Does an Innovative Paper-Based Health Information System (PHISICC) Improve Data Quality and use in Primary Health Care? Protocol of a Multi-Country, Cluster Randomised Controlled trial in Sub-Saharan African Rural Settings.

Abstract BackgroundFrontline health workers in remote, rural health facilities are the first contact of the formal health sector and are confronted with the need to make life-saving clinical and public health decisions. Appropriate health information systems (HIS) provide data to support the collection and use of data, thus facilitating decision-making. However, HIS focus on reporting and are unfit to support critical decisions at the peripheral level. Since data tools are paper-based in most primary health care settings, we have produced an innovative paper-based HIS (PHISICC), embracing all health care areas in primary health care, using a Human Centred Design, co-creation approach. The PHISICC tools aid decision-making, include recording and reporting and substitute the regular HIS tools. We are carrying out a cluster-randomised controlled trial in three African countries to assess the effects of PHISICC compared with the current systems, on data use and quality, quality of health care and health worker perceptions, in remote, rural settings.MethodsWe have selected study areas in rural zones of Côte d’Ivoire, Mozambique and Nigeria. Seventy health facilities in each country have been randomly allocated to using PHISICC tools or to continuing to use the regular HIS tools (35 per arm). We have selected three villages in the catchment area of each health facility to carry out surveys in 10 households each. Outcomes of interest include data quality and use, coverage of health services, health workers perceptions and other process and explanatory variables. DiscussionWe strive to contribute to producing robust evidence on health systems interventions, affecting people in remote, rural settings where the most vulnerable live. The PHISICC tools focus on decision-making rather than data and are meant to support health workers decisions as well as reporting to the higher levels of the system. Robust evidence on HIS can better find its way to high quality systematic reviews and guidance development to inform policy and practice.Trial registration: Pan African Clinical Trials Registry - PACTR201904664660639. Registered 01/04/2019, https://pactr.samrc.ac.za/Search.aspx.