Accelerating implementation of District Health Information Systems: Perspectives from healthcare workers from KwaZulu-Natal, South Africa

Background: Although electronic health record systems are critical for healthcare management, there has been genuine concern about the quantity and quality of data generated by these systems inhibiting its full implementation. Objectives: The purpose of this article was to explore the experiences of healthcare workers (HCWs) and challenges facing the acceleration of the District Health Information System (DHIS) in the KwaZulu-Natal (KZN) province of South Africa. Methods: In this study, an interpretive research paradigm was followed to explore the current state of electronic health in South Africa from the experiences of HCWs in the KZN province. Semi-structured focus group interviews conducted with 20 participants drawn from the district office, clinical nurse practitioners and data capturers allowed thematic analysis of data using a systems approach to link the perspectives HCWs to the design of the DHIS. Results: The participants held the view that e-health is crucial for monitoring disease trends, policy development, planning and allocation of infrastructure, information technology (IT), financial and human resources. Nevertheless, the participants highlighted a concern surrounding e-health regulations, ethics and data confidentiality; data quality and lack of interoperability of Health Information Systems (HIS). This concern was attributed to data fragmentation, internal politics and lack of coordination of the data system. Conclusions: The study suggests that good quality data – from an integrated DHIS, is highly critical for the effective utilisation, implementation and acceleration of e-health systems in the province to support epidemiological surveillance and modelling of outbreaks, such as the COVID-19 pandemic.