Learning from implementation: health worker insights on strengthening immunisation data quality in Kampala’s lower-level private-for-profit health sector following implementation of a data quality improvement intervention

Lower-level private-for-profit health facilities are integral to expanding access to routine immunisation services within Uganda’s urban health system. And yet, limited research has examined how these providers implement and sustain data quality improvement efforts amid resource constraints and competing profit motives. This qualitative inquiry examines provider experiences and insights following the implementation of a data quality improvement intervention, generating lessons to inform strategies for strengthening immunisation data quality within Kampala’s lower-level private-for-profit health sector. The endline assessment adopted a qualitative case study approach and was embedded within the Urban Immunisation Data Quality Improvement intervention. A purposively selected sample of twenty implementers took part in the study and were drawn from the lower-level private-for-profit immunisation health service providers in the two city divisions of Kawempe and Makindye. Monitoring visits and endline interviews informed the inquiry, where the interactions were audio recorded, later transcribed and thematically analysed using Atlas. ti following the Performance of Routine Information System Management (PRISM) framework which guided the deductive and inductive analytical approaches with anonymised quotes illuminating respondents’ voices. Overall, results revealed that the co-designed intervention strengthened some existing data improvement strategies, such as the birth cohort registers, monitoring charts, and data review, thereby improving tracing, timeliness, and awareness. Yet the paper-based dependence in some health facilities, lack of equipment, and costs related to improvisation in pursuit of data quality persisted. While the support supervision fostered ownership, the understaffing and high staff turnover, and uneven leadership in some health facilities limited progress. Reporting and feedback improved overall but remained inconsistent, especially in health facilities not yet onboarded onto the DHIS2 system. While the co-designed intervention worked to improve data tracking and awareness, sustained data quality gains require stronger infrastructure, leadership, workforce stability, and embedded feedback-driven data use processes.