As part of an ongoing effort to scale up health management information system (HMIS) reform in Ethiopia the Regional Bureau of Health (RHB) of Southern Nations Nationalities and People’s Region (SNNPR) of Ethiopia in collaboration with the MEASURE Evaluation HMIS scale-up team planned to enhance efforts for strengthening HMIS performance in four phases: (1) zonal HMIS performance assessment; (2) developing a HMIS strengthening action plan; (3) implement HMIS strengthening interventions and (4) routine monitoring of the HMIS performance to measure the effect of the interventions. In August 2011 the first round of the zonal HMIS performance assessment was conducted in a cluster of zones (viz. Hadiya and Kambata Tembaro) and special woreda (Halaba) who were implementing the reformed HMIS since mid or late 2010. The assessment was based on the Performance of Routine Information System Management (PRISM) framework. This framework promotes strengthening of the HMIS performance i.e. better data quality and improved information use by addressing technical organizational and behavioral factors affecting HMIS data quality and use for health service performance improvement. This document reports on the assessment findings that serve as a basis for formulating interventions to improve the HMIS performance and as a baseline for future monitoring of HMIS performance improvement in the zones. Additionally lessons learned from this assessment will further inform needed modifications and/or adaptations of the HMIS performance assessment tools to be used for assessments in the remaining zones of SNNPR.