Assessing the functionality of the routine health information system in health facilities of Yaoundé, Cameroon
Description
This was a cross-sectional descriptive and analytical health facility-based study for 9 months (from November 2024 to July 2025) in six health districts (HDs) in Yaoundé: Biyem-Assi, Cité Verte, Djoungolo, Efoulan, Nkolbisson, and Nkolndongo. Each HD contains a mix of public and private (confessional and non-confessional) HFs operating at primary, secondary, and tertiary levels of care, reflecting the pluralistic structure of Cameroon's national health system. Yaoundé, the political capital of Cameroon is located in the Centre region. It hosts the highest concentration of HFs and health information management infrastructure in the country. This characteristic makes it an appropriate site for a comprehensive assessment of RHIS performance. The diversity of HF types, ownership models, and HD characteristics present in Yaoundé enable analysis of RHIS performance across a broad spectrum of institutional contexts.
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At the Health Facility (HF) level, we included HFs located within the administrative boundaries of the six HDs, facilities that had been operational for at least twelve months prior to data collection, HFs with at least one staff member formally responsible for data management or health information activities, and HFs that provided written informed consent for participation. HFs that were temporarily closed or suspended at the time of data collection, specialised HFs that did not contribute to the national Routine Health Information Systeme (RHIS) reporting framework were excluded. Within each selected HF, questionnaires were addressed to either of the two categories of respondents: the facility head or the designated data manager with possible complementarity of responses between the two. The primary variable of interest was the overall functionality of the RHIS at the HF level, operationalised as a continuous percentage score ranging from 0 to 100%. It was subsequently dichotomised into a binary categorical variable (good versus poor functionality) for descriptive classification purposes. Other variables included: socio-professional characteristics of respondents (age, sex, professional qualification, years of professional experience, position of responsibility within the institution, and duration in the current post), HF status (public, private confessional, or private non-confessional), and the Health Facility and Community Information System (HFCIS) standards. RHIS functionality was quantified at subdomain, domain, and global levels using a standardised percentage scoring approach. Each score represents the proportion of the maximum achievable performance actually attained by a given HF. The global score thus integrates performance across all four domains, giving each domain a weight proportional to its number of items. The global RHIS functionality score was dichotomised to produce a binary outcome : Good functionality if its global RHIS functionality score was ≥ 60%; or Poor functionality if its global RHIS functionality score was < 60%, a classification threshold applied in prior RHIS assessments in Cameroon. The analysis and dashboard module produces a suite of pre-programmed summary outputs, including frequency distributions of categorical responses for each item, subdomain, and domain across all facilities. It also produces graphical visualisations enabling rapid comparative analysis of RHIS performances across HFs and districts. Following automated score generation by the data analysis and dashboard module, data was then transferred to IBM SPSS version 27.0 for further statistical analysis. Continuous variables were presented as mean ± standard deviation, and categorical variables were presented as frequencies and percentages. Pearson Chi-square test and Fisher's Exact test were used to establish associations and a p-value <0.05 was considered statistically significant.