RESUMO
Objectives@#Health systems are shifting from traditional methods of healthcare delivery to delivery using digital applications. This change was introduced at a primary care centre in Chandigarh, India that served a marginalised population. After establishing the digital health system, we explored stakeholders’ perceptions regarding its implementation. @*Methods@#Ethnographic methods were used to explore stakeholders’ perceptions regarding the implementation of the Integrated Health Information System for Primary Health Care (IHIS4PHC), which was developed as a patient-centric digital health application. Data were collected using focus group discussions and in-depth interviews. Participatory observations were made of day-to-day activities including outpatient visits, outreach field visits, and methods of health practice. The collected information was analysed using thematic coding. @*Results@#Healthcare workers highlighted that working with the digital health system was initially arduous, but they later realised its usefulness, as the digital system made it easier to search records and generate reports, rapidly providing evidence to make decisions. Auxiliary nurse midwives reported that recording information on computers saved time when generating reports; however, systematic and mandatory data entry made recording tedious. Staff were apprehensive about the use of computer-based data for monitoring their work performance. Patients appreciated that their previous records were now available on the computer for easy retrieval. @*Conclusions@#The usefulness of the digital health application was appreciated by various primary healthcare stakeholders. Barriers persisted due to perceived needs for flexibility in delivering healthcare services, and apprehensions continued because of increased transparency, accountability, and dependence on computers and digital technicians.
RESUMO
Despite the underlying importance of surveillance systems for the management of HIV/AIDS prevention and control programmes,there has been limited analysis of the quality of HIV/AIDS case-detection and case-reporting systems, beginning with peripheral facilities through to those at national levels. In Mozambique, HIV cases are generally correctly detected despite some unreliable use of test kits beyond their expiry date, uneven distribution of test kits among facilities, frequent disregard for bio-safety mea sures and irregular external quality assessment. Furthermore, HIV/AIDS case-reporting is compromised by poor data quality, including under-reporting and discrepancies across different reporting channels and organisational levels, as well as a lack of standardised data forms, data items collected and report formats. Our analysis of HIV/AIDS surveillance systems in Mozambique leads to the following key recommendations: (1) a strengthening and standardisation of both the case-detection and case-reporting systems at all levels; (2) the regular training of staff at peripheral facilities, to allow for better testing and improved local data analysis,validation and interpretation; (3) the redesign of reporting systems for blood banks, including integration of the AIDS case-reportingsubsystems into one; and (4) the use of baseline data as a foundation for more comprehensive analysis across the country, in response to UNAIDS advice regarding second-generation HIV surveillance