Leveraging Health Information System Maturity Assessments to Guide Strategic Priorities: Perspectives from African Leaders

Introduction Central to a functional public health system is a strong health information ecosystem and robust data use. Many low-and-middle-income countries (LMICs) face the task of digitizing their health information systems (HIS). For health leaders, deciding what to prioritize when investing in HIS strengthening is central to this daunting challenge. Objectives The study explores how HIS maturity assessment contributes to HIS strengthening, describes the facilitators and barriers to HIS maturity assessments, and how health leaders can prioritize conducting maturity assessments. Methods This descriptive qualitative study employed key informant interviews (KIIs) with fourteen eHealth leaders at national and international levels working or supporting Ministries of Health’s national HIS in LMICs. Results were analyzed using Dedoose Version 9.0 to develop themes based on the health systems’ building blocks as a framework for identifying facilitators and barriers to conducting HIS maturity assessment. Results Participants identified maturity assessments as a critical beginning step to HIS strengthening, showing the system’s performance, and building a baseline response to systematic data quality challenges. Barriers to conducting HIS maturity assessment include lacking collaborators’ buy-in, fragmented vision, low financial/human resources, and overdependence on donor priorities. Non- supportive policies, a lack of execution champions, and an inadequately skilled workforce in conducting maturity assessments or negotiating for their prioritization hinder maturity assessment implementation. Frequently identified facilitators to promoting HIS maturity assessment include multi-stakeholder engagement, understanding the country’s HIS ecosystem, and priorities to appropriately integrate maturity assessment objectives. Recommendations include capacity building in data use and conducting maturity assessments at all health system levels to grow the demand and value of HIS maturity assessments. Conclusion Promoting HIS maturity assessments can help leaders prioritize areas to improve in the HIS ecosystem, making appropriate decisions that steward HIS maturity advancement. Addressing challenges that hinder HIS assessment implementation holds promise to identify a pathway to a strengthened health system. Author Summary Our manuscript specifically spotlights the perspectives of African eHealth leaders, centering voices on the barriers and facilitators to planning and implementing HIS maturity assessments. We demonstrate their perspective on how conducting maturity assessments can inform understanding of gaps to address in the HIS and strategic direction. We detail the leaders’ recommendations for using HIS maturity assessments in strengthening HIS governance and overall health systems for better population health outcomes in LMIC settings. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The ethics committee of the University of Washington (UW) internal review board (IRB) reviewed and approved the research under the UW IRB STUDY00018156 I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data to the study is stored in a secure folder in SharePoint drive under the University of Washington. This data can be made available to reviewers upon request. A link to the dashboard may be made available to authorized reviewers as it contains patient information that cannot be shared widely according to patient rights and confidentiality of information regarding health data.