In Africa, digital technologies are rapidly changing the way health care is provided, monitored, and evaluated. Ethiopia’s experience with the national web-based health information management platform, District Health Information Software 2 (DHIS2), shows how data systems can be a game changer in advancing improved maternal and child health (MCH) outcomes—even in settings with few medical resources.

A recently-published study in Archives of Public Health led by our team, with financial and technical support from the World Health Organization’s Alliance for Health Policy and Systems Research (Alliance), demonstrates that DHIS2 has made a significant contribution to the improvement of maternal and child health services in Ethiopia. Since the system was introduced, the study shows improvements, many dramatic, across a range of maternal and child health markers, from the rate of births in medical facilities to vaccinations to the use of family planning services.

DHIS2 is an open-source software platform designed for reporting, analyzing, and disseminating health data. It is the world’s largest health management information systems (HMIS) platform; more than 100 countries use it, representing a population of about 2.4 billion people. DHIS2 was developed and implemented by the HISP (health information services provider) network, a collaboration of the University of Oslo HISP Centre and HISP groups around the world.

Before the 2017 nationwide implementation of DHIS2, Ethiopia’s primary health care facilities or units (PHUs) grappled with fragmented, paper-based systems. Many lacked the timely, accurate data needed to guide decision-making in areas including antenatal care, immunization, and skilled birth attendance. The government adopted DHIS2 to fix that.

Study methods

Using a mixed-methods approach (combining quantitative and qualitative methods) we explored the potential contribution of the DHIS2 software, introduced in 2017, to better understand its impact on maternal and child health service delivery.

For the quantitative part, we collected data from over 200 health facilities in five diverse regions of Ethiopia: Urban, agrarian, pastoralist, and cash-crop producing areas. We reviewed data and reports on key maternal and child health service indicators from 2013 to 2022, using 2017 as a reference point to compare changes before and after the introduction of DHIS2. We applied descriptive statistics and advanced interrupted time series analysis to track trends over time.

For the qualitative part, we spoke with a range of key stakeholders, including health workers, experts, and local public health officials, to understand the challenges and improvements in service delivery. Their perspectives were analyzed by identifying common themes. The study offers some key lessons for policy and practice across Africa.

Our study shows that PHUs, managers, and practitioners quickly embraced DHIS2. Its introduction led to a marked increase in the use of data for health planning, resource allocation, and monitoring. Likewise, nearly 87% of facilities used DHIS2 data for budgeting decisions, and over 96% for service delivery monitoring. Importantly, 80% also used it to directly inform clinical decision-making.

Improved outcomes across key maternal and child health indicators

Key public health measures show marked improvements after DHIS2 was adopted. Births in medical facilities surged from a monthly per-PHU average of 21 to 56 following DHIS2 implementation. Immunization coverage, particularly for pentavalent vaccines and full childhood vaccinations, also improved dramatically. The study also found a significant increase in the uptake of family planning, postnatal care services, and protection at birth—with more mothers receiving adequate tetanus vaccination to provide passive immunity to their newborns.

Health facilities also became more responsive in managing pneumonia cases and in reducing vaccine dropout rates, two critical areas where timely data can be lifesaving. Qualitative insights from interviews with regional health officers revealed that the information available via the DHIS2 platform enabled health service managers to act immediately when coverage dropped or supplies ran out, which they said was hardly possible before.

Remaining challenges and future potential

While these results clearly show the system’s effectiveness in improving public health, challenges remain. About 30% of Ethiopia’s health facilities lack an internet connection. Variations in training, data interpretation skills, and security concerns—especially in conflict-affected regions—also limit the full potential of the system.

To scale the system’s impacts, further investment in digital infrastructure, training, and support for offline functionality is essential. Our recommendations include enabling real-time reporting, expanding DHIS2 integration with community-level data systems, and ensuring consistent access across all regions.

Implications for Africa and beyond

Ethiopia’s experience with DHIS2 is part of a broader digital health movement across Africa. From Kenya to Senegal to Nigeria, countries are adapting DHIS2 and other online platforms to tackle persistent health system gaps. This research provides strong empirical evidence that these digital tools, when used well, directly contribute to better health outcomes—not just better reporting.

As African countries continue to expand their digital health ecosystems, Ethiopia’s story shows that data alone is not enough. What matters is how the data is used—to inform decision-making, empower providers, and ultimately, save lives.

Taddese Zerfu is a Research Fellow with IFPRI’s Development Strategies and Governance (DSG) Unit based in Addis Ababa, Ethiopia. Opinions are the author’s.

This work was supported by the WHO Alliance for Health Policy and Systems Research.

Reference:
Zerfu, Taddese Alemu; Asressie, Moges; Tareke, Amare Abera; Begna, Zenebu; Habtamu, Tigist; Werkneh, Netsanet; et al. 2025. Contributions of District Health Information Software 2 (DHIS2) to maternal and child health service performance in Ethiopia: An interrupted time series mixed-methods study. Archives of Public Health 83(2025): 173. https://doi.org/10.1186/s13690-025-01641-0