Healthcare facility health information system status in Somalia: Evidence from the 2022–2023 Harmonised Health Facility Assessment

Background: Health information systems (HISs) support facility reporting, data-quality monitoring, planning, and decision-making. In Somalia, routine HIS performance is constrained by paper-based workflows, limited trained data personnel, fragmented reporting channels, and variable use of data for management. Objective: The objective of this study was to assess facility-level HIS practice status using the 2022–2023 Somalia Harmonised Health Facility Assessment. Method: This secondary cross-sectional analysis included 1219 facilities with complete HIS module data across the Federal Member States and Banadir Region. HIS practice status was constructed from nine binary indicators covering trained data staff, written data-quality guidance, review and use of service information, observed data outputs, external routine and notifiable-disease reporting, unique outpatient identifiers, and inpatient records. Facilities meeting at least five indicators were classified as having higher HIS practice status. Descriptive statistics summarised facility characteristics and indicators, and chi-square tests assessed unadjusted associations with selected facility and contextual characteristics. Results: Of 1219 facilities, 962 (78.9%) met the study definition of higher HIS practice status. Gaps were observed in designated full-time data staff (216, 17.7%), notifiable-disease reporting (628, 51.5%), unique outpatient identifiers (631, 51.8%), and individual inpatient records (639, 52.4%). Data-quality checking (948, 77.8%), written data-quality guidance (938, 76.9%), and use of service information for planning and management (950, 77.9%) were more common. HIS practice status varied in unadjusted analyses by region, facility management, and ownership, but specific between-region differences were not assessed through post hoc comparisons. Conclusion: Most assessed facilities met the study’s operational definition of higher HIS practice status, but important gaps remain in dedicated data staffing, notifiable-disease reporting, patient identification, and individual patient records. Priorities include facility data staffing, routine data-quality review, reporting feedback, and stronger patient record systems. The findings represent cross-sectional facility-level associations and should not be interpreted as causal effects or evidence of change over time. Implications for health information management practice: Health information management practice in Somalia should prioritise dedicated data personnel, routine data-quality review and feedback, complete notifiable-disease reporting, and stronger patient identification and record systems.