Leveraging a DHIS2 Based Ecosystem to Improve Health Data Management and Reporting: Innovations from the Monitoring, Reporting, and Evaluation (MORE-ZM) System in Zambia

Abstract Background Digital health information systems (HIS) are essential for strengthening health system performance in low and middle-income countries (LMICs). In Zambia, before October 2020, HIS in programs supported by the U.S. Centers for Disease Control and Prevention (CDC) were fragmented, with limited harmonization and reliance on manual reporting, impacting timeliness and data use. With support from CDC, the monitoring, reporting and evaluation – Zambia (MORE-ZM) system was built to address these gaps using an open source district health information software 2 (DHIS2)–based ecosystem. This paper presents its implementation process and outcomes. MORE-ZM streamlined implementing partners systems into a multi-instance DHIS2 setup with centrally managed metadata. Rollout followed a collaborative process across 1,584 facilities in five provinces. Three innovations were introduced: the monitoring, evaluation and reporting (MER) parser for automated transformation of electronic health record (EHR) outputs into DHIS2 imports, the automation tool for donor reporting which is referred to as the monthly BOB report, and DHIS2–Power BI connectors for dashboards. Training included 1,575 staff. Results The multi-instance system architecture provided stability during routine operational interruptions. Although no formal data were collected, it was observed that manual MER reporting took several days while the automated MER parser took few minutes and monthly donor reports were generated within half an hour. Integration of DHIS2 with Power BI enabled near real-time visualization. Training supported system use and adoption. Conclusions MORE-ZM demonstrates that harmonizing systems with DHIS2 and applying automation can transform reporting into timely information flow. These solutions strengthened data use in CDC-supported programs, offering scalable lessons for other LMICs.