Improving Health Information Systems for Decision-Making in Least Developed Countries: A Systematic Review

Health Information Systems (HIS) play a vital role in evidence-based decision-making, resource allocation, and health system performance monitoring. However, in Least Developed Countries (LDCs), the effectiveness of HIS remains severely constrained by structural, technical, and human resource limitations. This systematic review synthesizes empirical and theoretical literature on the performance, challenges, and reform strategies for HIS in LDCs. A total of 35 peer-reviewed studies and policy reports were examined, focusing on data quality, institutional governance, capacity development, digital integration, and decision-making processes. The findings indicate that while digitization and donor support have improved data generation, persistent gaps in data use, interoperability, and decentralized planning significantly undermine HIS utility. Weak institutional cultures around data use, inadequate training, fragmented systems, and limited infrastructure were identified as major barriers. Conversely, participatory data review, performance-based feedback, and localized governance models have shown promise in enhancing HIS effectiveness. The study proposes a multi-level framework to guide HIS reforms tailored to LDC contexts, emphasizing the integration of technical tools with human and institutional capacity building. The review concludes that sustainable HIS strengthening in LDCs requires moving beyond technology adoption to prioritize contextual relevance, system alignment, and long-term investment in data-use culture.