Implementation context, determinants, and outcomes of eCHIS and DHIS2 for maternal health reporting in Southwest Ethiopia

Aim Health Information Systems (HISs) are often unavailable or unsustainable in many developing countries, including Ethiopia. We aim to explore implementation context, challenges, and enablers of the electronic Community Health Information System (eCHIS) and District Health Information System (DHIS2) in Jimma Zone, Ethiopia. Methods A convergent parallel mixed-methods study was conducted from October to December 2025 in three districts of Jimma Zone, Ethiopia. Quantitative data were collected through a cross-sectional survey of 320 primary health-care workers selected from 88 health posts and 28 health centers, while qualitative data were obtained from 14 key informant interviews using maximum variation sampling. Quantitative data were analysed using descriptive statistics and multivariable logistic regression in SPSS v27, while qualitative data underwent thematic analysis using ATLAS.ti 7.1.8; findings were integrated through triangulation. Result Overall, 63.8% of the participants reported eCHIS/DHIS2 use for maternal health data, with 47.5% achieving adequate use (≥80% timely/complete reporting). Predominant barriers included unreliable electricity (61.3%), unstable internet (77.5%), frequent tablet issues (60.0%), limited training (56.9% without recent eCHIS training), and absent dedicated Health Information Technicians (HITs). (60.0%), and poor eCHIS-DHIS2 interoperability (81.9% manual processes), supported by qualitative themes of infrastructure gaps, human resource shortages, and weak supervision. Five independent predictors of adequate use were identified: recent training (AOR=2.8, 95% CI:1.7–4.6), stable internet (AOR=3.5, 95% CI:2.1–5.9), dedicated HIT (AOR=1.9, 95% CI:1.1–3.2), partner support (AOR=2.6, 95% CI:1.5–4.4), and recent supervision (AOR=2.3, 95% CI:1.4–3.9). Conclusion Although eCHIS and DHIS2 are widely used for maternal health reporting in Jimma Zone, only a minority of facilities and health workers achieve timely and complete use. Actionable investments in digital infrastructure, structured training programs, dedicated HIT staffing, and strengthened supportive supervision are essential to scale maternal health reporting systems effectively.