A comparative study of electronic and paper-based systems on the timeliness and completeness of immunization data in UGANDA: A case of Moyo and Adjumani Districts

Abstract

Background: High-quality immunization data are fundamental for effective planning and monitoring of immunization programs. In Uganda, the coexistence of electronic and paper-based reporting systems presents a critical opportunity to evaluate their comparative impact on data quality, specifically timeliness and completeness.

Objective: This study aimed to compare the timeliness and completeness of immunization data between the electronic Community Health Information System (eCHIS) in Moyo District and the paper-based system in Adjumani District, and to explore health workers' perceptions and experiences with both systems.

Methods: A comparative cross-sectional mixed-methods study was conducted. Quantitative data were collected from 220 health workers (113 in Moyo, 107 in Adjumani) and analyzed using multivariate logistic regression. Qualitative data were gathered through key informant interviews and focus group discussions and analyzed thematically.

Results: The use of eCHIS was significantly associated with superior data timeliness and completeness. Health workers in Moyo were over seven times more likely to submit timely (Adj OR = 7.15, 95% CI: 2.72–18.82, p=0.001) and complete reports compared to those in Adjumani. Qualitative findings revealed that health workers perceived eCHIS as user-friendly and efficient, reducing workload and minimizing errors through automated reminders and validation checks. In contrast, the paper-based system was described as time-consuming, prone to errors, and hampered by logistical challenges like form stockouts. Key barriers to optimal eCHIS performance included unreliable electricity, poor internet connectivity, and gaps in digital literacy.

Conclusion: The eCHIS demonstrates a clear advantage over paper-based systems in enhancing the timeliness and completeness of immunization data in Uganda. For successful nationwide scale-up, sustained investment in digital infrastructure, continuous training, and robust technical support are essential to overcome existing barriers and fully realize the benefits of digital health information systems.