Table 2.

Thematic presentation of factors affecting the sustainable implementation of the District Health Information System version 2 (DHIS2) platform for case-based surveillance of malaria.

Theme	Example quotes
Governance	“It adds on the already heavy workload, there should be people specific to do malaria data entry” “It brought about migration from manual system to electronic platform given that COVID-19 necessitates the use of technology.” “Have government employees being part of the system programming and maintenance/being part of the project or have ownership to the system” “Majority of health care workers should be shown the importance of using the health systems” “Cascade mentoring of DHIS utilization in facilities as facility based training” “Every time an update is introduced on the paper data collection tools (guidelines), the same should also be updated on the DHI2 system to make sure that the paper forms and the system are in sync at all times”.
Infrastructure	“Frequent network downtimes resulting in delays in reporting when the system is down” “It is not linked with other applications that the government has created to formulate reports and daily activities” “Data capture even when there is no connectivity and later sync when the internet connection is regained” “More gadgets should be availed for each facility and errors or SIM card malfunctions should be urgently addressed” “System linkage/interoperability with other existing systems” “Making sure internet is reliable at facilities”
Capacity building	“Requires more practice for better or improved competencies” “Capacity building to be strengthened for the local IT Officers” “Training should have frequent support visits” “Cascade mentorship programmes of DHIS utilization in facilities as facility-based training” “All health care workers should be trained and shown the importance of using the health information systems” “Topics covered to be taken step by step or explained in full with more practicals” “Training content coverage should be more than 80% practicals” “There should have been site visit immediately after training to assess situations on the ground”
Data security	“Use of authentication passwords and encryption algorithms for data security and privacy” “The link is not trustworthy”
Usability	“It picks everything you enter whether good or bad” “No free choice to select the period you want to view the data, all are fixed to daily, weekly, monthly, etc” “It's confusing sometimes as one can enter patients twice but not knowing” “Clients are attached to the diagnosing facility rather than the origin of infection” “If an error is made during entering of cases and you want to correct it, there isn't an option to edit especially on the date of diagnosis and notification” “Data management greatly improved for the intervention of positive malaria cases” “DHIS2 is easy to use as it simplifies data management and analysis” “It is pleasant, easier and quick to use, you can retrieve your information if you need to utilize it for something” “Timely data reporting” “Completeness of reports is achieved” “Easy analysis of data, using maps and graphs for visualisations” “Easy to formulate reports if used adequately and effectively” “It covered most aspects of malaria case-based surveillance” “DHIS2 has simplified malaria surveillance and indeed it is a very valuable tool” “Gives a good situational analysis of what is happening on the ground” “DHIS2 enables foursight mapping, by using the GPS coordinates to locate malaria case outbreaks or hotspots.” “Everything is now at our fingertips, we have data in the form of tables, charts and reports generated from the dashboard than prior to the DHIS2 where we used to manually manage the data using excel charts.” “We easily make decisions based on the data from the system”