Institutional Dynamics Shaping Data Use in Health Management at the District Level in Malawi: Case of Selected District Health Offices

Abstract

Background: While there has been overwhelming evidence of the importance of data use in health management, data use in Malawi’s Health Management Information System remains low. This paper investigates how institutional dynamics are shaping data use in health management at the district level in Malawi Health Management Information System, focusing on four selected District Health Offices (DHOs).

Methods: This qualitative study applied semi-structured interviews, active participant observations and document reviews to collect data at selected District Health Offices in Malawi.

Results: The study findings have demonstrated that institutional dynamics’ mechanisms shaping data use in health management at the district level are 1) District Health Office regulations and policy 2) organisational structures and partnership patterns 3) data management and data use, and 4) District Health Office collaboration with healthcare partner organisations in shared activities. These mechanisms provide an organisational context in which health managers’ efforts deal rationally with constraints and uncertainty, resulting in a change process of established data use. While the Ministry of Health has stipulated regulatory policies to guide healthcare services delivery at District Health Offices, strong and supportive organisational leadership is crucial. The Ministry of Health’s commitment to quarterly supervision visits motivates Directors of Health and Social Services at the District Health Offices. In turn, the District Health Officers provide supportive leadership in strengthening community-level organisation structures where data is collected for effective data use. The paper details how the definition of Programme Managers’ norms, roles, behaviours, and inter-organisational interactive patterns, initiated a change process that led to improved data use at one District Health Office out of the four selected District Health Offices. The findings imply that, despite inadequate resources, these Programme Managers acted as a bridge between the District Health Office and the community level. Not only did the Programme Managers ensure that data was collected from the organisation structures at the community level but the Programme Managers also became a critical resource enabling timely District Health Management Team performance assessment data reviews at the District Health Office. District Health Management Team’s performance assessment data reviews facilitated informed data use decision-making in planning and management of healthcare services delivery to the district health population. However, inadequate resources, weak community organisation structures, and lack of coordination and collaborations in shared activities and data use for sustainable healthcare organisation partnerships compromise effective data use in health management in most District Health Offices.

Conclusion: The study argues for a well-articulated definition of the District Health Offices’ policy guidance from the Ministry of Health in mapping healthcare partner organisations’ activities to ensure effective data reporting across the districts. Not only will the effective data reporting result in collaboration and coordination of shared healthcare activities but also strengthen informed data use in healthcare services delivery to the district health population.