This project examines clinical skill gaps among healthcare workers (HWs) in Rwandan primary care settings using data from a digital Clinical Decision Support Algorithm (CDSA) for pediatric care. Analyzing 20,204 consultations across 16 health centers, we identified patterns of measurement omissions and inaccuracies, leading us to observe 188 consultations and conduct interviews to understand causes. Key gaps in basic and complex measurements were found, highlighting the need for targeted training to improve CDSA data quality and enhance patient care. This research informs strategies for effective CDSA use in low-resource settings.