Going Paperless

MEASURE Evaluation helps Swaziland ensure data quality as the country digitizes its health information system.

MEASURE Evaluation helps Swaziland ensure data quality as the country digitizes its health information system.

Photo by Christina Villella, MEASURE Evaluation
Health systems in low- and middle-income countries face considerable challenges in providing high-quality, affordable, and universally accessible care. Electronic medical record systems with accurate and reliable information can improve health care by informing clinical decisions and ensuring patients follow through with their treatments. However, ensuring quality health information remains a problem due to incomplete records and delayed reporting.

MEASURE Evaluation recently assisted the Kingdom of Swaziland’s Ministry of Health (MOH) in creating standards for its new Client Management Information System (CMIS), including data management procedures for information obtained and stored by the electronic medical record. These procedures guided a national data quality audit (DQA) that took place over three weeks in late October through early November 2016.


The work was part of a larger effort funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which provides technical and financial support to Swaziland’s MOH in fighting the HIV epidemic. Together, MOH and PEPFAR are strengthening health information systems, monitoring and evaluation (M&E) activities, routine data collection and management, data quality, and development of information products.

Christina Villella, who supports the health informatics and DATIM portfolios for MEASURE Evaluation, helped conduct the assessment. “The DQA served two purposes,” she says. “One was to see what’s changed since the last assessment in 2012. The other was to create a baseline of data captured by electronic medical records in the new CMIS.”

dqa team pic.jpg
The DQA team

MEASURE Evaluation trained staff from MOH and its local partner, the Institute for Health Management (IHM) Southern Africa, to use a Routine Data Quality Assessment (RDQA) tool to track data accuracy, timeliness, and completeness. The tool, developed by MEASURE Evaluation, also assesses functional components of the data management and reporting system, including:

  • System structure, functions, and capabilities
  • Use of data for decision making
  • Data management processes
  • Linkage with national reporting system
  • Data collection and reporting forms and tools
  • Indicator definitions and reporting guidelines

The DQA provided MOH, PEPFAR, and implementing partners an opportunity to verify reported program performance data, assess the ability of the national health management information system (HMIS) to report quality data, and pinpoint strengths and weaknesses of the system for additional improvement where necessary.


In February 2017, MEASURE Evaluation, along with the MOH and IHM, shared findings of the assessment with key stakeholders, as well as recommendations on how to improve data quality at this critical stage when the country is digitizing its health management information system (HMIS).

“Officials in Swaziland did a lot of work ahead over the last few years to standardize HMIS indicators and come up with uniform registers and reporting tools,” Villella says. “The MOH Strategic Information Division has a centralized HMIS unit and M&E unit, instead of having several vertical programs doing their own data collection and reporting. This centralized system has set the country up for success in rolling out the national electronic medical record system, CMIS, and being able to respond to the results of the assessment.”

The experience also built capacity within the country to carry out future DQAs. “MOH and IHM staff were really doing an audit of themselves,” Villella says, “and they were quite honest about their strengths and weaknesses, which is important and impressive. They wanted to learn the methods so they can continue to conduct DQAs. Now they have the standard operating procedures, DQA tools, training, and experience to do so.”

To learn more about MEASURE Evaluation’s data quality assessments and capacity-building, visit https://www.measureevaluation.org/our-work/data-quality

Filed under: Data , Health information systems , Data Quality , Electronic Health Records
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