management and analysis The participants' responses were transcribed verbatim. The coding process was carried out using Atlas ti. 8 software and thematic analysis technique was employed. To start with, the analysis team used an inductive approach to create a codebook based on the first two transcript coding. One coder created the master project and then shared the transcripts with the team. The agreed code was imported into the software, and then the bundle was shared. Once the coding was finished, each code report was generated, cleaned, and prepared for synthesis. The coders synthesized each code, removed or merged any no longer appearing codes and classified all remaining codes into theme domains. Finally, the themes were reviewed and defined. The consolidated criteria for reporting qualitative studies were followed in the reporting of the study findings( 25 ). Trustworthiness of the study In order to ensure trustworthiness, this study utilized a mix of participant and data collection techniques. Additionally, an interview guide reviewed by experts in the field was used, and long-term engagement with the participants was maintained. Ethical considerations The Institutional Review Board of Hawassa University College of Medicine and Health Sciences granted ethical clearance (approval number IRB/213/3). The University of Gondar and Hawasa Universities were provided a support letter. Prior to the collection of data, each study participant provided informed consent. Participants' information was collected in a private room within the University, RHB, WoHo, and health facilities. Results Participant characteristics A total of 42 individuals from health systems and universities were interviewed for the study. Out of these participants, 9 were female, and their ages ranged from 22 to 45 years old. The majority of the participants, 35 out of 42 (83.3%), had more than 5 years of work experience. Almost 50% of the participants (21 out of 42) were from health centers, followed by 33.3% (14 out of 42) from the Woreda Health Office (WoHo) (Table 1). Best practices and lessons learned from the model facilities The study explored the best practices and lessons learned for enhancing the quality of data and its use in the CBMP implementation model woredas. The findings are presented using the Performance Routine Information System Management (PRISM) framework, which encompasses HIS interventions (technical, behavioral, and organizational) and HIS performance (data quality and data use) (26). Furthermore, during the presentation, a specific topic was discussed concerning sustainability and the factors related to challenges (Figure 1). HIS interventions This study examines how local CBMP universities designed and implemented interventions tailored to the unique needs and gaps identified in the baseline assessment. It also explores the collaboration between the Federal Ministry of Health (FMOH), Regional Health Bureaus (RHB), Zonal Health Department (ZHD), Woreda Health Office (WoHo), and local health facilities in planning and executing these interventions. Each intervention was customized based on the context and needs of the specific Woreda. The report categorizes the best practices and lessons learned from the interventions into three areas: Technical, Behavioral, and Organizational, using the PRISM framework. Technical interventions This study investigated the various technical support measures that the universities under the CBMP program provided to district health offices and healthcare facilities. Among the selected interventions were the supply of up-to-date HIS materials and manuals, the construction and renovation of HIS infrastructure, and the implementation of digitalization in the system. According to the respondents, the CBMP universities have provided helpful manuals and guidelines to support the proper implementation of Health Information Systems (HIS). The participants also observed that the manuals covered topics such as data quality and information use, computer troubleshooting and maintenance, HMIS indicator definition, HMIS data recording and processing, National Classification of Disease (NCoD), and Information Revolution (IR) HIS self-assessment checklist. Both soft and hard copies of these manuals and guidelines were made available, and they have assisted facilities and health professionals in their daily HIS-related activities. HMIS focal person from health center stated: "Different guidelines and reference manuals were provided by the universities that support improving the technical skills and practice of health professionals." (KII, HC HMIS focal). Respondents reported implementing various HIS infrastructure interventions through domestic resource mobilization, such as the renovation of MRUs and the establishment of separate HMIS offices. Hospital quality head stated: "… We prepared new standard shelves and expanded the number of services providing windows in the MRU. Currently, the number of windows increased from one to four and the clients are now served and hosted at different windows based on their service character." (KII, hospital quality head). Digitalizing the services at the district and health facility levels was among the technical interventions to enhance HIS implementation. The provision of internet modems, Wi-Fi, and CDMA to all health facilities was identified by the study participants as a critical intervention to support HIS digitalization. Besides, CBMP implementation allowed the facilities to use smart care and DHIS 2. A director at CBMP Participant University described: " After providing the computer, we have provided them with internet access; It is needed to send the data online. For those facilities that didn't access internet service in that area, we provided them with CDMA." (KII, CBMP director). Behavioural Interventions Interventions targeting the behavior of health professionals included mentorship, peer-to-peer learning, and need-based capacity-building trainings were provided. Based on the feedback received from the study participants, the CBMP institutions provided various short-term trainings that were relevant and helpful in enhancing the capacity and skills of healthcare professionals to carry out HIS operations with efficiency and effectiveness. This, in turn, improved their overall behavior. Furthermore, the participants noted that the training programs were mostly need-based, offered hands-on experience, and were conducted in well-organized training labs. A CBMP training and mentorship coordinator stated: “ Training needs were based on need assessment during facility mentorship and recommendations from the woreda health office and facilities . Besides, health facilities are supposed to conduct HIS needs assessments every six month and submit to the woreda office”. (KII, CBMP mentorship and training coordinator). The universities that are part of CBMP are creating and executing training programs to improve the skills of Healthcare Information System (HIS) professionals. These programs include both short-term and long-term trainings. As part of their efforts, the universities conducted a national study in 2018 to forecast the HIS human resource needs for the next 10 years. The report indicates that the country requires more than 50,000 HIS professionals(27). Therefore, universities recommended national HIS curricula harmonization. CBMP university DDCF coordinator mentioned: "... With the national HIS HR forecasting result, national HIS program curriculum harmonization and eight HIS program supporting modules were prepared. Besides, with the support of DUP, more than 4000 copies of HIS supporting modules were distributed to the ten universities and colleges that provide the HI program…." (KII, University DDCF coordinator). Onsite peer-to-peer learning and orientation is one of the ways to improve the implementation of HIS activities. Professionals who received training at CBMP universities implement this method by informing all staff members about the training they received upon returning to their facility. This way, they can effectively transfer the knowledge and skills they have acquired. A hospital quality head stated: “… the hospital established a system that every trained staff should provide training orientation about the training they obtained to staffs who didn’t get through a peer-to-peer orientation.” (KII, Hospital quality head). Peer-to-peer mentorship was implemented to improve HIS activity implementation. Almost all participants responded that mentorship has been provided. Both the University of Gondar and Hawassa University stated that they used well-trained mentors. They engaged participants from the RHB and woreda health offices during the mentorship, which was conducted quarterly. A respondent stated: " … We are conducting mentorship with the lead of university mentors in collaboration with participants from the RHB and woreda health office. “(KII, CBMP director). Despite universities declare mentorship have a significant impact, their approaches differed. Hawassa university participant mentioned that, they follow an approach Focus, Gap analysis and develop an action plan – Execute, Cascade and Reward (FGD-ECR). FGD-ECR approach focused and invested to a selected one facility to make it learning and demonstration site for other. A respondent from Hawassa University explained: "…We have observed that the checklist-based mentorship didn't bring any changes, so we followed an approach for our mentors to take time with the health professionals and coach them on how it is done while on the job. This approach significantly improves HIS at the health facilities within two weeks." (KII, CBMP training coordinator). The university of Gondar respondent stated that the beginning of the mentorship intervention, there were challenges related to consistency and a shared understanding of the mentorship process. After two rounds of the mentorship, a workshop was organized to help mentors develop a common understanding of the process. During the workshop, inconsistencies in the understanding of the mentorship checklist and process were identified. A university DDCF coordinator stated: "… After two rounds of mentorship, we prepare a workshop to assess the practice of mentorship, and we have identified inconsistencies in understanding the mentorship checklist and mentorship approach. We discussed the mentorship checklist and approach with the mentors, and after that, we had good mentorship practice…." (KII, University DDCF coordinator) . A participant from the University of Gondar has shared that they use four different models for providing mentorship. These models are University lead, Woreda lead, cluster, and remote/virtual mentorship. The university takes the lead in providing mentorship, and RHB, ZHD, and WoHo work together to implement the university lead mentorship. Similarly, the woreda lead mentorship approach is where the woreda health office conducts mentorship independently. The cluster mentorship approach involves selecting staff from the top-performing health facility, who then mentor the other health facilities assigned in their cluster. Additionally, virtual/remote mentorship is a useful approach to help solve problems facing the health facilities and woreda health offices remotely. This type of mentorship includes attending PMT meetings through conference calls using the mobile phones of university mentors. CBMP training and mentorship coordinator stated: "During the university lead mentorship, members are from the RHB, ZHD, woreda health office, and University. But, the woreda lead mentorship is led by the woreda health office independently. In addition, virtual mentorship is conducted by the university mentors by telegram and phone call. The cluster mentorship is by the facilities in the woreda and managed by the woreda health office" (KII, CBMP training and mentorship coordinator). Organizational interventions According to the study, various interventions related to the organization such as collaboration, leadership engagement, local resource mobilization, HIS governance, HMIS task audit, evidence generation, experience sharing, and reward and recognition were implemented to improve the activities related to Health Information System (HIS). The participants in the study highlighted that the district health offices, RHB, and CBMP universities collaborated closely to implement most of the HIS activities. Supportive supervision, joint planning, joint curricula development, mentorship, review meetings and training are part of the collaborative implementation strategy. A study participant from regional health bureau acknowledged the collaboration as: "As RHB, we collaborated with the University of Gondar in several activities that include baseline assessment, mentorship, and supportive supervision with prior communication.” (KII, RHB PPD). One of the interventions to improve health information systems (HIS) is to provide computers for local use. Universities have been successful in mobilizing computers and supplying them to Regional Health Bureaus (RHB), district health offices, and local health facilities. This organizational intervention has helped enhance HIS activities at the local level. A study participant from a regional health bureau indicated: " … The availability of computers was assessed at the health facilities. And provided for those facilities that don’t have it as one intervention package considering it as a basic requirement to generate a report and use data." (KII, RHB PPD). A study participant from a health facility is also witnessed the recipient of computer and printer based on mentorship gap identification: "We received two computers from Hawassa University that we did not have before. Currently, we are using DHIS2, which we previously needed to go to submit reports with a hard copy." (KII, HC HMIS focal). This study examines how leadership engagement can improve Health Information System (HIS) activities within an organization. The research found that involving leaders in the early stages of project implementation is not easy, but leadership engagement increases over time with collaborative implementation science research, regular mentorship, and targeted meetings. Participants in the study reported that leadership engagement has a positive impact on HIS activities. A study participant from Hawassa University stated: "At the early stage of project implementation communications were mainly with only the facilities which lacks leadership engagement. Later on, we realized that we need leadership decisions. You cannot simply convince them allocate HIS budget for the HC without engagement..." (KII, RCSD). According to respondents, there is no established HIS governance and accountability framework that is implemented at the national, regional, and local levels. As a result, they created their own accountability frameworks for facility management at the local level to address this issue. The framework enabled them to monitor and manage HIS activities closely and also helped them to tackle challenges related to behavior and attitude. A respondent from a health facility stated: " Our HIS governance strategy was developed by the facility management and disseminated to the staff. All staff are oriented and informed to implement the HIS activities as their routine activity and accountability will be ensured based on the stated framework." (KII, HC head). Experience sharing, recognition and reward, and joint evidence generation and utilization were also organizational factors that enhanced HIS activity, taken as best practices and lessons in the study areas. A participant explained how experience sharing, making things easier, clearing doubts, and inspiring health professionals to move for action: "…We provided three days of training to the staff at MRU in the woreda. However, when we visited the facilities after the training, we noticed that some of them were not performing as expected. To address this issue, we decided to assign vehicles and per diem to take them to Wojel Health Center. There, they could observe how their peers were doing at their MRU, which had been renovated. After a full day of experience sharing, they returned with a radical change in their approach to their work. This experience sharing played a significant role in improving their performance." (KII, WrHo head) CBMP universities and implementers used rewards and recognition as motivation strategies. Some of the rewards and recognition include certificates, flash discs, computers, mobile phones, scholarships, and tea making materials for best-performer individuals and case teams. A Woreda Health Office respondent stated: "… The top performer is awarded a cup, while others receive certificates. If a health extension worker has been better at connecting TB suspects than others, she will receive 100 birr mobile airtime." (KII, WrHO head). Both universities involved in the CBMP program collaborated with stakeholders to conduct an implementation science research aimed at improving Health Information Systems (HIS). According to respondents from the University of Gondar, the implementation research was based on the findings of operational research conducted at the local health facility, and the results of the research were published (28). His performance improvement The performance improvement of the model woredas was measured by comparing the quality of data and information use before and after the implementation of CBMP. This study revealed that prior to CBMP implementation, many facilities did not conduct Lot Quality Assurance Sampling (LQAS), and the quality of data was not checked before it was sent to the next level. A study participant from CBMP University stated: "… None of the health facilities used data quality assurance techniques, and none were conducting LQAS for data quality check-ups." (KII, CBMP Training and Mentorship coordinator) This study found that prior to the implementation of the CBMP, patient data was incomplete, there was no central MRU, and smart care was not available. However, these issues were addressed and improved after the implementation of the interventions. Improving the quality of data was a challenging task that required a gradual and collaborative effort. Study participant from CBMP University mentioned that: "….We follows the learning by doing principle. We don't order them to do it; rather, we work the LQAS together." (KII, RCSD). In addition to producing quality health data, the assessment includes the use of PMT functionality, data dissemination, visualization, strategic problem-solving approach, and implementation of quality improvement projects. Before the CBMP implementation, most study participants reported that the PMTs were not fully functional. However, the functionality gradually evolved after the implementation. A respondent from health centre stated, currently they are even having PMT at case team level because of the intervention. "….Now, they even evaluate at their case team level. I now get evaluated case team reports; for example, the MCH case team evaluates before submitting to HMIS; they even do LQAS and submit it to me. That is a new experience in PMT activity" (KI HC HMIS focal). CBMP universities have helped health facilities and woreda health offices in disseminating core data elements to the stakeholders to enhance evidence-based decision-making. They have provided training on how to prepare data dissemination tools such as brochures, banners, leaflets, and bulletin, and how to use the DHIS2 dashboard. Additionally, they have advised the facilities to use local and national languages to disseminate information to create awareness about the health services and available data. A study participant from health centre stated: " By the brochure we prepare, we created awareness in the community about our facility services and performances. Especially during our CBHI promotion campaign, discussing the information we disseminate with the community helps us a lot ….." (KII, HC HMIS_Focal). A strategic problem-solving approach was implemented in the model woredas to enhance the use of data for decision-making. Health Centre Head study participant stated: "….we went to the community and cleaned stagnant water and reduced the case. That is how we are using the data; it is not just politics; rather, we are identifying problems and taking actions" (KII, HC_Head). In addition, the model woredas provided valuable insights and best practices for quality improvement projects (QIP). The QIPs are implemented collaboratively by the facility's quality improvement team and the PMT. The PMT is responsible for identifying gaps and sharing them with the quality team. Together, they identify the root causes and design appropriate strategies to address them. Participant from Quality team stated: " We designed this intervention after we prioritized the problems and selected the most important one with the quality team " (KII, Hospital Quality Head). The current study also identified factors that require strengthening to make the HIS change sustainable and other factors considered as a challenge for the existing best practices and lessons learned stated below. Sustainability The study participants stated that some of the above findings, namely institutional capacity building, HIS governance framework, leadership engagement, and creating data ownership, can be used as a sustainability strategy. One of the study participants stated that they implemented HIS governance frameworks to monitor and manage behavioral-related challenges. Moreover, participants mentioned that they adapted this monitoring system, which helped them to sustain the HIS performance. "… We have prepared the HIS governance accountability framework by the management to follow the HIS activities, and as a facility, we have a weekly internal supervision with HMIS task audit platform which checklist based." (KII, PHCU Director). Improved leadership engagement and data ownership can enhance the sustainability of HIS activities. Additionally, participants found CBMP interventions to be highly effective and recommended their implementation in other areas. Participant from Health Centre mentioned: "…. The CBMP program interventions helped us improve our staff's technical skill and increase our value and attitude towards health data. It is good to reach these interventions to other areas even." (KII, HC head). In addition, the study identified some challenges that should be taken into account when expanding to other regions. These challenges include frequent unplanned campaigns, limited involvement from consortium universities, insufficient computer resources, high staff turnover, dissatisfaction among HIS staff regarding career development and salary. These factors may pose challenges to the long-term sustainability of the current HIS improvement efforts and its ability to be scaled up to similar settings. Participant from RHB stated: "…a s you might have heard, HIT staffs felt discriminated and disappointed after JEG was implemented…It is a paradox that how can you take this facility to digitalization …without treating HIT equally with other staffs… He added that HIT professionals are changing their field of study because of lack of vertical growth. They are changing their profession to clinical field streams" (KII, RHB plan & program officer) Respondents also described how frequent and unplanned campaigns affect their HIS activity. A respondent from WoHo stated: "There are also different campaigns and emerging priorities that they (PMT members) have to be engaged in…becomes difficult for them to cascade other activities in parallel." (KII, WoHo Head). According to the respondents, one of the major challenges in implementing Health Information System (HIS) activities, such as Electronic Medical Records (EMR), is the poor competency of MRU staff. They noted that most staff members of the MRU are working based on their experience or after being promoted from their previous roles, such as security guards or housekeepers. Additionally, the respondents pointed out that the attitude towards the role of MRU staff as doable by anyone assigned is a significant issue that affects the implementation of HIS activities. "…. the staffs working in the unit were promoted from their previous housekeeping and security roles, and since they have been working from experience, it was challenging and energy-consuming (KII, WrHo M&E officer). A mixed study design identified low-level ownership as the main challenge. Poor facility responsiveness to feedback and misinterpreting CBMP as a research agenda rather than a partnership were also mentioned as challenges (29). Discussion The Capacity Building and Mentorship Partnership project had the objective of improving Health Information System (HIS) activities through the implementation of various interventions. The study found that the participants witnessed multiple technical, behavioral, and organizational HIS interventions, which led to positive changes in data quality and information utilization. The assessment also discovered that the program was comprehensive, as it considered context-specific and customized interventions. This section presents exceptional interventions that are regarded as best practices and lessons learned. These practices should be shared with the wider community for possible implementation in similar settings. Mentorship is an important step towards ensuring high-quality data and effective use of information in model woredas. However, during its implementation, certain variations were observed. The mentorship program was found to be comprehensive, covering all levels of healthcare systems from primary to tertiary care. It is change-oriented, educative, and participatory and delivered by well-trained and friendly mentors, which makes the mentorship program vital in bringing the intended changes. The above findings are consistent with earlier empirical evidence that highlights the role of mentorship in changing healthcare providers' attitudes, knowledge, and skills ( 16 , 22 , 23 , 30 , 31 ). Healthcare leaders play a vital role in transforming data into insights and actions, as access to high-quality data is crucial to improving health outcomes. This study has shown that leadership engagement is critical in transforming data into action, allocating budgets, and leading subordinates, among other important tasks. To engage leaders, the CBMP program has applied various approaches, such as review meetings, HIS training, and experience sharing. Leaders' experience in using data to make decisions, coupled with a positive experience in effect, has changed their attitude, demand, and value for data, making them important drivers of HIS activities. Several other studies have also supported this finding ( 32 , 33 ), engaging leaders assist in making timely decisions, providing vision, and monitoring activities. In addition, universities have adopted an evidence-based approach to their interventions. Evidence-based research has identified effective methods such as PBNFI, FGD-ECR, and PBLA. It has been demonstrated that universities can provide efficient solutions in a timely manner. Studies have also shown that developed countries often seek solutions from researchers in higher education institutions ( 18 , 34 ). This study has identified several new interventions that are important for the evolution of behavior, ultimately leading to improved health information systems (HIS) and health outcomes. Universities that implement these interventions need to first address the gaps that were identified, and then move on to capacity-building activities, while continuing to identify gaps, deliver mentorship, and generate evidence. According to this study, changing the culture of information use and digitization is a step-by-step process that requires structural changes, strong collaboration, a flexible approach, evidence, leadership engagement, commitment, and a sense of ownership of the HIS. The practice-based learning approach is considered to be the most effective method for training individuals in practical skills. This method involves real-world training with suitable trainees, as opposed to the traditional approach which relies heavily on theoretical lectures. This approach is globally recognized for its ability to enhance critical thinking, motivation for learning, and problem-solving ( 35 , 36 ). On the other hand, university-led mentorship was one of the welcomed collaborative approaches in which the university took the lead and guided the overall mentorship process. Strengths and Limitations Although the study was conducted in only three regions of the country, the findings can be applied to other areas if context-specific factors are taken into consideration. However, it is important to note that this study only evaluated the model woredas, which may not necessarily provide the best practices or reflect the challenges faced by non-model woredas. Therefore, there is potential for improvement and lessons to be learned from non-model woredas. Conclusion and recommendation In summary, various interventions were put in place, and many of them showed potential for being transferable, scalable, and replicable. The training and mentorship methods employed by the universities were highly regarded, as they were designed to meet the needs of the learners and focused on practical learning. The mentorship programs were recognized as a crucial aspect of capacity-building and were delivered through both on-site and remote approaches. Additionally, on-site peer-to-peer learning was explored as an important capacity-building intervention. As part of a critical intervention, the study looked into the availability of various HIS tools and manuals. These resources were found to be helpful for health professionals, serving as local guidance and references for their HIS-related activities. Additionally, several primary organizational interventions were identified as promising. These included engaging leaders, creating data ownership, establishing HIS governance and accountability frameworks, conducting regular HMIS task audits, mobilizing resources, sharing experiences, collaborating, and providing rewards and recognition. According to the study, collaborative intervention among universities and health systems through CBMP has enhanced the quality of data and its usage. Moreover, the data use culture was improved through data visualization and dissemination, PMT functionality, and developing various QI projects using the SPS approach. The study shed light on sustainability strategies, such as institutional capacity building, resource mobilization, leadership engagement, and creating a sense of ownership. They also used the HIS accountability framework and regular HMIS task audits to follow the HIS activities. Although we have had some great experiences, learned valuable lessons, and achieved sustainable results, there are still some challenges that need to be addressed to maintain our progress and expand to other settings. Specifically, we need to pay attention to issues such as staff turnover, MUR staff competency, HIS staff satisfaction, and weak collaboration among consortium universities, as they present significant obstacles. Implication for a learning health system This study has demonstrated that it is possible to achieve sustainable change by collaborating and intervening to achieve the overall goals of the health system, particularly in the area of the information revolution agenda. Collaborative projects that involve universities, health systems, and health facilities can help the health system to achieve its objectives. The study has shown how these institutions can work together, learn from the process, and drive change in the health system. Ultimately, the findings of this study contribute to a continuous learning process among different institutions, which can be used to create learning health systems and share findings with other contexts. Abbreviations CBMP: Capacity Building Mentorship and Partnership, DDCF: Doris Duck Charitable Foundation, DUP: Data Use Partnership, FGD-ECR: Focus, Group analysis, Develop action plan, Cascade reward and recognition, PBLA: Practice Based Learning Approach, PBNFI: Performance Based Non-financial Incentive, PMT: Performance Management Team, RCSD: Research and Community Service Director. Declarations Ethics approval The Institutional Review Board of Hawassa University College of Medicine and Health Sciences granted ethical clearance (approval number IRB/213/3). Consent for publication : Not applicable. Availability of data and materials : The datasets used during the current study are available from the corresponding author on a reasonable request. Competing interests : The authors declare that they have no competing interests. Funding : the financial support of Doris Duke Charitable Foundation under grant number 2017187. Authors' contributions : All authors participated in the conception and design of this study including data collection tool development. All authors read and approved the final manuscript. Acknowledgments: “This work would not be possible without the financial support of Doris Duke Charitable Foundation under grant number 2017187. The mission of the Doris Duke Charitable Foundation is to improve the quality of people’s lives through grants supporting the performing arts, environmental conservation, medical research and child well-being, and through preservation of the cultural and environmental legacy of Doris Duke’s properties.” The authors also would like to acknowledge the study participants, data collectors and supervisor. References World Health O. Everybody's business--strengthening health systems to improve health outcomes: WHO's framework for action. 2007. WHO. Framework and standards for country health information systems / Health Metrics Network, World Health Organization. – 2nd ed. ISBN 978 92 4 159594 0. Accessed on 5/23/2021: https://www.who.int/healthinfo/country_monitoring_evaluation/who-hmn-framework-standards-chi.pdf. 2008. WHO. Toolkit on monitoring health systems strengthening: Health Information Systems. Accessed on 5/23/2021: https://www.who.int/healthinfo/statistics/toolkit_hss/EN_PDF_Toolkit_HSS_InformationSystems.pdf 2008. FMOH. Health Sector Transformation Plan. Addis Ababa: Ministry of Health Ethiopia. 2016. Woldemariam Hirpa HT, Nigussie F, Argaw H. Implementation of an integrated health management information system and monitoring and evaluation system in ethiopia: progress and lessons from pioneering regions. Citeseer; 2012. FMOH. Federal Democratic Republic of Ethiopia Ministry of Health POLICY AND PRACTICE M&E strategic plan. 2014. Endriyas M, Alano A, Mekonnen E, Ayele S, Kelaye T, Shiferaw M, et al. Understanding performance data: health management information system data accuracy in Southern Nations Nationalities and People’s Region, Ethiopia. BMC health services research. 2019;19(1):1-6. Bogale A. Implementation Status of Health Management Information System in Hospitals of South West Shoa Zone, Oromia, Central Ethiopia. Clinicoecon Outcomes Res. 2021;13:1-8. Shiferaw AM, Zegeye DT, Assefa S, Yenit MK. Routine health information system utilization and factors associated thereof among health workers at government health institutions in East Gojjam Zone, Northwest Ethiopia. BMC Med Inform Decis Mak. 2017;17(1):116-. Asemahagn MA. Determinants of routine health information utilization at primary healthcare facilities in Western Amhara, Ethiopia. Cogent Medicine. 2017;4(1):1387971. Ethiopia F. Health sector transformation plan I. Adis Ababa. 2015. Health-Ethiopia Mo. Health Sector Transformation Plan-II, Available at https://e-library.moh.gov.et/library/wp-content/uploads/2021/07/HSTP-II.pdf. 2021. Tilahun B, Gashu KD, Mekonnen ZA, Endehabtu BF, Asressie M, Minyihun A, et al. Strengthening the national health information system through a capacity-building and mentorship partnership (CBMP) programme: a health system and university partnership initiative in Ethiopia. Health Research Policy and Systems. 2021;19:1-11. Martin M. The Management of University-Industry Relations: Five Institutional Case Studies from Africa, Europe, Latin America, and the Pacific Region. Improving the Managerial Effectiveness of Higher Education Institutions: ERIC; 2000. ethiopia MoH. MOH Ethiopia SPECIAL BULLETIN 23rd ANNUAL REVIEW MEETING, available at https://www.moh.gov.et/site/sites/default/files/2021-10/Special%20bulletin.pdf. 2021. Gondar Uo. Capacity Building and Mentorship Program (CBMP), available at https://ehealthlab.org/cbmp/. 2017. Jimma University. Capacity Building and Mnetorship Program (CBMP), available at https://www.ju.edu.et/ehis/?q=node/377. 2019. loland P SP, Burkholder B, Slutsker L, De Cock KM. The role of public health institutions in global health system strengthening efforts: the US CDC's perspective. PLoS Med 2012;9(4). MInistry of Health Ethiopia. Health Sector Transformation Plan.: MOH,; 2016. Abera WS, Halallo BA, Beshir IA, Desta BF, Argaw MD. a strategy that improves the culture of information use at primary health care units in Ethiopia. 2021. Ababa A. Federal democratic republic of Ethiopia ministry of health. Ethiopia: Postnatal Care. 2003. Alemu MB, Atnafu A, Gebremedhin T, Endehabtu BF, Asressie M, Tilahun B. Outcome evaluation of capacity building and mentorship partnership (CBMP) program on data quality in the public health facilities of Amhara National Regional State, Ethiopia: a quasi-experimental evaluation. BMC Health Services Research. 2021;21(1):1-13. Chanyalew MA, Yitayal M, Atnafu A, Mengiste SA, Tilahun B. The Effectiveness of the Capacity Building and Mentorship Program in Improving Evidence-Based Decision-making in the Amhara Region, Northwest Ethiopia: Difference-in-Differences Study. JMIR Medical Informatics. 2022;10(4):e30518. Simons H. Case study research: In-depth understanding in context. The Oxford handbook of qualitative research. 2014:455-70. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International journal for quality in health care. 2007;19(6):349-57. Aqil A, Lippeveld T, Hozumi D. PRISM framework: a paradigm shift for designing, strengthening and evaluating routine health information systems. Health policy and planning. 2009;24(3):217-28. Tilahun B, Endehabtu BF, Gashu KD, Mekonnen ZA, Animut N, Belay H, et al. Current and future needs for human resources for Ethiopia’s national health information system: survey and forecasting study. JMIR Medical Education. 2022;8(2):e28965. Tilahun B, Derseh L, Atinafu A, Mamuye A, Mariam TH, Mohammed M, et al. Level and contributing factors of health data quality and information use in two districts in Northwest Ethiopia: social-ecological perspective. BMC Medical Informatics and Decision Making. 2021;21(1):1-14. Chanyalew MA, Yitayal M, Atnafu A, Tilahun B. Routine health information system utilization for evidence-based decision making in Amhara national regional state, northwest Ethiopia: a multi-level analysis. BMC Medical Informatics and Decision Making. 2021;21(1):1-10. HUCMHS. Best Practices/Innovations for Creating IR Model Woreda: Capacity Building and Mentorship Program (CBMP). In: T KGaA, editor. Hawassa, Ethiopia2021. Tilahun B, Gashu KD, Mekonnen ZA, Endehabtu BF, Asressie M, Minyihun A, et al. Strengthening the national health information system through a capacity-building and mentorship partnership (CBMP) programme: a health system and university partnership initiative in Ethiopia. Health Research Policy and Systems. 2021;19(1):1-11. Patty Thierry Sheridan VWaLAF. Health Information Management Leaders and the Practice of Leadership through the Lens of Bowen Theory. Perspect Health Inf Manag. 2016;13. Bahreini R GM, Gedik FG, Yousefi M, Janati A. . Components of contributing conditions to strengthen health system management and leadership capacity building: a systematic review and decision making framework Leadersh Health Serv (Bradf Engl) 2021. Mesoud Mohammed BY, Biniam Tilahun, Daniel Getachew, Wubshet Denboba, Naod Wendirad. Bridging the Gulf between the Academia and Social Sector; the Case of Capacity Building and Mentorship Program of the MOH of Ethiopia. In: Yeshanew NWaB, editor. Twenty-third annual health sector meeting: Responsive Health System in the New Beginnings!; Addis Ababa: MoH; 2020. F. WD. Problem based learning. BMJ. 2008(336 :971 ). Tudor Car L KB, Dunleavy G, Smart NA, Semwal M, Rotgans JI, Low-Beer N, Campbell J. . Digital Problem-Based Learning in Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res. 2019;21(2). Table Table 1: Background characteristics of study participants, Ethiopia, 2022 Characteristics Category Number of participants Sex Male 33 Female 9 Age ≤ 25 5 26 -30 11 31 -45 26 Position CBMP Director 2 RHB Director 2 CBMP or DDCF Coordinator 3 Facility/Hospital/WoHo Head 14 Case team/HMIS/program/plan officer or focal 21 Educational status Diploma 14 BSc/MD 11 MPH 16 PhD 1 Work experience Below five years 7 5 to 10 years 20 Above ten years 15 Total 42 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3999275","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":277412965,"identity":"86d86a44-e002-4ff8-8648-9e42e33ed0cc","order_by":0,"name":"Hiwot Belay","email":"","orcid":"","institution":"1Data Use Partnership, John Snow Inc Addis Ababa, Ethiopia","correspondingAuthor":false,"prefix":"","firstName":"Hiwot","middleName":"","lastName":"Belay","suffix":""},{"id":277412966,"identity":"199af7e2-3837-4049-af43-3984ca831519","order_by":1,"name":"Wubshet Demboba","email":"","orcid":"","institution":"1Data Use Partnership, John Snow 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Ethiopia.","correspondingAuthor":false,"prefix":"","firstName":"Netsanet","middleName":"","lastName":"Abera","suffix":""},{"id":277412972,"identity":"05bd7198-14ed-4acc-8ad0-6ff2c2b57e7d","order_by":7,"name":"Abebaw Gebeyehu","email":"","orcid":"","institution":"1Data Use Partnership, John Snow Inc Addis Ababa, Ethiopia","correspondingAuthor":false,"prefix":"","firstName":"Abebaw","middleName":"","lastName":"Gebeyehu","suffix":""}],"badges":[],"createdAt":"2024-02-29 10:02:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3999275/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3999275/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52540646,"identity":"3712e54b-d541-4a88-a9b5-f7aa5368f3dc","added_by":"auto","created_at":"2024-03-12 17:23:10","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":116369,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3999275/v1/d31eddcf50f0e926388cedc3.jpg"},{"id":55803757,"identity":"fd21f53b-12cf-43ac-8b71-a0a7cf62b85c","added_by":"auto","created_at":"2024-05-03 13:56:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":656492,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3999275/v1/bbb56bc4-395a-439e-84ef-83eaa5386e65.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Improving Data Quality and Information Use through Capacity Building and Mentorship Program in Ethiopia: Best Practices and Lessons Learned","fulltext":[{"header":"Background","content":"\u003cp\u003eHealth Information System (HIS) is an essential part of the six essential building blocks of a health system functioning to improve healthcare quality (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The health information system is fundamental for planning, monitoring, and evaluating healthcare services, controlling epidemics, tracking disease trends, and managing healthcare resources. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Ethiopia's health sector has made significant progress by adopting and implementing a Health Management Information System (HMIS) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Despite the achievements in HIS implementation, health data quality production and use culture persisted as a major gap characterized by untimely, incomplete, poor data production and use culture (\u003cspan additionalcitationids=\"CR7 CR8 CR9\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The Federal Ministry of Health in Ethiopia has recognized the importance of Health Management Information Systems (HMIS) and has made it a priority in their Health Sector Transformation Plan (HSTP). As part of this plan, they have designed an Information Revolution (IR) to transform the production of quality data, the culture of data use, the digitization of health information systems, and governance towards universal coverage(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Furthermore, the FMOH is attempting to improve HIS implementation by engaging with Higher Education Institutions (HEIs) in their respective areas, through the design of a Capacity Building and Mentorship Program (CBMP)(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Evidence suggests that the involvement of higher education institutions has a significant impact on capacity building, technology transfer, training, and collaborative research(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e CBMP is a collaborative initiative with the federal ministry of health, regional health bureaus, and selected universities. The universities were selected to geographically cover all the national administrative regions of Ethiopia. \"They were actively involved in technical capacity-building activities, which included mentorship, training, and supervision. Additionally, they worked towards harmonizing and expanding the pre-service programs for the development of Health Information Systems (HIS) professionals and evidence generation. The Federal Ministry of Health (FMOH) collaborates with other partners to finance and oversee the Capacity Building and Mentorship Program (CBMP)\"(\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). CBMP\u0026rsquo;s primary objectives include (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) improving health data quality and information utilization, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) improving the capacity of health workers and health managers to prepare, analyze, and use quality health information for evidence-based decision-making, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) building the capacity of health workers and health managers at all levels (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) implementing DHIS 2 at facilities and district health offices and, (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), undertaking embedded implementation science research that helps to improve HIS implementation. The CBMP program aimed to create model woredas by achieving the objectives mentioned above(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The Connected Woreda Strategy (CWS) is a district-level tool that monitors HIS performance, improves HIS capacity, data quality, and information use culture at the point of data production(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The Comprehensive Health Services (CWS) utilizes assessment tools to evaluate the status of primary healthcare units. The Federal Ministry of Health (FMOH) declares model woreda and health facilities based on a predetermined set of criteria and assessment checklist dashboard. The assessment is based on three domains of performance: HIS infrastructure, data quality, and administrative data usage. HIS infrastructure and data quality are given a weightage of 30% each, while administrative data usage is given a weightage of 40%(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Woredas are classified into three categories based on their scores: emerging, candidate, and model when they score below 65%, between 65\u0026ndash;90%, and above 90%, respectively. To declare the performance status, a multi-stage assessment process is required where the facility conducts a self-assessment, followed by verification from the CBMP-Implementing University, and final verification by the FMOH.\u003c/p\u003e \u003cp\u003eEmpirical evidences documented the effectiveness and implementation status of the CBMP program and the woreda\u0026rsquo;s performance status (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). It has been observed that the best practices and lessons learned from the model woredas were not adequately studied and recorded. Documenting the best experiences and lessons from the model woredas in a scientific manner can be an efficient and effective approach to scale up to other settings and create a learning health system. Therefore, the objective of this study is to explore the best practices and lessons learned from model health facilities and their implications for a learning health system in Ethiopia.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting and period\u003c/h2\u003e \u003cp\u003eThis study was conducted between March and June 2022 in four woredas and one town administration located in the Amhara, Sidama, and Benishangul Gumuz regional states of Ethiopia. The study included two model woredas, namely Awobel and Wogera Woredas from the Amhara region, Assosa town administration from the Benishangul-Gumuz region, and Shebedino and Hawella Woredas from the Sidama region.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA descriptive exploratory case study design involves a comprehensive examination of the complexity and uniqueness of a specific \"initiative, policy, institution, program or system in a real-life\" setting from various perspectives was employed(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The study used the exploration of the best practices and lessons learned during the CBMP intervention period. The research team adopted the Performance of Routine Information System Management (PRISM) framework to illustrate the information explored by the participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003e The study population includes purposively selected University CBMP, program leaders and coordinators, Regional Health Bureau directors, Health Centre, Hospital, and Woreda Health Office (WoHo) heads, Case team/HMIS/program/plan officers, or focal persons. Moreover, program and policy documents, published and unpublished articles, and program implementation documents are also included to supplement the participant\u0026rsquo;s responses\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSampling and data collection procedure\u003c/h2\u003e \u003cp\u003eForty-two key informants were purposefully selected and included in the study. In addition, policy and program documents were reviewed to supplement the qualitative findings. A semi-structured questionnaire was initially developed in English to gather information on PMT, data management, analysis, visualization and use, capacity building, and infrastructure. Each section explored the interventions implemented, the role of the intervention in data quality assurance, dissemination and use, best practices, lessons learned, challenges, and recommendations. A data extraction tool was developed and used to map available evidence and extract necessary information. Four data collectors conducted the qualitative interviews, and the availability and convenient times of all key informants were pre-arranged. To maintain the quality of the data, three days of training were provided to the data collectors. The training covered general guidelines on data-collection methods, sampling and data-collection procedures, and discussions on the content of each question.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData management and analysis\u003c/h2\u003e \u003cp\u003e The participants' responses were transcribed verbatim. The coding process was carried out using Atlas ti. 8 software and thematic analysis technique was employed. To start with, the analysis team used an inductive approach to create a codebook based on the first two transcript coding. One coder created the master project and then shared the transcripts with the team. The agreed code was imported into the software, and then the bundle was shared. Once the coding was finished, each code report was generated, cleaned, and prepared for synthesis. The coders synthesized each code, removed or merged any no longer appearing codes and classified all remaining codes into theme domains. Finally, the themes were reviewed and defined. The consolidated criteria for reporting qualitative studies were followed in the reporting of the study findings(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTrustworthiness of the study\u003c/h2\u003e \u003cp\u003eIn order to ensure trustworthiness, this study utilized a mix of participant and data collection techniques. Additionally, an interview guide reviewed by experts in the field was used, and long-term engagement with the participants was maintained.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e The Institutional Review Board of Hawassa University College of Medicine and Health Sciences granted ethical clearance (approval number IRB/213/3). The University of Gondar and Hawasa Universities were provided a support letter. Prior to the collection of data, each study participant provided informed consent. Participants' information was collected in a private room within the University, RHB, WoHo, and health facilities.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipant characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 42 individuals from health systems and universities were interviewed for the study. Out of these participants, 9 were female, and their ages ranged from 22 to 45 years old. The majority of the participants, 35 out of 42 (83.3%), had more than 5 years of work experience. Almost 50% of the participants (21 out of 42) were from health centers, followed by 33.3% (14 out of 42) from the Woreda Health Office (WoHo) (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eBest practices and lessons learned from the model facilities\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study explored the best practices and lessons learned for enhancing the quality of data and its use in the CBMP implementation model woredas. The findings are presented using the Performance Routine Information System Management (PRISM) framework, which encompasses HIS interventions (technical, behavioral, and organizational) and HIS performance (data quality and data use) (26).\u0026nbsp;Furthermore, during the presentation, a specific topic was discussed concerning sustainability and the factors related to challenges (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHIS interventions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study examines how local CBMP universities designed and implemented interventions tailored to the unique needs and gaps identified in the baseline assessment. It also explores the collaboration between the Federal Ministry of Health (FMOH), Regional Health Bureaus (RHB), Zonal Health Department (ZHD), Woreda Health Office (WoHo), and local health facilities in planning and executing these interventions. Each intervention was customized based on the context and needs of the specific Woreda. The report categorizes the best practices and lessons learned from the interventions into three areas: Technical, Behavioral, and Organizational, using the PRISM framework.\u003c/p\u003e\n\u003ch3\u003eTechnical interventions\u003c/h3\u003e\n\u003cp\u003eThis study investigated the various technical support measures that the universities under the CBMP program provided to district health offices and healthcare facilities. Among the selected interventions were the supply of up-to-date HIS materials and manuals, the construction and renovation of HIS infrastructure, and the implementation of digitalization in the system.\u003c/p\u003e\n\u003cp\u003eAccording to the respondents, the CBMP universities have provided helpful manuals and guidelines to support the proper implementation of Health Information Systems (HIS). The participants also observed that the manuals covered topics such as data quality and information use, computer troubleshooting and maintenance, HMIS indicator definition, HMIS data recording and processing, National Classification of Disease (NCoD), and Information Revolution (IR) HIS self-assessment checklist. Both soft and hard copies of these manuals and guidelines were made available, and they have assisted facilities and health professionals in their daily HIS-related activities. HMIS focal person from health center stated: \u003cem\u003e\"Different guidelines and reference manuals were provided by the universities that support improving the technical skills and practice of health professionals.\" (KII, HC HMIS focal).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eRespondents reported implementing various HIS infrastructure interventions through domestic resource mobilization, such as the renovation of MRUs and the establishment of separate HMIS offices.\u0026nbsp;Hospital quality head stated: \u003cem\u003e\"… We prepared new standard shelves and expanded the number of services providing windows in the MRU. Currently, the number of windows increased from one to four and the clients are now served and hosted at different windows based on their service character.\" (KII, hospital quality head).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDigitalizing the services at the district and health facility levels was among the technical interventions to enhance HIS implementation. The provision of internet modems, Wi-Fi, and CDMA to all health facilities was identified by the study participants as a critical intervention to support HIS digitalization. Besides, CBMP implementation allowed the facilities to use smart care and DHIS 2. A director at CBMP Participant University described:\u0026nbsp;\"\u003cem\u003eAfter providing the computer, we have provided them with internet access; It is needed to send the data online. For those facilities that didn't access internet service in that area, we provided them with CDMA.\" (KII, CBMP director).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eBehavioural Interventions\u003c/h3\u003e\n\u003cp\u003eInterventions targeting the behavior of health professionals included mentorship, peer-to-peer learning, and need-based capacity-building trainings were provided.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on the feedback received from the study participants, the CBMP institutions provided various short-term trainings that were relevant and helpful in enhancing the capacity and skills of healthcare professionals to carry out HIS operations with efficiency and effectiveness. This, in turn, improved their overall behavior. Furthermore, the participants noted that the training programs were mostly need-based, offered hands-on experience, and were conducted in well-organized training labs.\u0026nbsp;A CBMP training and mentorship coordinator stated: “\u003cem\u003eTraining needs were based on need assessment during facility mentorship and recommendations from the woreda health office and facilities\u003c/em\u003e.\u0026nbsp;\u003cem\u003eBesides, health facilities are supposed to conduct HIS needs assessments every six month and submit to the woreda office”. (KII, CBMP mentorship and training coordinator).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe universities that are part of CBMP are creating and executing training programs to improve the skills of Healthcare Information System (HIS) professionals. These programs include both short-term and long-term trainings. As part of their efforts, the universities conducted a national study in 2018 to forecast the HIS human resource needs for the next 10 years. The report indicates that the country requires more than 50,000 HIS professionals(27). Therefore, universities recommended national HIS curricula harmonization. CBMP university DDCF coordinator mentioned:\u0026nbsp;\u003cem\u003e\"...\u003c/em\u003e\u003cem\u003eWith the national HIS HR forecasting result, national HIS program curriculum harmonization and eight HIS program supporting modules were prepared. Besides, with the support of DUP, more than 4000 copies of HIS supporting modules were distributed to the ten universities and colleges that provide the HI program….\" (KII, University DDCF coordinator).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOnsite peer-to-peer learning and orientation is one of the ways to improve the implementation of HIS activities. Professionals who received training at CBMP universities implement this method by informing all staff members about the training they received upon returning to their facility. This way, they can effectively transfer the knowledge and skills they have acquired.\u0026nbsp;A hospital quality head stated:\u0026nbsp;\u003cem\u003e“… the hospital established a system that every trained staff should provide training orientation about the training they obtained to staffs who didn’t get through a peer-to-peer orientation.”\u0026nbsp;\u003c/em\u003e\u003cem\u003e(KII, Hospital quality head).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePeer-to-peer mentorship was implemented to improve HIS activity implementation. Almost all participants responded that mentorship has been provided. Both the University of Gondar and Hawassa University stated that they used well-trained mentors. They engaged participants from the RHB and woreda health offices during the mentorship, which was conducted quarterly.\u0026nbsp;A respondent stated:\u0026nbsp;\u003cem\u003e\"\u003c/em\u003e\u003cem\u003e… We are conducting mentorship with the lead of university mentors in collaboration with participants from the RHB and woreda health office. “(KII, CBMP director).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDespite universities declare mentorship have a significant impact, their approaches differed. \u0026nbsp; Hawassa university participant mentioned that, they follow an approach Focus, Gap analysis and develop an action plan – Execute, Cascade and Reward (FGD-ECR). FGD-ECR approach focused and invested to a selected one facility to make it learning and demonstration site for other. A respondent from Hawassa University explained:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"…We have observed that the checklist-based mentorship didn't bring any changes, so we followed an approach for our mentors to take time with the health professionals and coach them on how it is done while on the job. This approach significantly improves HIS at the health facilities within two weeks.\" (KII, CBMP training coordinator).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe university of Gondar respondent stated that the beginning of the mentorship intervention, there were challenges related to consistency and a shared understanding of the mentorship process. After two rounds of the mentorship, a workshop was organized to help mentors develop a common understanding of the process. During the workshop, inconsistencies in the understanding of the mentorship checklist and process were identified. A university DDCF coordinator stated:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"… After two rounds of mentorship, we prepare a workshop to assess the practice of mentorship, and we have identified inconsistencies in understanding the mentorship checklist and mentorship approach. We discussed the mentorship checklist and approach with the mentors, and after that, we had good mentorship practice….\" (KII, University DDCF coordinator)\u003c/em\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA participant from the University of Gondar has shared that they use four different models for providing mentorship. These models are University lead, Woreda lead, cluster, and remote/virtual mentorship. The university takes the lead in providing mentorship, and RHB, ZHD, and WoHo work together to implement the university lead mentorship. Similarly, the woreda lead mentorship approach is where the woreda health office conducts mentorship independently. The cluster mentorship approach involves selecting staff from the top-performing health facility, who then mentor the other health facilities assigned in their cluster. Additionally, virtual/remote mentorship is a useful approach to help solve problems facing the health facilities and woreda health offices remotely. This type of mentorship includes attending PMT meetings through conference calls using the mobile phones of university mentors. CBMP training and mentorship coordinator stated:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"During the university lead mentorship, members are from the RHB, ZHD, woreda health office, and University. But, the woreda lead mentorship is led by the woreda health office independently. In addition, virtual mentorship is conducted by the university mentors by telegram and phone call. The cluster mentorship is by the facilities in the woreda and managed by the woreda health office\" (KII, CBMP training and mentorship coordinator).\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eOrganizational interventions\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eAccording to the study, various interventions related to the organization such as collaboration, leadership engagement, local resource mobilization, HIS governance, HMIS task audit, evidence generation, experience sharing, and reward and recognition were implemented to improve the activities related to Health Information System (HIS). The participants in the study highlighted that the district health offices, RHB, and CBMP universities collaborated closely to implement most of the HIS activities.\u003c/p\u003e\n\u003cp\u003eSupportive supervision, joint planning, joint curricula development, mentorship, review meetings and training are part of the collaborative implementation strategy. A study participant from regional health bureau acknowledged the collaboration as:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"As RHB, we collaborated with the University of Gondar in several activities that include baseline assessment, mentorship, and supportive supervision with prior communication.” (KII, RHB PPD).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;One of the interventions to improve health information systems (HIS) is to provide computers for local use. Universities have been successful in mobilizing computers and supplying them to Regional Health Bureaus (RHB), district health offices, and local health facilities. This organizational intervention has helped enhance HIS activities at the local level. A study participant from a regional health bureau indicated:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"\u003c/em\u003e\u003cem\u003e… The availability of computers was assessed at the health facilities. And provided for those facilities that don’t have it as one intervention package considering it as a basic requirement to generate a report and use data.\" (KII, RHB PPD).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA study participant from a health facility is also witnessed the recipient of computer and printer based on mentorship gap identification:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"We received two computers from Hawassa University that we did not have before. Currently, we are using DHIS2, which we previously needed to go to submit reports with a hard copy.\"\u0026nbsp;\u003c/em\u003e\u003cem\u003e(KII, HC HMIS focal).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This study examines how leadership engagement can improve Health Information System (HIS) activities within an organization. The research found that involving leaders in the early stages of project implementation is not easy, but leadership engagement increases over time with collaborative implementation science research, regular mentorship, and targeted meetings. Participants in the study reported that leadership engagement has a positive impact on HIS activities. A study participant from Hawassa University stated:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"At the early stage of project implementation communications were mainly with only the facilities which lacks leadership engagement. Later on, we realized that we need leadership decisions. You cannot simply convince them allocate HIS budget for the HC without engagement...\" (KII, RCSD).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAccording to respondents, there is no established HIS governance and accountability framework that is implemented at the national, regional, and local levels. As a result, they created their own accountability frameworks for facility management at the local level to address this issue. The framework enabled them to monitor and manage HIS activities closely and also helped them to tackle challenges related to behavior and attitude.\u0026nbsp;A respondent from a health facility stated:\u003c/p\u003e\n\u003cp\u003e\"\u003cem\u003eOur HIS governance strategy was developed by the facility management and disseminated to the staff. All staff are oriented and informed to implement the HIS activities as their routine activity and accountability will be ensured based on the stated framework.\"\u0026nbsp;\u003c/em\u003e(KII, HC head).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eExperience sharing, recognition and reward, and joint evidence generation and utilization were also organizational factors that enhanced HIS activity, taken as best practices and lessons in the study areas.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA participant explained how experience sharing, making things easier, clearing doubts, and inspiring health professionals to move for action:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"…We provided three days of training to the staff at MRU in the woreda. However, when we visited the facilities after the training, we noticed that some of them were not performing as expected. To address this issue, we decided to assign vehicles and per diem to take them to Wojel Health Center. There, they could observe how their peers were doing at their MRU, which had been renovated. After a full day of experience sharing, they returned with a radical change in their approach to their work. This experience sharing played a significant role in improving their performance.\"\u0026nbsp;\u003c/em\u003e(KII, WrHo head)\u003c/p\u003e\n\u003cp\u003eCBMP universities and implementers used rewards and recognition as motivation strategies. Some of the rewards and recognition include certificates, flash discs, computers, mobile phones, scholarships, and tea making materials for best-performer individuals and case teams. A Woreda Health Office respondent stated:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\"…\u003cem\u003e\u0026nbsp;The top performer is awarded a cup, while others receive certificates. If a health extension worker has been better at connecting TB suspects than others, she will receive 100 birr mobile airtime.\"\u0026nbsp;\u003c/em\u003e(KII, WrHO head).\u003c/p\u003e\n\u003cp\u003eBoth universities involved in the CBMP program collaborated with stakeholders to conduct an implementation science research aimed at improving Health Information Systems (HIS). According to respondents from the University of Gondar, the implementation research was based on the findings of operational research conducted at the local health facility, and the results of the research were published\u0026nbsp;(28).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHis performance\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eimprovement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe performance improvement of the model woredas was measured by comparing the quality of data and information use before and after the implementation of CBMP. This study revealed that prior to CBMP implementation, many facilities did not conduct Lot Quality Assurance Sampling (LQAS), and the quality of data was not checked before it was sent to the next level. A study participant from CBMP University stated:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"… None of the health facilities used data quality assurance techniques, and none were conducting LQAS for data quality check-ups.\"\u003c/em\u003e \u003cem\u003e(KII, CBMP Training and Mentorship coordinator)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study found that prior to the implementation of the CBMP, patient data was incomplete, there was no central MRU, and smart care was not available. However, these issues were addressed and improved after the implementation of the interventions. Improving the quality of data was a challenging task that required a gradual and collaborative effort. Study participant from CBMP University mentioned that:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"….We follows the learning by doing principle. We don't order them to do it; rather, we work the LQAS together.\" (KII, RCSD).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn addition to producing quality health data, the assessment includes the use of PMT functionality, data dissemination, visualization, strategic problem-solving approach, and implementation of quality improvement projects.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBefore the CBMP implementation, most study participants reported that the PMTs were not fully functional. However, the functionality gradually evolved after the implementation. A respondent from health centre stated, currently they are even having PMT at case team level because of the intervention.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"….Now, they even evaluate at their case team level. I now get evaluated case team reports; for example, the MCH case team evaluates before submitting to HMIS; they even do LQAS and submit it to me. That is a new experience in PMT activity\" (KI HC HMIS focal).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCBMP universities have helped health facilities and woreda health offices in disseminating core data elements to the stakeholders to enhance evidence-based decision-making. They have provided training on how to prepare data dissemination tools such as brochures, banners, leaflets, and bulletin, and how to use the DHIS2 dashboard. Additionally, they have advised the facilities to use local and national languages to disseminate information to create awareness about the health services and available data. A study participant from health centre stated:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\"\u003cem\u003eBy the brochure we prepare, we created awareness in the community about our facility services and performances. Especially during our CBHI promotion campaign, discussing the information we disseminate with the community helps us a lot\u003c/em\u003e…..\" (KII, HC HMIS_Focal).\u003c/p\u003e\n\u003cp\u003eA strategic problem-solving approach was implemented in the model woredas to enhance the use of data for decision-making.\u0026nbsp; Health Centre Head study participant stated:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"….we went to the community and cleaned stagnant water and reduced the case. That is how we are using the data; it is not just politics; rather, we are identifying problems and taking actions\" (KII, HC_Head).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn addition, the model woredas provided valuable insights and best practices for quality improvement projects (QIP). The QIPs are implemented collaboratively by the facility's quality improvement team and the PMT. The PMT is responsible for identifying gaps and sharing them with the quality team. Together, they identify the root causes and design appropriate strategies to address them. Participant from Quality team stated:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\"\u003cem\u003eWe designed this intervention after we prioritized the problems and selected the most important one with the quality team\u003c/em\u003e\" (KII, Hospital Quality Head).\u003c/p\u003e\n\u003cp\u003eThe current study also identified factors that require strengthening to make the HIS change sustainable and other factors considered as a challenge for the existing best practices and lessons learned stated below. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSustainability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The study participants stated that some of the above findings, namely institutional capacity building, HIS governance framework, leadership engagement, and creating data ownership, can be used as a sustainability strategy. One of the study participants stated that they implemented HIS governance frameworks to monitor and manage behavioral-related challenges. Moreover, participants mentioned that they adapted this monitoring system, which helped them to sustain the HIS performance.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"…\u003c/em\u003e\u003cem\u003eWe have prepared the HIS governance accountability framework by the management to follow the HIS activities, and as a facility, we have a weekly internal supervision with HMIS task audit platform which checklist based.\" (KII, PHCU Director).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eImproved leadership engagement and data ownership can enhance the sustainability of HIS activities. Additionally, participants found CBMP interventions to be highly effective and recommended their implementation in other areas. Participant from Health Centre mentioned:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\"…. The CBMP program interventions helped us improve our staff's technical skill and increase our value and attitude towards health data. It is good to reach these interventions to other areas even.\" (KII, HC head).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn addition, the study identified some challenges that should be taken into account when expanding to other regions. These challenges include frequent unplanned campaigns, limited involvement from consortium universities, insufficient computer resources, high staff turnover, dissatisfaction among HIS staff regarding career development and salary. These factors may pose challenges to the long-term sustainability of the current HIS improvement efforts and its ability to be scaled up to similar settings. \u0026nbsp;Participant from RHB stated:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\"…a\u003cem\u003es you might have heard, HIT staffs felt discriminated and disappointed after JEG was implemented…It is a paradox that how can you take this facility to digitalization …without treating HIT equally with other staffs…\u003c/em\u003eHe added that HIT professionals are changing their field of study because of lack of vertical growth.\u0026nbsp;\u003cem\u003eThey are changing their profession to clinical field streams\"\u0026nbsp;\u003c/em\u003e(KII, RHB plan \u0026amp; program officer)\u003c/p\u003e\n\u003cp\u003eRespondents also described how frequent and unplanned campaigns affect their HIS activity. A respondent from WoHo stated:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\"There are also different campaigns and emerging priorities that they\u0026nbsp;\u003c/em\u003e(PMT members)\u003cem\u003e\u0026nbsp;have to be engaged in…becomes difficult for them to cascade other activities in parallel.\"\u0026nbsp;\u003c/em\u003e(KII, WoHo Head).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to the respondents, one of the major challenges in implementing Health Information System (HIS) activities, such as Electronic Medical Records (EMR), is the poor competency of MRU staff. They noted that most staff members of the MRU are working based on their experience or after being promoted from their previous roles, such as security guards or housekeepers. Additionally, the respondents pointed out that the attitude towards the role of MRU staff as doable by anyone assigned is a significant issue that affects the implementation of HIS activities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\"….\u003cem\u003e\u0026nbsp;the staffs working in the unit were promoted from their previous housekeeping and security roles, and since they have been working from experience, it was challenging and energy-consuming\u0026nbsp;\u003c/em\u003e(KII, WrHo M\u0026amp;E officer).\u003c/p\u003e\n\u003cp\u003eA mixed study design identified low-level ownership as the main challenge. Poor facility responsiveness to feedback and misinterpreting CBMP as a research agenda rather than a partnership were also mentioned as challenges (29).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe Capacity Building and Mentorship Partnership project had the objective of improving Health Information System (HIS) activities through the implementation of various interventions. The study found that the participants witnessed multiple technical, behavioral, and organizational HIS interventions, which led to positive changes in data quality and information utilization. The assessment also discovered that the program was comprehensive, as it considered context-specific and customized interventions. This section presents exceptional interventions that are regarded as best practices and lessons learned. These practices should be shared with the wider community for possible implementation in similar settings.\u003c/p\u003e \u003cp\u003eMentorship is an important step towards ensuring high-quality data and effective use of information in model woredas. However, during its implementation, certain variations were observed. The mentorship program was found to be comprehensive, covering all levels of healthcare systems from primary to tertiary care. It is change-oriented, educative, and participatory and delivered by well-trained and friendly mentors, which makes the mentorship program vital in bringing the intended changes. The above findings are consistent with earlier empirical evidence that highlights the role of mentorship in changing healthcare providers' attitudes, knowledge, and skills (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHealthcare leaders play a vital role in transforming data into insights and actions, as access to high-quality data is crucial to improving health outcomes. This study has shown that leadership engagement is critical in transforming data into action, allocating budgets, and leading subordinates, among other important tasks. To engage leaders, the CBMP program has applied various approaches, such as review meetings, HIS training, and experience sharing. Leaders' experience in using data to make decisions, coupled with a positive experience in effect, has changed their attitude, demand, and value for data, making them important drivers of HIS activities. Several other studies have also supported this finding (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), engaging leaders assist in making timely decisions, providing vision, and monitoring activities.\u003c/p\u003e \u003cp\u003eIn addition, universities have adopted an evidence-based approach to their interventions. Evidence-based research has identified effective methods such as PBNFI, FGD-ECR, and PBLA. It has been demonstrated that universities can provide efficient solutions in a timely manner. Studies have also shown that developed countries often seek solutions from researchers in higher education institutions (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study has identified several new interventions that are important for the evolution of behavior, ultimately leading to improved health information systems (HIS) and health outcomes. Universities that implement these interventions need to first address the gaps that were identified, and then move on to capacity-building activities, while continuing to identify gaps, deliver mentorship, and generate evidence. According to this study, changing the culture of information use and digitization is a step-by-step process that requires structural changes, strong collaboration, a flexible approach, evidence, leadership engagement, commitment, and a sense of ownership of the HIS.\u003c/p\u003e \u003cp\u003eThe practice-based learning approach is considered to be the most effective method for training individuals in practical skills. This method involves real-world training with suitable trainees, as opposed to the traditional approach which relies heavily on theoretical lectures. This approach is globally recognized for its ability to enhance critical thinking, motivation for learning, and problem-solving (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). On the other hand, university-led mentorship was one of the welcomed collaborative approaches in which the university took the lead and guided the overall mentorship process.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eAlthough the study was conducted in only three regions of the country, the findings can be applied to other areas if context-specific factors are taken into consideration. However, it is important to note that this study only evaluated the model woredas, which may not necessarily provide the best practices or reflect the challenges faced by non-model woredas. Therefore, there is potential for improvement and lessons to be learned from non-model woredas.\u003c/p\u003e \u003c/div\u003e "},{"header":"Conclusion and recommendation","content":"\u003cp\u003eIn summary, various interventions were put in place, and many of them showed potential for being transferable, scalable, and replicable. The training and mentorship methods employed by the universities were highly regarded, as they were designed to meet the needs of the learners and focused on practical learning. The mentorship programs were recognized as a crucial aspect of capacity-building and were delivered through both on-site and remote approaches. Additionally, on-site peer-to-peer learning was explored as an important capacity-building intervention.\u003c/p\u003e\u003cp\u003eAs part of a critical intervention, the study looked into the availability of various HIS tools and manuals. These resources were found to be helpful for health professionals, serving as local guidance and references for their HIS-related activities. Additionally, several primary organizational interventions were identified as promising. These included engaging leaders, creating data ownership, establishing HIS governance and accountability frameworks, conducting regular HMIS task audits, mobilizing resources, sharing experiences, collaborating, and providing rewards and recognition.\u003c/p\u003e\u003cp\u003eAccording to the study, collaborative intervention among universities and health systems through CBMP has enhanced the quality of data and its usage. Moreover, the data use culture was improved through data visualization and dissemination, PMT functionality, and developing various QI projects using the SPS approach.\u003c/p\u003e\u003cp\u003eThe study shed light on sustainability strategies, such as institutional capacity building, resource mobilization, leadership engagement, and creating a sense of ownership. They also used the HIS accountability framework and regular HMIS task audits to follow the HIS activities.\u003c/p\u003e\u003cp\u003eAlthough we have had some great experiences, learned valuable lessons, and achieved sustainable results, there are still some challenges that need to be addressed to maintain our progress and expand to other settings. Specifically, we need to pay attention to issues such as staff turnover, MUR staff competency, HIS staff satisfaction, and weak collaboration among consortium universities, as they present significant obstacles.\u003c/p\u003e\u003ch2\u003eImplication for a learning health system\u003c/h2\u003e\u003cp\u003eThis study has demonstrated that it is possible to achieve sustainable change by collaborating and intervening to achieve the overall goals of the health system, particularly in the area of the information revolution agenda. Collaborative projects that involve universities, health systems, and health facilities can help the health system to achieve its objectives. The study has shown how these institutions can work together, learn from the process, and drive change in the health system. Ultimately, the findings of this study contribute to a continuous learning process among different institutions, which can be used to create learning health systems and share findings with other contexts.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCBMP: Capacity Building Mentorship and Partnership, DDCF: Doris Duck Charitable Foundation, DUP: Data Use Partnership, FGD-ECR: Focus, Group analysis, Develop action plan, Cascade reward and recognition, PBLA: Practice Based Learning Approach, PBNFI: Performance Based Non-financial Incentive, PMT: Performance Management Team, RCSD: Research and Community Service Director.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Institutional Review Board of Hawassa University College of Medicine and Health Sciences granted ethical clearance (approval\u0026nbsp;number IRB/213/3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: The datasets used during the current study are available from the corresponding author on a reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e:\u0026nbsp;The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u0026nbsp;the financial support of Doris Duke Charitable Foundation under grant number 2017187.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e: All authors participated in the conception and design of this study including data collection tool development. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003e\u0026ldquo;This work would not be possible without the financial support of Doris Duke Charitable Foundation under grant number 2017187. The mission of the Doris Duke Charitable Foundation is to improve the quality of people\u0026rsquo;s lives through grants supporting the performing arts, environmental conservation, medical research and child well-being, and through preservation of the cultural and environmental legacy of Doris Duke\u0026rsquo;s properties.\u0026rdquo; The authors also would like to acknowledge the study participants, data collectors and supervisor. \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health O. 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Routine health information system utilization and factors associated thereof among health workers at government health institutions in East Gojjam Zone, Northwest Ethiopia. BMC Med Inform Decis Mak. 2017;17(1):116-.\u003c/li\u003e\n\u003cli\u003eAsemahagn MA. Determinants of routine health information utilization at primary healthcare facilities in Western Amhara, Ethiopia. Cogent Medicine. 2017;4(1):1387971.\u003c/li\u003e\n\u003cli\u003eEthiopia F. Health sector transformation plan I. Adis Ababa. 2015.\u003c/li\u003e\n\u003cli\u003eHealth-Ethiopia Mo. Health Sector Transformation Plan-II, Available at https://e-library.moh.gov.et/library/wp-content/uploads/2021/07/HSTP-II.pdf. 2021.\u003c/li\u003e\n\u003cli\u003eTilahun B, Gashu KD, Mekonnen ZA, Endehabtu BF, Asressie M, Minyihun A, et al. Strengthening the national health information system through a capacity-building and mentorship partnership (CBMP) programme: a health system and university partnership initiative in Ethiopia. Health Research Policy and Systems. 2021;19:1-11.\u003c/li\u003e\n\u003cli\u003eMartin M. The Management of University-Industry Relations: Five Institutional Case Studies from Africa, Europe, Latin America, and the Pacific Region. Improving the Managerial Effectiveness of Higher Education Institutions: ERIC; 2000.\u003c/li\u003e\n\u003cli\u003eethiopia MoH. MOH Ethiopia SPECIAL BULLETIN 23rd ANNUAL REVIEW MEETING, available at https://www.moh.gov.et/site/sites/default/files/2021-10/Special%20bulletin.pdf. 2021.\u003c/li\u003e\n\u003cli\u003eGondar Uo. Capacity Building and Mentorship Program (CBMP), available at https://ehealthlab.org/cbmp/. 2017.\u003c/li\u003e\n\u003cli\u003eJimma University. Capacity Building and Mnetorship Program (CBMP), available at https://www.ju.edu.et/ehis/?q=node/377. 2019.\u003c/li\u003e\n\u003cli\u003eloland P SP, Burkholder B, Slutsker L, De Cock KM. 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Health policy and planning. 2009;24(3):217-28.\u003c/li\u003e\n\u003cli\u003eTilahun B, Endehabtu BF, Gashu KD, Mekonnen ZA, Animut N, Belay H, et al. Current and future needs for human resources for Ethiopia\u0026rsquo;s national health information system: survey and forecasting study. JMIR Medical Education. 2022;8(2):e28965.\u003c/li\u003e\n\u003cli\u003eTilahun B, Derseh L, Atinafu A, Mamuye A, Mariam TH, Mohammed M, et al. Level and contributing factors of health data quality and information use in two districts in Northwest Ethiopia: social-ecological perspective. BMC Medical Informatics and Decision Making. 2021;21(1):1-14.\u003c/li\u003e\n\u003cli\u003eChanyalew MA, Yitayal M, Atnafu A, Tilahun B. Routine health information system utilization for evidence-based decision making in Amhara national regional state, northwest Ethiopia: a multi-level analysis. BMC Medical Informatics and Decision Making. 2021;21(1):1-10.\u003c/li\u003e\n\u003cli\u003eHUCMHS. Best Practices/Innovations for Creating IR Model Woreda: Capacity Building and Mentorship Program (CBMP). In: T KGaA, editor. Hawassa, Ethiopia2021.\u003c/li\u003e\n\u003cli\u003eTilahun B, Gashu KD, Mekonnen ZA, Endehabtu BF, Asressie M, Minyihun A, et al. Strengthening the national health information system through a capacity-building and mentorship partnership (CBMP) programme: a health system and university partnership initiative in Ethiopia. Health Research Policy and Systems. 2021;19(1):1-11.\u003c/li\u003e\n\u003cli\u003ePatty Thierry Sheridan VWaLAF. Health Information Management Leaders and the Practice of Leadership through the Lens of Bowen Theory. Perspect Health Inf Manag. 2016;13.\u003c/li\u003e\n\u003cli\u003eBahreini R GM, Gedik FG, Yousefi M, Janati A. . Components of contributing conditions to strengthen health system management and leadership capacity building: a systematic review and decision making framework Leadersh Health Serv (Bradf Engl) 2021.\u003c/li\u003e\n\u003cli\u003eMesoud Mohammed BY, Biniam Tilahun, Daniel Getachew, Wubshet Denboba, Naod Wendirad. Bridging the Gulf between the Academia and Social Sector; the Case of Capacity Building and Mentorship Program of the MOH of Ethiopia. In: Yeshanew NWaB, editor. Twenty-third annual health sector meeting: Responsive Health System in the New Beginnings!; Addis Ababa: MoH; 2020.\u003c/li\u003e\n\u003cli\u003eF. WD. Problem based learning. BMJ. 2008(336 :971 ).\u003c/li\u003e\n\u003cli\u003eTudor Car L KB, Dunleavy G, Smart NA, Semwal M, Rotgans JI, Low-Beer N, Campbell J. . Digital Problem-Based Learning in Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res. 2019;21(2).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 1: Background characteristics of study participants, Ethiopia, 2022\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"97%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.91836734693877%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of participants \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.91836734693877%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.91836734693877%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026le; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e26 -30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e31 -45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePosition\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.91836734693877%\" valign=\"top\"\u003e\n \u003cp\u003eCBMP Director\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eRHB Director\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eCBMP or DDCF Coordinator\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eFacility/Hospital/WoHo Head\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eCase team/HMIS/program/plan officer or focal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEducational status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.91836734693877%\" valign=\"top\"\u003e\n \u003cp\u003eDiploma\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eBSc/MD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eMPH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003ePhD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.408163265306122%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eWork experience\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.91836734693877%\" valign=\"top\"\u003e\n \u003cp\u003eBelow five years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e5 to 10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003eAbove ten years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.30769230769231%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"66.66666666666667%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"CBMP, HIS, Best experience, Lessons learned, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-3999275/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3999275/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The Capacity Building and Mentorship Program (CBMP) is a collaborative initiative of the Federal Ministry of Health of Ethiopia (FMOH) and selected Universities to enhance the Information Revolution Agenda. Recently, the FMOH declared that some CBMP implementations woredas are models. Therefore, assessing the best practices and lessons learned among the model woredas is essential for the success and scalability of the program. This study explores the best practices and lessons learned and their implications for creating a learning health system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: - \u003c/strong\u003eA descriptive exploratory case-study design was conducted in four verified model woredas and one town administration across three regions: Amhara, Sidama, and Benishangul-Gumuz of Ethiopia. The study involved interviewing forty-two informants who were purposively selected from the model districts. A semi-structured interview guide was used to explore information on the Performance Monitoring Team (PMT), data management, analysis, visualization and use, capacity building, and infrastructure. The data collected was analyzed thematically using Atlas ti. 8 software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: - \u003c/strong\u003eSix themes were explored in this study: technical, behavioral, organizational intervention, health information system performance improvement, sustainability, and challenges. Need-based and practical capacity-building training, local resource mobilization, leadership engagement, HIS task audit, HIS accountability framework, reward, and recognition were some of the critical best experiences and lessons to be shared. Besides data visualization and dissemination, the Performance Monitoring Team (PMT) functionality and quality improvement project using strategic problem-solving approaches enhanced the intervention implementation. This study asserted local resource mobilization, leadership engagement, and institutional capacity building as critical factors for the sustainability of existing achievements. However, staff shortage and turnovers, job evaluation grading complaints, and low competency of medical record unit staff were existing challenges affecting the sustainability and scalability of the best experiences and lessons.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and recommendation: - \u003c/strong\u003eNumerous\u003cstrong\u003e \u003c/strong\u003ebest experiences and lessons are identified among model districts. Need-based and practical HIS capacity-building training, leadership engagement, local resource mobilization, and HIS accountability framework were scalable and replicable best experiences and lessons. However, staff shortage and turnover, local Health Information Technician complaints, and contextual factors must be considered while scaling up to other areas.\u003c/p\u003e","manuscriptTitle":"Improving Data Quality and Information Use through Capacity Building and Mentorship Program in Ethiopia: Best Practices and Lessons Learned","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-12 17:23:05","doi":"10.21203/rs.3.rs-3999275/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b8454164-e973-4214-847c-ea732f845f73","owner":[],"postedDate":"March 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-30T09:01:19+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-12 17:23:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3999275","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3999275","identity":"rs-3999275","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}