Effect of digitizing Community Health Information System on the delivery and use of maternal and child health services: Propensity score matching analysis
Clinical Snapshot
PICO Framework
| P — Population | Women of reproductive age (n=1,728), women with children 0-11 months (n=1,118), and women with children 12-23 months (n=569) in rural Ethiopian communities |
| I — Intervention | Electronic Community Health Information System (eCHIS) implementation |
| C — Comparator | Communities without eCHIS (traditional paper-based system) |
| O — Outcomes | Modern contraceptive use, institutional delivery rates, Pentavalent vaccination coverage (first and third doses), and full vaccination coverage |
Bottom Line
This Ethiopian study demonstrates that digitizing community health information systems significantly improves maternal and child health service uptake in rural settings. The eCHIS intervention showed clinically meaningful increases in contraceptive use (13 percentage points), institutional deliveries (8.9 percentage points), and childhood vaccination coverage (up to 14.6 percentage points). While the cross-sectional design limits causal inference, the propensity score matching and consistent positive effects across multiple outcomes strengthen the evidence. For Australian practice, these findings support continued investment in digital health infrastructure, particularly for remote and underserved communities. The results suggest that well-implemented digital health information systems can bridge service delivery gaps, though adaptation to local contexts and healthcare systems would be essential. The magnitude of effects, while statistically significant, should be interpreted cautiously given the observational design and potential for unmeasured confounding.
Key Findings
P Value: p < 0.01 for all primary outcomes
Effect Size: PR 1.25 for contraceptive use, PR 1.18 for institutional delivery, PR 1.36 for full vaccination
Primary Outcome: Maternal and child health service uptake
Nnt Or Sensitivity: Number needed to treat: 8 for contraceptive use, 11 for institutional delivery, 7 for full vaccination
Confidence Interval: Not reported
Clinical Application
Requires significant infrastructure investment and training but demonstrates scalable impact on health service delivery Relevant for remote Aboriginal and Torres Strait Islander communities and rural areas with digital health initiatives under Australia's Digital Health Strategy Rural communities with limited healthcare infrastructure implementing digital health information systems
Abstract
INTRODUCTION: In 2018, Ethiopia's government digitized its Community Health Information System (eCHIS) to enhance Health Extension Program service delivery. However, the impact of eCHIS on health outcomes remains unclear. This study, therefore, examined the effects of eCHIS on the uptake of maternal and child health services. METHODS: A post-test-only, non-equivalent group household survey design was used, collecting data from July to August 2024 in rural communities with and without eCHIS. A stratified multistage sampling technique was employed to recruit respondents. A sample of 1,728 women of reproductive age (271 in eCHIS and 1,457 in non-eCHIS woredas), 1,118 women with children ages 0-11 months (188 in eCHIS and 930 in non-eCHIS), and 569 women with children ages 12-23 months (301 in eCHIS and 268 in non-eCHIS) were included in this study. Propensity scores were used to match intervention and comparison communities based on women's age, religion, parity, education, household wealth, distance to health facilities, and autonomy. A modified Poisson regression analysis, adjusting for covariates, was conducted to estimate the adjusted prevalence ratios (PR) for maternal and child health outcomes. RESULTS: Modern contraceptive use was 66% in intervention areas versus 56% in comparison areas. Institutional delivery rates were 95% in intervention and 79% in comparison areas. In intervention areas, 94% of children received the first dose of the Pentavalent vaccine compared to 83% in comparison areas, while 85% and 68%, respectively, received the third dose. Adjusted analyses showed that eCHIS intervention areas had statistically significant increases in contraceptive use (13.0 percentage points; PR: 1.25; p-value < 0.01) and institutional deliveries (8.9 percentage points; PR: 1.18; p-value < 0.01) compared to comparison areas. Similarly, the average treatment effect of eCHIS on Pentavalent 1, Pentavalent 3, and full vaccination coverage showed significant increases of 10.3 (PR: 1.13; p-value < 0.01), 13.6 (PR: 1.26; p-value < 0.01), and 14.6 (PR: 1.36; p-value < 0.01) percentage points, respectively. CONCLUSION: This study underscores the transformative potential of eCHIS in improving maternal and child health outcomes in Ethiopia. Sustained investment in digital health systems can help scale effective health care services to rural and underserved communities.
References
- 1.Tiruneh, G. T., Tadesse, G., Hailemariam, A. M., Kifle, Y., Shewangzaw, T., Hunegnaw, B. M., Alem, G., Fesseha, N., Bogale, B., Mekuria, G., Hunduma, A., & Emaway, D. (2026). Effect of digitizing Community Health Information System on the delivery and use of maternal and child health services: Propensity score matching analysis. *PLoS One*, Article 0350270. https://doi.org/10.1371/journal.pone.0350270
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