Table 1 Summary of themes and sub-themes highlighting enablers and barriers of eCHIS implementation

Intervention characteristics

• Intervention source

• Evidence strength and quality

• Relative advantage

• IT infrastructure

• Design quality and packaging

• Cost

Design, network and electricity, digital literacy and adaptability of the intervention

• Homegrown technology

• Considers PHCUs workflows

• Designed for data quality and use

• Presence of embedded medical eligibility criteria

• Reminds service components

• Presence of multimedia for service provision

• Case validation

• Technology fear

• Limited awareness

• Limited or absent electricity

• Limited or absent network

• Unintegration of eCHIS with DHIS2

• Existence of side-by-side manual work

Data quality and accessibility

• Perceptions of performance expectancy

• Ease of use of the system

• Implementers eagerness to use

• Data protection and accessibility

• Workload of the implementers

Costs for support and mentoring

• Presence of tablet usage guideline

• Unspecified budget

Outer setting

• Facility needs and resources

• Organizational networks

• Peer pressure

• External policy and incentives

Commitment to data quality and use

Networking and competing interest

Policy, procedures and working environment

• eCHIS is flagship agenda of the government

• Need to improve healthcare data quality and use

• Presence of communication

• Establishing of new awarding committee

• Staff turnover

• Lack of conducive working environment

• Limited networking with external institutions

• Presence of competing projects like CBHI

• Lack of incentive mechanisms

Inner setting

• Knowledge and information management

• Networks and communications

• Tension for change

• Gender considerations

• Data quality and access

• Organizational incentives and rewards

• Goals and feedback

• Leadership Engagement

• Available resources

• Access to knowledge and information

Governance and ownership

Resource availability and standardization

Data quality,use and perception

Feedback and regular meetings, and communication Embedded knowledge, skill and attitudes towards eCHIS

Motivation and security issue

• Presence of regular PMT meetings

• Technical support

• Strong need to improve data quality and use

• Good perception

• Positive attitude towards effort expectancy

• Presence of feedback and communication

• Mentoring and support from the local and University technical team support

• Skill oriented trainings provided

• Knowledge shared during training

• Self-motivation by using the system

• Absence of help desk for HEWs at district

• Low tablet performance (old tablets with low storage)

• Lack of specific budget for eCHIS

• Lack of institutionalization

• Considering eCHIS as extra job

• Leaders’ limited comittemnt

• Limited local adminstrators engagement

• Limited support due to resource

• Need of ongoing capacity building

• Absence of reward or in kind or financial incentive

• Security issue (fear of robbery or tablet lost)

Individuals’ characteristics

-Knowledge and beliefs about the intervention

-Self-efficacy

Trainings, capacity building, and equipping implementers

Sociodemographic characteristics

Local supports

• HEWs interest to use eCHIS

• Presence of active HEWs

• Need of extra trainings and skills

• Using tablet for personal use or social events like weeding

• Limited self-expectancy

• Low educational background

• Older age

• Absence of experience sharing

• Lack of peer-to-peer support

• Absence of guideline for reference

• Lack of accountable person at district level

Implementation process

-Planning

-Engagement

-Reflecting and evaluating

Planning, monitoring, and evaluation

Community awareness and engagement

• Engagement of UoG and ARHB

• Monitoring the progress, evaluating and giving feedback

• Lack of defined plan

• Lack of clear job description for HITs

• Lack of community awareness

• Absence of local security support

• Limited involvement of volunteers and kebele administration

• Limited attention at PMT meetings or facility meetings towards eCHIS