Final reflections about future research could be of interest, and I could raise a question: What would I do next time or in a second research to follow up the scaling process? It would certainly be interesting to visit facilities again and observe their work routines, how they interact with the system, how it assists them in decision-making and which experiences they receive. Of course, I obtained some information about it already from Akros, but it would be essential to see how decisions and planning activities are changing over a longer period of time. It would also be significant to develop a more detailed plan for implementation of all the suggested improvements from the framework for decentralized evidence-based decision-making at the facility level (see chapter 2) and follow up with the process of implementation of these changes. Furthermore, it would be possible to evaluate if these measures strengthen health management and increase consciousness about HMIS principles and concepts.
As mentioned before, different decision types and how they should be approached are not discussed widely in the literature and there is a lack of knowledge how decision-making process differentiates depending on different kinds of decision in the context of health management and which tools can support different types of decisions (i.e., clinical, administrative and managerial). Making profound research in this direction could also contribute to improved – more organized and effective evidence-based decision-making. It would be interesting to also evaluate how knowledge of using DHIS2 and making decisions based on dashboards is spread among more facility workers, as people presented at the trainings now have to educate their colleagues and new staff. Will the main idea of the trainings be carried on to new people? As my research has shown, already trained staff understood correctly the main purpose of the DHIS2 and their role in it, will they apply their knowledge in a way that trainings aimed them to and if so, will new DHIS2 users at the facility level follow the same strategy?
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