2.
0 CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction The Health Management Information System (HMIS) is a framework of
interconnected elements that collect, process, report, and support the use of health data to
enhance service efficiency and effectiveness (Rumisha et al., 2020). WHO reports indicate that
nearly 40% of countries face data quality challenges, with many lacking the capacity to validate
health data accuracy (Morris, Nyongesa & Sokiri, 2024). Although HMIS is a critical pillar of health
systems, gaps such as incomplete, inconsistent, untimely, and inaccurate data collection have been
observed (Rumisha et al., 2020). This chapter reviews literature on factors affecting HMIS data
quality, arranged thematically according to research objectives, and highlights gaps in knowledge.
2.2 Health Workers’ Behavioral Factors on Data Quality The health workforce, alongside policies
and guidelines, plays a vital role in service delivery and patient safety. Key behavioral factors
include staff knowledge, digital literacy, attitudes, confidence, experience, and skills in HMIS tasks
(Chanyalew et al., 2021). Improving staff behavior and competencies directly enhances institutional
service quality (Kozjek & Ovsenik, 2016).
2.2.1 Knowledge Factors Knowledge is essential for effective HMIS use and supports patient safety
by enabling staff to understand risks and system errors (Endriyas et al., 2019). With growing
reliance on cloud and big data technologies, skills in data management and security are
increasingly critical (Alaoui et al., 2020). However, lack of expertise leads to poor data quality in
many facilities (Kozjek & Ovsenik, 2016). Studies also indicate that a motivated HMIS focal person
improves data accuracy (Ngugi et al., 2020). Addressing these behavioral gaps is key to reliable
data quality.
2.2.2 Training and Competency Adequate HMIS training strengthens staff skills in data collection
and analysis, ensuring that information supports decision-making (Chanyalew et al., 2021). Without
skilled personnel, collected data remains underutilized (Mucee et al., 2016). Competency is strongly
linked to data quality (Morris et al., 2024), with capacity-building programs and recognition
incentives found to improve performance (Agarwal et al., 2023). Weak skills in monitoring and
evaluation remain a global challenge (Kenyenga et al., 2022). Studies across Africa confirm that
staff competency, motivation, and recognition improve HMIS outcomes (Silas, 2017; Cheburet &
Odhiambo, 2016). Inadequate training on data tools, interpretation, and reporting continues to
undermine quality worldwide (Hlaing & Myint, 2022; Alipour & Ahmadi, 2017).
2.3 Technological Factors on Data Quality Technology is central to HMIS data collection,
processing, and analysis. Key elements include data tools, reporting standards, system design, and
scalability (Dagnew et al., 2018). Properly designed systems support data accuracy, yet challenges
such as incomplete and untimely reporting persist in many countries (Kenyenga et al., 2022).
Standardized indicators play a critical role in data quality (Wude et al., 2020). Studies highlight
issues such as multiple reporting tools, lack of computers, redundancy across systems, and weak
IT infrastructure (Mucee et al., 2016; Wandera et al., 2019). Poorly designed EMRs further
compromise data integrity and patient safety (Dagnew et al., 2018). Complexity of data collection
tools and inadequate user training also increase errors (Radwan Choughri, 2018).
2.4 Organizational Factors on Data Quality Organizational support, including training, supervision,
funding, leadership, and data governance, influences HMIS outcomes (Glette & Wiig, 2021).
Capacity-building initiatives and regular feedback improve data quality (Lemma et al., 2020).
Inadequate funding remains a major barrier, with health information systems underfunded in most
facilities (Cheburet & Odhiambo, 2016). Strong leadership is essential for implementing policies,
motivating staff, and ensuring coordination (Rumisha et al., 2020; Chanyalew et al., 2021).
Conversely, poor leadership leads to duplication, inconsistency, and incomplete data. Supportive
supervision and fair employment practices improve staff performance, while lack of feedback
frustrates health workers (Lemma et al., 2020). Weak policy enforcement, poor accountability, and
limited staff training further hinder HMIS performance (Hassenstein & Vanella, 2022).
2.5 Literature Gaps Reviewed studies reveal that data quality is often assessed using
completeness and timeliness, but definitions vary. While most literature links staff competency and
motivation to data quality, few studies examine the role of data demand, quality-checking skills, or
HIS complexity. Limited research uses inferential statistics to analyze relationships between data
quality, information use, and behavioral, technical, or organizational factors. This highlights the
need for further empirical studies on these aspects.