Barriers to using eHealth data for clinical performance feedback in Malawi: A case study

•We qualitatively analyzed barriers to EMR data use for audit and feedback in Malawi.•Primary barriers included provider rotations and disruptions to care processes.•User acceptance of eHealth and performance indicator lifespan were also key barriers.•The barriers are dynamic and could inform routine data quality assessment.•Understanding the clinical setting as a complex adaptive system yielded key insights.