1.2 Literature Review
Population-based surveys are the primary sources of data in most low-income countries [6]. Although data obtained from surveys is extremely valuable, it is usually generalised to country and provincial levels. Results-based management, on the other hand, requires the availability of health care data for districts and local areas [7]. An increasing amount of evidence suggests that timely and reliable routine health information is essential for ensuring the continuance of adequate health system performance and that routine health information system should be strengthened to support effective and cost-effective monitoring [8, 9, 10].
Although routine DHIS data (like all other methods of data collection) has certain limitations, the biggest advantage it presents to managers is that it can support evidence-based management at all levels of the Health Care System (HCS), from facility to national level. Regular updates also enable the early identification of specific problems in particular communities down to the level of service delivery. This can provide a basis for implementing whatever corrective measures will make the most effective impact, while at the same time supporting the continuous measurement of inequities and definable progress towards established targets [5].
In spite of this, DHIS data is not used effectively in both developed and developing countries [11, 12]. Poor utilisation of health information (especially routine health information) is an obstacle to effective health system management and performance The goal to reduce the under-five mortality rate (U5MR) between 1990 and 2015 by two thirds has been identified as the most difficult MDG to achieve at the current rate of progress, especially in Sub-Saharan Africa[13, 14]. Malawi is one of the countries in top 9 of African states which will likely meet its MGD4 target [15] currently at 112 per 1000 live births [16] which is a commendable effort. Reasons for this progress are partly because of good political will as well as efforts by MoH to implement an Integrated Management of Childhood Illness (IMCI) program, which focuses on leveraging synergies across different state and non-state implementing agencies, to increase coordination and effectiveness [17]. Immunization rates against measles across the continent vary from one country to the next and a number of countries have made great efforts to increase coverage . For example, 17 countries, including Malawi reported a 90 per cent and above coverage rate, with only three countries (Nigeria, Somalia, and Chad) below 50 per cent immunization coverage in 2009 [18].
Despite all these efforts data quality on full immunization coverage of children within their first year of age remain inconsistent when comparing reports from vertical district programmes such as EPI and routine Health Management Information System (HMIS) even though the data come from the same source [19]. Poor data quality arising from various issues such as ambiguity in data definitions, lack of a data dictionary, poor human resource capacity among others, adversely impact the functioning of programs such as the EPI [20].
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