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With 2.2 million inpatient admissions and 6.9 million individuals accessing outpatient services annually, hospitals and health care facilities in Uganda are constantly accumulating health information (Ugandan Ministry of Health, 2014b). To collect, monitor, and manage this constant inundation of information, health care facilities use a comprehensive Health Information System (HIS), which can also contribute to the maintenance and improvement of health care services (Brown, Patrick, & Pasupathy, 2013). According to the World Health Organization (WHO, 2010), the four key functions of any HIS are: (i) data generation, (ii) compilation, (iii) analysis and synthesis, and (iv) communication and use.
In low resource settings, a HIS can be used to support a diverse range of health projects and has been successfully integrated into a variety of clinical settings, including health care facilities in Brazil, Haiti, Kenya, Malawi, Peru, and Uganda (Fraser et al., 2005). Each of these systems typically consist of six components, which are: (i) resources, (ii) indicators, (iii) data sources, (iv) data management, (v) information productions, and (vi) dissemination and use (WHO, 2008). The unique conditions and challenges of each health care facility operating in a limited resource setting has made it challenging to achieve uniform standards amongst these components (Braa, Hanseth, Heywood, Mohammed, & Shaw, 2007), and few low resource countries have been able to develop systems that are able to achieve all four key functions outlined by the WHO (2010). However, by understanding local needs and priorities, and determining the availability of resources, a HIS can be adjusted for barriers specific to each location, which improves its ability to aid in the provision of health care (Braa et al., 2007; Fraser et al., 2005). Specifically, in Uganda, individual health care facilities’ HIS and mTrac, an SMS-based disease surveillance and health system strengthening tool, contribute data to a national data aggregation system called eHMIS-DHIS2 (Ugandan Ministry of Health, 2014a). This arrangement generates health information to monitor the health status and services at all levels (Ugandan Ministry of Health, 2014a). To ensure a HIS adequately monitors problems of public health importance, each HIS should be evaluated once it has been established (Center for Disease Control and Prevention [CDC], 2001). The completion of rigorous and effective evaluations creates opportunities for further development and improvement of a HIS (Ammenwerth et al., 2004).
An evaluation consists of an assessment of system attributes and a review of system operations, which should generate results that promote the best uses of health resources (CDC, 2001). Several HIS evaluation frameworks have been generated for assessing system performance, each focusing on slightly different components of a HIS as related to human, organizational, and technological factors (Yusof, Papazafeiropoulou, Paul, & Stergioulas, 2008). However, with HISs evolving in structure, function, and diversity, the associated complexities within its evaluations have also increased, which has created several problems for conducting adequate and consistent evaluations (Ammenwerth et al., 2004). The concept of evaluating a HIS is further seen as challenging as there is no consensus on what to measure, who to involve, or the methods that should be used (Klecun-Dabrowska & Cornford, 2001).