Enhancing Healthcare Performance in Ethiopia Using DHIS2

Ethiopia is Africa’s second-largest country, with a population exceeding 120 million people as of 2025. Despite notable progress in strengthening its healthcare system in recent years, driven by substantial investments from the government and international partners, the predominantly rural population still faces significant barriers to accessing safe drinking water, as well as adequate food, housing, sanitation, and healthcare services. The country’s vast geographic diversity further complicates efforts to deliver healthcare services across all regions, and communicable diseases such as HIV/AIDS, tuberculosis, malaria, hepatitis and others still pose serious challenges.

In 2017, the Ministry of Health began working toward full national implementation of DHIS2 as a health management information system (HMIS), to improve health data management in the country, and enable informed decisions about policies, interventions, and resource allocation. It has made impressive progress toward this goal over the last seven years, beginning with initial customization and deployment of DHIS2 in 2017, training more than 7,000 health workers and managers to use the software, and expanding data collection to cover all of the nation’s 30,000+ public health facilities as of 2024, providing data on health services and outcomes for that serve a population of more than 120 million people. Ethiopia’s HMIS is one of the world’s largest DHIS2 implementations, and it has greatly strengthened Ethiopia’s capacity to collect, analyze, and act on health data.

In 2024, researchers studied how this DHIS2 implementation had contributed to improved data quality, data availability, and performance within primary health unit facilities in Ethiopia. Their findings, published in the journal PLOS One, indicated that DHIS2 had significantly improved both the quality and the accessibility of data within Ethiopia, leading to improved healthcare management and accountability across facilities.

“DHIS2 revolutionizes data access, liberating us from HMIS constraints. Previously, accessing data was restricted by time and place. Now, with DHIS2, data is at our fingertips anytime, anywhere, contingent upon stable connectivity. It’s a transformative leap in accessibility and efficiency.” – Regional primary health care unit leader (source)

Nationwide implementation provides data for informed decisions about healthcare services

Ethiopia relied largely on paper-based registers and manual reporting of health data until the country began its transition to a hybrid paper-digital record keeping process in 2008. From 2008 until 2017, health data was entered into two separate, desktop-based, proprietary HMIS systems operated in different regions, which had been developed with support from various organizations. This use of disparate systems created significant challenges in interoperability, dramatically limited data analysis and use and hampering informed decision making. Additionally, the HMIS reporting forms were not standardized, and data for these two standalone systems was pulled from records maintained by health facilities and management offices, which made it quite difficult to compare data across different locations, according to a 2024 article in the Ethiopian Journal of Health Development. The authors reported that “having two different HMIS versions created significant challenges due to a lack of integration and interoperability, leading to data confusion and analysis complications.”

Ethiopia first implemented DHIS2 in 2017, after a thorough and systematic review of the platform’s capabilities, and a detailed comparison to the tools already in use by the ministry. The country’s assessment team recommended DHIS2 for use as the HMIS in part because of its ability to combine data capture, analysis and reporting in one platform, and because it allows government ownership of both the system and the data, among other benefits. With support from the Global Fund, the World Health Organization, JSI, and other partners, and technical support from local DHIS2 implementation partner HISP Ethiopia, the MoH began customizing the software for use in its local context and conducted a successful pilot. By September of that year, DHIS2 was rolled out to more than 5,300 public health facilities, and within one year, it had scaled to almost all government facilities and more than 5,000 private facilities across the country. At many of these facilities and health posts, data is collected on paper forms (due to infrastructure challenges such as lack of electricity, computers, and/or internet access) then recorded in DHIS2 at the district level, at which point it is immediately available for review and analysis.

In 2018, the ministry conducted wide-scale capacity building and national scale-up, documenting the process across regions and tracking the lessons learned during implementation, creating a resource for subsequent system customizations and upgrades. Most recently, the MoH completed a DHIS2 software upgrade to version 40 in 2024, with development work by HISP Ethiopia supported by the Global Fund, which has long invested in system strengthening in Ethiopia, including the country’s initial implementation of DHIS2 and its ongoing support for HIV, TB and malaria programs, which are part of the HMIS. HISP Ethiopia has been a long-term partner of the MoH throughout this period, supporting DHIS2 configuration, scale-up, and capacity building for MoH staff, supporting the local ownership and sustainability of the system.

This DHIS2 implementation has been one of the largest and most successful in the country to date according to the article published in the Ethiopian Journal of Health Development, and health officials plan to keep expanding and integrating with additional systems. “We’re using DHIS2 in all government (health) facilities,” said Gemechis Melkamu, a digital health lead executive for the Ministry of Health. The article’s authors state that more than 95% of government health facilities consistently reported through DHIS2 between 2018 and 2022, with more than 90% completeness and 70% timeliness on average. Digitizing health data with DHIS2 has drastically reduced reporting time in many areas, from up to 26 days using the previous process, to as few as five days using DHIS2. “In our country, health facilities must submit reports by day 21, with health posts sending data to health centers by day 23. Health centers finalize reports by day 26. Notably, some regions submit reports as early as day five, highlighting improved efficiency,” explained a district primary health care unit leader in the PLOS One article.

In addition to more timely and accurate reporting, DHIS2 has also made it easier for workers at all levels of the health system to access and use data to make decisions. For example, Zewditu Memorial Hospital expanded its emergency department based on the data entered and analyzed in DHIS2. Staff noticed an upward trend in emergency department utilization, so they presented that data to the hospital management team, who decided to increase the size and capacity of the department, to better meet patient needs. “Hospital management decided we needed bigger room, (more) beds, and that is one decision that has come from DHIS2, using the data,” said Binyam Fekadu, a health information technician at Zewditu Memorial Hospital.

Research has even indicated that the use of DHIS2 at the health facility level in Ethiopia is correlated with higher client satisfaction with the health services they receive, according to a 2025 article in the journal Global Health Action. The researchers found an increase in satisfaction of 9.5 percentage points for facilities using DHIS2, likely due to the link between systematic review of service data and more timely, patient-centered care.

“The web-based nature of DHIS2 offers a distinct advantage: accessibility from any location with just a username and password. Previously, with paper-based reporting, accessing data beyond the facility was cumbersome. DHIS2 eliminates these barriers, providing on-demand data access, anytime, anywhere.” – Key informant on Ethiopian health system (source)

A strategic focus on governance, leadership, and advocating for data use

The Ministry of Health in Ethiopia has taken an intentional approach to implementing DHIS2 as a national health information system, creating strategies to advocate for data use and align the efforts of multiple stakeholder organizations. Though Ethiopia’s large population does pose a challenge, it can also represent a unique return on investment for aid organizations and others, according to Yakob Wondarad Tadesse, a senior health information systems advisor with Ethiopia’s Ministry of Health. “If you invest in Ethiopia, you can address so many populations,” he said. The size of the country is reflected in the scale and complexity of its health information system, as well. “We have more than 38,000 organization units, including 1,400 indicators, more than 30 data sets, and more than 9,200 data elements,” Wondarad said.

The ministry has created a “Harmonization and Alignment Strategy” to guide all efforts to build, strengthen, integrate and use DHIS2-based information systems within the country, which Wondarad said the government is serious about enforcing. “We are really strict with this strategy,” he said. “If any donor or implementing partner comes to Ethiopia, they must be guided by this strategy, which is ‘one plan, one budget, and one report.’ We don’t accept any prior system (or) prior reporting, so if you plan to invest, you must align with this strategy.” Additionally, the ministry fosters coordination through its digital health blueprint, health information system strategic plan, maturity assessments, governance structure, and national protocol for data sharing and access.

As a means to further advocate data use for performance improvement, the ministry also participates in National Health Data Week each year, and asks leaders to identify and share their commitments to enhancing those information systems. “This is one of the innovative ways to bring high-level leaders to commit to investing in health information systems,” Wondarad said. “We do National Health Data Week every year, and that’s become a very good strategy to advocate for the use of data for performance improvement.”

Wondarad cited another strategy the ministry is using to boost data use across the country’s health sector—recognizing model districts or “woredas” for the work they have done with health information systems. “We recognize those districts that are champions in modernizing health information systems,” he explained. “We have three different criteria—the health information system structure, then data quality, and data use.” The ministry is aiming to improve data quality by investing in data use, so it is prioritizing such data use and recognizing woredas that are a model for enhancing health information systems.

Additionally, the ministry has made a concerted effort to strengthen academic programs related to health information systems through its Capacity Building and Mentorship Partnership (CBMP) initiative focused on strengthening subnational health information systems. Established in 2017, the CBMP involves partnership between six local universities, the ministry, and regional health bureaus, and is funded by the Bill and Melinda Gates Foundation. These universities also create centers of excellence for the country’s DHIS2 implementation, as well as the eCHIS or electronic community health information system, and for electronic medical records. Additionally, the MoH also prioritizes curriculum design to build the workforce, and promotes related data synthesis, research and publication. Ethiopia has made significant contributions to research on HIV and climate studies, and continues to strengthen its research on health data and health information systems. In its October 2024 publication “Transforming primary health care to accelerate progress towards SDG,” the Ministry of Health shared 37 such articles about research, new initiatives and best practices related to primary health care and health sector development from the prior year alone.

Local innovations drive integration and expand interoperability

Ethiopia’s implementation of DHIS2 has included many local innovations and custom applications, and has strengthened interoperability across sectors. “We became very innovative due to many local challenges,” Wondarad explained, citing challenges related to Ethiopia’s calendar, which is eight years behind the Gregorian calendar, and has 13 months in a year, rather than 12. Additionally, the MoH relies on offline deployment for software in many of its facilities. “We deploy offline for almost half of our health facilities, and that makes us come up with different innovative ideas and innovative applications,” he said. Among those applications are several tools that were developed on top of DHIS2 by HISP Ethiopia and are having a positive impact on data quality within Ethiopia’s information systems, including apps for Disease Registration, Custom Data Set Report, Routine Data Entry, Planning, Import/Export, Laboratory Reception, and COVID Certificate. 

Initiatives that cross sectors, including the Woreda Transformation initiative, the Multisector Food and Nutrition Information System, the integration of the Multisector Response Information System (MRIS) and rehabilitation, and the country’s new work on climate and health—all of which utilize DHIS2—have become a high priority for the ministry, as well. The Woreda Transformation initiative is based on a dashboard for visualizing the digital transformation progress at the woreda (district) level, with facility-level calculations based on catchment population data from DHIS2. The Multisector Food and Nutrition Information System uses the same DHIS2 instance (the HMIS) to collect and analyze data from all sectors—including agriculture, health, education, finance, trade, labor, and more—and provides access to data and information for the National Information Platform for Nutrition. It is currently rolled out to 240 districts. The MRIS captures 15+ data elements and key indicators for a cross-sector response to HIV services and non-clinical data, and is integrated with monthly rehabilitation information from approximately 40 facilities. The country is also exploring DHIS2 for Climate & Health to integrate its climate data into its DHIS2 system, with HISP Ethiopia providing technical support and a connection to the larger HISP-led multicountry project team.

Expanding to new sectors and planning for the future

The DHIS2 implementation in Ethiopia has been an overwhelmingly positive experience for the Ministry of Health, and has improved data use across the country. “This is a good experience, and also our end users, health facilities and all—they are very interested and very happy with the system,” Melkamu said. “At different levels, leaders have (been) easily accessing the data from the facilities,” he explained, citing ease of access for physicians and other stakeholders to enter data and access reports. “The system can easily present the data, since it has a number of data (visualization features), and it’s very easy for the end users.”

The 2024 article from the Ethiopian Journal of Health Development shared challenges that the country faced during implementation, including training and infrastructure, but concluded that the national roll-out has been a success. “DHIS2 is arguably the most successful electronic platform in the country’s health sector. Indeed, no other electronic system is owned by the government and can capture data from almost all health facilities in the country. Its real-time data capturing capabilities, data visualization and use at all levels, stakeholder collaboration, national and regional support schemes, and governance mechanisms are unparalleled.” Similarly, the PLOS One journal article authors recommended that Ethiopia’s “healthcare providers should continue to leverage (DHIS2’s) robust features and prioritize ongoing staff training to improve digital literacy and data management skills.”

Looking ahead, the MoH aims to continue scaling this DHIS2 implementation, and plans to strengthen its team of software developers to support further integration with additional systems as well. It is investing in building local expertise to manage and sustain its systems, and has now trained more than 10,000 people to use DHIS2 through a combination of training methods, including DHIS2 Academies on data use and analytics. Additionally, Melkamu said the MoH also plans to have all private facilities report their data through DHIS2 in the future.

Ethiopia’s national implementation of DHIS2 provides a model for other countries evaluating DHIS2 as a potential solution for data management and reporting. The authors of the 2024 article in the Ethiopian Journal of Health Development concluded that “Ethiopia’s journey to a unified DHIS2 system demonstrates the potential of Health Information System (HIS) to improve health outcomes when implemented effectively. It also provides valuable insights for other countries considering DHIS2 as their primary data management and reporting tool.”