Table 2.

Emerging themes, sub-themes and categories by cadre of health professionals

Facility managers (FMs)	Sub-district/district/provincial/health information managers	M&E and PMTCT program managers
1. Use of information
• Selective use for reporting	• Selective use of information for monitoring outcomes for political purposes; reporting and campaigns;	• Selective use for reporting • Inadequate use of data for planning purposes
	• Different perspective on data-use
2. Barriers to information-use
• Lack of trust in the data		• Data not trusted
• Willingness and attitude of users  • Lack of culture of information-use	• Lack of skill to interpret data for planning • Lack of culture of information-use	• Packaging of information • Lack of culture of information-use
• Ripple effect of lack of staff at facility level		• Lack of skills to use data
• Timeliness of feedback on information		• Lack of accountability for accurate data
3. Data quality issues
• Perceptions of ‘poor-quality data’  • Inaccurate information provided by patient	• Perceptions of ‘poor-quality data’	• Staff at different levels involved in several registers for one program
		• Cooperation between staff at facility level
4. Reasons for poor data quality  a) Human resources
• Staff attitude of non-care	• Staff attitude of non-care	• Three data-collection tools for one program
• Human error in data collection  • Work overload/staff turnover  • Lack of trained data capturers/clerks	• Clinicians unprepared/lack of skill for data collection • Staff rotation and turnover • Lack of feedback/data interrogation	• Follow up issues: results not captured • Migration of parents/mothers • Access to/tracing all babies born into the cohort
• Lack of ownership of RHIS process  • Limitations of supervisory visits/monthly audit	• Lack of numeracy skills	• Lack of feedback/data interrogation • Lack of accountability
b) Equipment
• Lack of resources and equipment for recording
c) Validation issues
• Lack of skills for validation	• Lack of validation at facility level, burden on higher levels • Snowball effect of non-validation at facility level • Extent of validating and coordinating overwhelming at district level	• No proper data validation at sub-district level
d) Training
	• Structure and content of training should be interactive and experiential in nature	• Experiential training/applied learning based on adult learning principles as preferred option which should be relevant, participatory, learner-centered, ownership
		• Staff turnover challenge in training