Understanding the challenges associated with the use of data from routine health information systems in low- and middle-income countries: A systematic review

Health Inf Manag. 2022 Sep;51(3):135-148. doi: 10.1177/1833358320928729. Epub 2020 Jun 30.


Background: Routine health information systems (RHISs) are crucial to informing decision-making at all levels of the health system. However, the use of RHIS data in low- and middle-income countries (LMICs) is limited due to concerns regarding quality, accuracy, timeliness, completeness and representativeness.

Objective: This study systematically reviewed technical, behavioural and organisational/environmental challenges that hinder the use of RHIS data in LMICs and strategies implemented to overcome these challenges.

Method: Four electronic databases were searched for studies describing challenges associated with the use of RHIS data and/or strategies implemented to circumvent these challenges in LMICs. Identified articles were screened against inclusion and exclusion criteria by two independent reviewers.

Results: Sixty studies met the inclusion criteria and were included in this review, 55 of which described challenges in using RHIS data and 20 of which focused on strategies to address these challenges. Identified challenges and strategies were organised by their technical, behavioural and organisational/environmental determinants and by the core steps of the data process. Organisational/environmental challenges were the most commonly reported barriers to data use, while technical challenges were the most commonly addressed with strategies.

Conclusion: Despite the known benefits of RHIS data for health system strengthening, numerous challenges continue to impede their use in practice.

Implications: Additional research is needed to identify effective strategies for addressing the determinants of RHIS use, particularly given the disconnect identified between the type of challenge most commonly described in the literature and the type of challenge most commonly targeted for interventions.

Keywords: data science; developing countries; health information systems; patient generated health data; public health informatics; public reporting of healthcare data; systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Data Collection
  • Delivery of Health Care
  • Developing Countries
  • Health Information Systems*
  • Information Systems