Table 2 Summary of themes, sub-themes, codes and sample quotes

Understanding towards HIS accountability framework

Guidance and regulation

• System of controlling HIS activities using governing protocols

“ HIS accountability framework is a system to oversee and regulate the HIS activities based on the assigned HIS roles and responsibilities”

• A system to ensure accountability for HIS roles and responsibilities

• A system to ensure being answerable for the HIS related work results

• A system to take administrative and corrective actions for the HIS activity results

• Regulatory means to monitor and control HIS activities

• Procedural standard to govern/cascade HIS activities

Perceived advantage of HIS accountability framework

Improving behavior towards data management

• To manage the behavioral problems towards HIS practice

“If the HIS accountability framework is implemented, it will govern the behavioral-related problems of the health professionals and be used to manage and control the recurrence of HIS-related errors based on the tangible guideline or protocol.”

• To enhance the adherence of health professionals for the HIS activities

• To enhance the commitment and sense of ownership of health professionals

Improving data quality and data use practice

• To enhance data handover and sharing practice

“HIS accountability framework is an ideal system to ensure the data quality which is appropriate recording and reporting practice and to use it for different program and clinical decisions”

• To enhance data security and privacy

• To ensure to data timeliness, completeness, and consistency

• To improve informed decision making practice & quality of care

• To have valid research output

Improving HIS leadership practice

• To effectively apply HIS leadership practices

“If the HIS accountability framework is introduced at the institutions, it will bring a good culture to give specific and targeted feedback to the implementers, enhancing the health professionals’ sense of ownership of the HIS data”

Implementation of HIS accountability framework

Current practice of HIS accountability framework

• No written system to govern the HIS activities

“…In my experience, I have not seen any experience of applying accountability system to oversee the activities of HIS”

• No Accountability framework practice

HIS implementation M&E platforms

• HIS specific internal supervisions

“We have a PMT comprised of various unit leads, responsible for overseeing the practice of health data and program performance activities. This team serves as a valuable M&E platform to assess the quality of data and program effectiveness on a monthly basis.”

• Performance Review Meeting (PMT)

• HMIS task audit

• Monthly HIS monitoring

• Supportive supervision

• Regular feedback

• Review meetings

Enablers of HIS accountability framework

Policy and practice

• National priority

“HIS is the current priority area and transformation agenda of the health system which is one potential opportunity to better implement the HIS accountability framework initiative”

• Partner engagement

• Progress in HIS program

Tools and infrastructure

• Digitization

“In the HIS program, digital systems are deployed and used for different purposes like DHIS2, eCHIS, mBrana, and Dagu. Applying these systems motivates health professionals to adhere to and value health data properly. This will be a good factor for effectively implementing the HIS accountability framework”

• Standardization of tools

Skill and capacity

• Experience of implementing the HIS activities

“HIS capacity building is highly provided in the in-service and pre-service modalities which gives the opportunity to have better number of health information experts. This would be a good facilitator the better implement the accountability framework.

• Skill and number of HIS professionals

Barriers of HIS

accountability framework

Poor culture of accountability

• Poor culture of accountability practice/system

“The culture and practice of making health professionals or other actors accountable for HIS related activities is very limited which will be a challenge to easily implement the HIS accountability framework”

Poor attitude towards health data

• Poor attitude for HIS from the leadership

“Weak leadership commitment throughout the system poses a significant challenge in effectively implementing the HIS accountability framework. There is a tendency for leaders to prioritize politically motivated tasks and activities over routine data related tasks"

• Poor leadership commitment

High turn over

• Leadership turnover

“High turnover of staff can hinder the effective execution of the HIS accountability framework, as experienced personnel depart and are replaced by new individuals who may lack familiarity with tasks associated with the HIS”

• Staff turnover

Poor infrastructure and guideline

• Lack of national guideline

“There is no national governance to be used as a benchmark for the health institutions, and the culture and experience of practicing accountability is limited. This could alter the effective implementation of the HIS accountability framework.”

• Poor infrastructure for HIS supplies

High workload

• Multiple responsibility and task load

“…staffs are working in a busy schedule: unless we manage the human resource need at each facility; it is difficult to design an accountability framework and order them to be governed by that framework.”

• Multiple recording tools

Insufficient knowledge and skill

• Skill and knowledge gap on HIS

“…skill and capacity building is not full cascaded and provided which would another potential challenge in implementing the HIS accountability framework”

• Poor leadership skill

Security treat

• Political instability/insecurity

“In the current condition, the health professionals are unstable and worry about other security issues. Besides, due to the interruption of the internet network, there is no means to follow and monitor the HIS tasks face to face and virtually. Due to this, it might be challenging to implement the framework in this condition"

Suggestion to design effective HIS accountability framework

Participatory and engagement

• Engaging the staffs and case teams and other actors

“As to me, most interventions have failed because they are not basing the real problem on the lower-level implementers. Therefore, engaging every actor and understanding their feelings and thoughts is very important for a successful intervention. If the engagement of the implementers develops the intervention, it will enhance the sense of ownership, and its adoption will be good.”

• Good to listen the saying, feeling, and emotion of the health professionals

Capacity building

• Build skill and knowledge on HIS and leadership

Priority

• Make HIS the political agenda

HIS supplies

• Fulfilling basic supplies and infrastructure of HIS activities