February 22, 2026BMC Health Services Research0 citationsOpen Access

Health data reporting challenges in public health facilities in the age of DHIS2: a mixed-methods study in the Teso sub-region of Uganda

MLMargaret R LawrenceUniversity of Virginia BFBenjamin P FullerUniversity of Virginia Medical Center HIHerbert Kirya IsabiryeMinistry of Health

Key Points

This study assesses health data reporting challenges at public health facilities in Teso, Uganda, under the DHIS2 system.
Compared reporting performance among districts using the DHIS2 database
Analyzed association between outpatient department visits and reporting rates
Conducted focused group discussions at seven health facilities
Employed linear regression to determine relationships among variables
Seven out of 11 districts achieved ≥ 80% completeness in reporting
Only two districts scored ≥ 80% for timely submissions
Increased outpatient visits correlate with higher reporting rates
Main reporting challenges include limited staff training and internet access issues

Abstract

In Uganda, the complete and timely reporting of priority disease data by health centers is critical for detecting outbreaks. However, all levels of health centers face significant reporting challenges, which compromise data fidelity and public health. To assess the efficacy of existing systems, we aimed to (i) compare reporting performance among districts in the Teso region of Eastern Uganda, (ii) ascertain the association between volume of outpatient department (OPD) visits and reporting rates at facilities, and (iii) characterize reporting challenges at public health facilities. We queried Uganda’s Electronic Health Management Information System database, DHIS2, regarding the completeness (reporting rate) and timeliness (reporting rate on time) of priority disease data submission within Teso from January 1st-April 30th, 2024. We selected the three lowest-performing districts in both metrics and assessed reporting at all health centers within these districts. We used linear regression to determine the relationship between the aggregate number of outpatient visits per health facility and their mean reporting rates. At seven health facilities across the three districts, we conducted focused group discussions to enumerate reporting challenges. Of all 11 districts in Teso, seven (64%) scored ≥ 80% for completeness and two (18%) scored ≥ 80% for submission timeliness across health facilities. The median (IQR) scores for completeness and timeliness were 83% (75–93%) and 69% (55–75%), respectively. The three lowest performing districts in both metrics were Soroti City, Soroti district, and Ngora district. In Soroti City, increasing number of OPD visits was associated with higher reporting rate percentages (b slope = 0.005, p = 0.01). The main reasons given for low reporting rates included limited staff trained on data entry protocols, competing responsibilities, and lack of reliable internet access. The implementation of DHIS2 has improved public health and disease surveillance in Uganda, but institutional-level data reporting challenges continue to impair disease tracking. Targeted interventions to relieve such barriers is possible.

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