Peer-Performance Review as a Strategy for Strengthening Health In-formation Systems: A Case Study from Ghana


  • Denis Leonard Adaletey University of Oslo Ghana Health Service
  • Bob Jolliffe University of Oslo, Norway
  • Jørn Braa University of Oslo
  • Anthony Ofosu Ghana Health Service




Background and Purpose: The Ghana Health Service (GHS) in 2012 embarked on an ambitious programme to improve its health information system (HIS) in order to improve upon healthcare delivery and also to meet the health related millennium development goals (MDGs). This resulted in nation-wide implementation of the District Health Information Management System (DHIMS2), software based on the District Health Information Software (DHIS2), in all its facilities and some private and quasi government health facilities. The DHIMS2 is the Ghanaian version of the global DHIS2 software developed by the University of Oslo.

Methods: As part of its mandate the GHS holds periodic peer reviews meetings at different levels of its structure as a mechanism for measuring service performance in order to identify service gaps that will lead to interventions to improving the coverage and quality of service to its client. This paper is a qualitative assessment of the DHIS2 software based on specified criteria from some of these review meetings in selected regions towards achieving the set goals. The paper will look at the status quo with respect to infrastructure, resources in general, human resource, stakeholder involvement, data quality and data use since the implementation of the DHIS2 project in Ghana. Data collection and analysis was qualitative using participant observation, focused group discussions, semi-structured interviews and document analysis.

Results: Our research has shown that the GHS has successfully implemented an integrated and sustainable web-based HIS. Data quality in all aspects has been improved through institutional arrangements such as peer-performance reviews using DHIS2 data and establishment of data quality assurance teams at all levels. This implicitly has promoted data use for decision making. The online system has also ensured data transparency and accessibility. ‘Break-downs’ in the system such as lack of funds, faulty equipment, lack of adequate and skilled human resource for data management is seen as some major challenges to data quality. Such ‘break-downs’ may also be seen as opportunity for system strengthening and sustainability as end-users are compelled to use personal resources for managing data.  Through institutionalized peer-performance review processes using data from the DHIS2 is improving the quality of health service data for planning and decision making. 

Conclusions: This research has demonstrated that with the right technology, policy and collaboration from interested stakeholders it is possible to implement a sustainable HIS in developing countries such as Ghana. We have also shown that institutionalized arrangements for data use has significantly improved the quality of service data generated which will aid planning and decision-making


Keywords: Health information system, Data quality, Data use, Peer review


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Author Biographies

  • Denis Leonard Adaletey, University of Oslo Ghana Health Service

    Department of Informatics,

    PhD Research Fellow

  • Bob Jolliffe, University of Oslo, Norway

    Department of Informatics

    PhD Research Fellow

  • Jørn Braa, University of Oslo

    Department of Informatics


  • Anthony Ofosu, Ghana Health Service

    Information, Monitoring and Evaluation (IME)

    MD, Deputy Director, Head of IME



Braa, J., Hanseth, O., Mohammed, W., Heywood, A., & Shaw, V. (2007). Developing Health Information Sys-tems in Developing Countries. The "Flexible Standards" Strategy. MIS Quarterly, 31.

Kossi, Edem Kwame, Johan Ivar Sæbø, Jørn Braa, Mohamed Mumeneeh Jalloh, and Ayub Manya. Developing Decentralised Health Information Systems in Developing Countries –Cases From Sierra Leone and Kenya. The Journal of Community Informatics. 2012;9(2)

Kvale, S., (2009). Learning the Craft of Qualitative Research Interviewing. Sage Publication Inc.

Heeks, R., Mundy, D., & Salazar, A. (1999a). Why Health Care Information Systems Succeed or Fail: University of Manchester.

Heeks, R. (2002). Information Systems and Developing Countries: Failure, Success, and Local Improvisation. The Information Society, 18, 101-112.

Avgerou, C. (2002). Information systems and global diversity (Vol. 1). Oxford: Oxford University Press Bødker, S., Ehn, P., Knudsen, J. L., Kyng, M., & Madsen, K. (1988). Computer support for cooperative design (invited paper). Paper presented at the Proceedings of the 1988 ACM conference on Computer-supported coop-erative work, Portland, Oregon, United States.

Avison, D., Lau, F., Myers, M. D., & Nielsen, P. A. (1999). Action Research. Communications of the ACM, 42(1), 94-97.

Baskerville, R. L. (1999). Investigating information systems with action research. Communications of the AIS, 2(3es), 4.

Baskerville, R. L., & Wood-Harper, A. T. (2002). A Critical Perspective on Action Research as a Method for Information Systems Research In M. D. Myers & D. Avison (Eds.), Qualitative Research in Information Systems (pp. 129-145): Sage Publications.

Klein, H. K., & Myers, M. D. (1999). A set of principles for conducting and evaluating interpretive field studies in information systems. MIS Quarterly, 23(1), 67-93. doi: 10.2307/249410

Baskerville, R. L. (1997). Distinguishing action research from participative case studies. Journal of Systems and Information Technology, 1(1), 24-43.

Susman, Gerald I, and Evered, Roger. An Assessment of the Scientific Merits of Action Research. Administra-tive Science Quarterly. 1978;23(4):582–603.

Braa, Jørn, Eric Monteiro, and Sundeep Sahay. Networks of Action: Sustainable Health Information Systems Across Developing Countries. Management Information Systems Quarterly. 2004;28(3):337–362.

Orlikowski, W., & Baroudi, J. J. (1991). Studying Information Technology in Organizations: Research Ap-proaches and Assumptions. Information Systems Research, 2(1).

Walsham, G. (1995). Interpretive case studies in IS research: nature and method. European Journal of Infor-mation Systems(4), 74-81.

Miles, M.B. and Huberman, A.M. (1994) Qualitative Data Analysis, Thousand Oaks:

Sage Publications

Shaw, Vincent (2005). Health information System Reform in South Africa: Developing an Essential Data set. Bulletin of the World Health Organization | August 2005, 83 (8)

Leonor Teixeira Santos, C. BS (2012) User-centered Requirements Engineering in Health Infor mation Systems. A Study in the Hemophilia Field. Computer Methods Programs Biomed 106(3):160–74

Fu Y, Li M, Chen F (2012) Impact Propagation and Risk Assessment of Requirement Changes for Software Development Projects Based on Design Structure Matrix. Int J Proj Manag 30(3):363– 373.

Jui-Jen Chen*, Wu-Chen Su*, Pei-Wen Wang and Hung-Chi Yen (2013) A CMMI-based Approach for Medical Software Project Life Cycle Study

Magdaleno AM, Werner CML, Araujo RM (2012) Reconciling Software Development Models: a Quasi-systematic Review. J Syst Softw 85(2):351–369




How to Cite

Peer-Performance Review as a Strategy for Strengthening Health In-formation Systems: A Case Study from Ghana. (2015). Journal of Health Informatics in Africa, 2(2).