Facility newborn and stillbirth data use and enabling factors at different levels of the health system: findings of the IMPULSE study across 142 sites in the Central African Republic, Ethiopia, Tanzania, and Uganda

Background: Improving data quality and use is a priority identified by the World Health Organization (WHO) to reduce stillbirths and newborn deaths; however, few studies have documented newborn and stillbirth data use in the African Region. To address this gap, we conducted a cross-sectional study from November 2022 to July 2024 in 12 regions and four city administrations across the Central African Republic (CAR), Ethiopia, Tanzania, and Uganda. Methods: We collected data using Every Newborn - Measurement Improvement for Newborn & Stillbirth Indicators (EN-MINI) tools, through direct observation, and from routine electronic and/or paper-based forms and reports. We analysed both the overall and country-level samples following the Performance of Routine Information System Management User's Kit. Results: We assessed 142 sites, comprising 93 health facilities and 49 data offices. Enabling factors, such as electronic systems, guidelines, annual plans, and feedback mechanisms, were highly available in Ethiopia (n/N = 22/30), moderately available in Uganda and Tanzania (n/N = 15/30 and n/N = 12/30), and scarce in the CAR (n/N = 1/30), with key indicators in all countries being ≥80%. Key data-use indicators showed similar patterns across countries, but lower frequencies (Ethiopia: n/N = 15/66; Uganda: n/N = 14/66; Tanzania: n/N = 5/66; the CAR: n/N = 1/66). Decisions documented in meetings rarely focussed on healthcare quality improvement, particularly at the district level (47.1% in Tanzania vs. 44.4% in Uganda vs. 30% in Ethiopia vs. 0% in the CAR). Data dissemination to public representatives was also subpar (40.8% in facilities, 71.4% in subnational offices). Among 141 end-users, 100% of respondents in the CAR, 75-82.4% in Tanzania and Uganda expressed the need to improve the newborn and stillbirth data use compared to 16.7-21.7% in Ethiopia. Conclusions: Newborn and stillbirth data use was low, despite variations across countries and health system levels. Evidence-based decision-making in health service delivery remains a priority action to reduce stillbirths and newborn deaths. This study identified context-specific, sustainable, and scalable interventions co-created with end-users to ensure wider newborn and stillbirth data use.