Process Evaluation on Community Health Information System in South-East Zone Tigray 2016
Authors: Adem Mesaud Mohammedbirhan , Gebrehiwot Tesfay G , Tequar Mengistu H , Awalom Taddele W 
Published: August 2020

Abstract
Back ground: As per the world health organization (WHO), Health Information System (HIS) is one of the six building blocks of the health system. Nations establish their HIS as per their context. Generally HIS regarding data management (the ability to collect, store, analyze and distribute data) is limited in Sub Saharan African countries (1).However, literatures found were not able to show the magnitude of the problems of the program implementation status. As the result of the announcement of WHO “health for all”, global health initiatives started to improve community health aligned with millennium development goals which emphasized the need to strengthen the primary health care to decrease child mortality, improve maternal health, and combat HIV/AIDS, malaria, and other communicable and non-communicable diseases. So community health information System became public health issue in Ethiopia (2).Cognizant of the importance of health information Federal Ministry of Health (FMOH) started reform of health information system and monitoring and evaluation (M&E) components to solve the data collection, reporting gaps and to strengthen the information Utilization (2).As the result of the above scenario, FMOH started to strengthen the HMIS and its principles standardization, specification, integration so as to improve the data collection, summation, analysis and dissemination for decision and action. Here Community Health Information System was scaled-up along with HMIS (2). Community Health Information System (CHIS) was designed to standardize data collection and integrate data systems to provide relevant information for decision-making at the health posts and to feed the HMIS on a regular basis. Family folder is a pouch, which is the main part of CHIS, is a data collection tool designed by the FMoH for Health Extension Workers (HEWs) to document both individual and household level data to be utilized as a source of information at the grass root level(3)Unlike the health centers` and hospitals` in health post there were different types of unorganized registers which were used to collect information on services provided within a single health domain, sometimes requiring a large group of registers to cover all health domains related to population. In addition, there was no any mechanism to identify which group of people needs, which type of health care services .But family folder informs patient care through the data contained in individual and family records, identifies patients in need of care through a set of tickler files, and enables reporting through supplementary tally sheets and family folder cards. The overall design of the FF innovation was to simplify the workflow of the community health worker and focus health care delivery at the community level (4).Methods: The study focused on process evaluation, on the implementation of CHIS in South-East Zone in Tigray. South East Zone was purposely selected due to the short distance to Mekelle that indirectly helped to reduce cost. Process evaluation, normative evaluation approach was used; Quantitative data was used to assess the implementation of CHIS in south east zone Tigray. A descriptive evaluation designs also used to describe activities which the program carried out. The sampling area was health posts found in south-east zone Tigray which were randomly selected from the nearest kushet to the health post and the Sample size was 634 family folders & respective houses. The dimensions used for the evaluation were: availability, compliance, completeness and consistency. These dimensions were helped to assess the CHIS implementation status in the south-east zone in Tigray.Results: Generally the result of this study is very good (87.48%), the availability of CHIS tools is 88.7%, compliance 92.54%, completeness 95.8% & consistency is 68.16%. The availability of Inks & brushes was 29% which is very low. 30% of the HEWs were using field book as a replacement of FF, 64.7% of health posts used more than 10 parallel recording and 76.4 % of health posts used reporting formats. In some health posts there was difference between expected and actual households registered in family folder. The consistency of the data between family folder and master family index was 97.7% and between family folder and households was 80%.Conclusion & recommendation: the implementation status of CHIS is very good but TRHB & stakeholders should give attention to strengthen the program and to stop parallel recording & reporting tools and CHIS should be revised and transformed in to e-CHIS.