Enablers and barriers to Electronic Community Health Information System (eCHIS) usage in Kenya: A Work System Framework Analysis of frontline health worker experiences

Introduction: The Electronic Community Health Information System (eCHIS) is Kenya’s flagship digital health solution rolled out to strengthen community health service delivery and accelerate progress towards achieving universal health coverage. Despite its widespread rollout, evidence from global health initiatives affirms that the mere presence of a system doesn’t guarantee meaningful use. Consistent eCHIS usage by frontline health workers remains a critical determinant of realising anticipated benefits, underscoring the need to understand the context-dependent enablers and barriers influencing such consistent usage, based on users’ lived experiences. Methods: The study employed a qualitative phenomenological design in three counties, conducting 22 interviews. A total of 12 Community Health Promoters (CHPs), 6 Community Health Assistants (CHAs), and 4 county focal persons participated in the study. The qualitative data were transcribed and analysed thematically using NVivo, guided by the Work System Framework (WSF), which examined usage across four dimensions: participants, information, technology, and processes. Results: The findings showed that sustained eCHIS usage is influenced by a set of interrelated socio-technical enablers and barriers across the WSF dimensions. The key enablers included incentives, supportive supervision, training opportunities, real-time data access, improved accuracy, device portability, transparency, and data ownership. The major barriers included inadequate and unequal training, household resistance to disclosing sensitive information, financial constraints, device failures, data synchronisation issues, missed household visits due to environmental challenges, and delayed system updates. Conclusion: The study’s contribution was to show that sustained system use is shaped by interactions among work system dimensions rather than by technology availability alone. Through the WSF, the study provides a holistic understanding of the socio-technical determinants that influence the sustained use of national digital health systems. The findings affirm the need for refresher training, infrastructure support, workflow alignment, and community trust to ensure sustained use of digital health systems in low-resource settings.