Electronic Health Record Systems for Maternal and Perinatal Care: A Cross-Sectional Assessment in Kilimanjaro, Tanzania

Background: Electronic health record systems (EHRSs) could significantly improve maternal and perinatal healthcare in sub-Saharan Africa, particularly in Tanzania. Although systems like the Government of Tanzania Hospital Management Information System (GoTHOMIS) and District Health Information System 2 (DHIS2) have been implemented, many healthcare facilities still rely on paper-based data collection, leading to inaccuracies. This study evaluates existing EHRSs for maternal and perinatal care in Kilimanjaro, Tanzania, assessing their types, features, and implementation to support better data quality and clinical decision-making. Methods: A cross-sectional study conducted from March to May 2024 in the Kilimanjaro region included all hospitals, health centers, polyclinics, and dispensaries. For dispensaries, convenience sampling was used for the selection of dispensaries with EHRSs. Data collection utilized semi-structured questionnaires administered via Research Electronic Data Capture (REDCap) to facility in-charges and health care workers managing EHRSs. The questionnaires explored various dimensions of EHRS. Data analysis was carried out using Stata version 14. Results: Out of 74 health facilities visited, 48(64.9%) were government-owned, and 59(79.7%) located in rural areas. Regarding facility level, 38(51.4%) was health centres, 21(28.4%) were hospitals, 13(17.6%) dispensaries, and 2(2.7%) were polyclinics. A total of 22 EHRSs were identified, with GoTHOMIS 42/74(56.8%), Mobile Pharmacovigilance (VigiMobile) 58/74(78.4%), and Electronic Integrated Disease Surveillance and Response (eIDSR) 58/74(78.4%) being the most widely implemented systems. Notably, 12/22 (54.5%) systems were operational within maternal and perinatal departments, and yet none could interface with others. Nine (75%) of the 12 systems aided in clinical decision-making, with 5/12(41.7%) able to work offline and synchronize data later, which were owned by the government. Conclusion: The EHRS deployment in the Kilimanjaro region is marked by fragmentation and a lack of coordination, despite substantial investments in digital health. Enhancements in maternal and perinatal care require better interoperability frameworks, adherence to legislation, and improved governance. The study does not evaluate national policy implementation or governance, limiting insights into regulatory effectiveness. Future research should focus on unifying digital platforms into a cohesive national architecture that also improves usability and performance.