Does a paper-based information system based on a human-centred design (PHISICC) reduce the time needed for reporting health data in Nigeria?

Frontline health workers spend a substantial part of their time on data related tasks that mainly serve the reporting needs of the higher levels of the health system, potentially compromising the quality of care. This study aims to assess the effects of an innovative paper-based health information system (PHISICC), developed using a human centred design approach, on the time health workers spend on data-related activities, compared to the standard health information tools. This is a time-motion study embedded within the PHISICC cluster randomised controlled trial in the Yala Local Government Area in Nigeria. In 25 primary health care facilities per arm, health workers carrying out their regular activities were continuously observed for one to three days over a three months period. A random effects logistic regression model was used to estimate the effect of the intervention on the proportion of time spent on several types of activities. The median total observation time per health facility was 8 hours and 7 minutes in the intervention arm and 8 hours and 30 minutes in the control arm. Health workers using PHISICC spent significantly more proportion of time in meeting personal needs (16.6% vs 6.9%; O.R.: 2.87; 95% CI: 1.03 to 7.99) and on tallying tasks (9.5% vs 1.3%; O.R.: 7.86; 95% CI: 2.39 to 25.93). However, there was no significant difference in the proportion of time spent on overall data-related activities between the two arms (41.3% with PHISICC vs 45.0% with standard tools). The PHISICC intervention increased tallying time, expected by design, but this did not translate into an overall reduction of data related time due to the easing of monthly reporting. The uptake of the intervention did not change reporting practices, likely due to the heavily rooted habits of health workers. PACTR201904664660639