Implementation Fidelity of Digital Health Information Systems and Facility-Level Data Quality in Tanzania: An Implementation Science Evaluation

Digital health information systems are widely deployed across African health systems, yet the relationship between how faithfully frontline staff enact these systems and the quality of the data they produce remains poorly specified. Drawing on the DHS Program indicator 'Nonusers who visited a health facility and discussed FP' (FP_NFPP_W_HFP), comprising 131 country-survey observations from 36 African countries between 1994 and 2025 (mean 12.674, SD 6.52, range 5.70 in Morocco to 27.10 in Malawi), the analysis illustrates how facility-level data quality varies systematically across contexts and demonstrates why fidelity measurement must precede data quality assessment. The framework proposes that adherence failures produce omission errors, dose failures produce coverage gaps, quality-of-delivery failures produce misclassification, and responsiveness failures produce selective reporting. Data quality interventions which target technological infrastructure without addressing fidelity mechanisms will produce limited and uneven improvements. The contribution is a testable conceptual model that reorders the evaluation sequence: fidelity first, data quality second, and system performance third.