Impact of Health Information System Interventions on Maternal Health Service Utilization in Oromia and Gambella Regions, Ethiopia: A Comparative Cross-Sectional Study

Objective: To examine the association between Health Information System (HIS) performance and maternal health service (MHS) utilization in the Oromia and Gambella regions, Ethiopia. Methods: A comparative cross-sectional study was conducted (15-25 October 2023) among 840 mothers in catchment areas of health facilities categorized as model (high HIS performance) or candidate (lower HIS performance). HIS performance was evaluated based on infrastructure (30%), data quality (30%), and data use (40%). MHS utilization was measured using a modified composite coverage index (CCI) integrating 10 essential interventions. Multivariable logistic regression (Stata/MP 17.0) identified predictors, reporting adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Results: MHS utilization was 60.3%, with higher crude odds in model facility areas (COR = 2.03, 95% CI [1.4-3.0]). After adjustment, this association attenuated (AOR = 1.4, 95% CI [0.92-2.15]). Key barriers included poverty (poorest quintile AOR = 0.45, 95% CI [0.30-0.68]) and limited transport access (AOR = 0.21, 95% CI [0.15-0.29]), which were associated with significantly lower MHS utilization. Sensitivity analyses confirmed robustness, and transport access modified the effect of facility type. Conclusion: HIS performance alone did not independently predict MHS utilization after accounting for structural inequities. Transportation and economic barriers disproportionately hinder access, even in high-performing systems. Integrating HIS strengthening with poverty-sensitive interventions (e.g., transport support, financial protection) is critical to achieving equitable maternal health outcomes.