Background: The Routine Health Information System (RHIS) is a crucial constituent of quality health care and services performance, generating a heavy workload to health workers, suffering from obsolescence, typically tackled with fragmented approaches. RHIS experience numerous dysfunctionalities and are neglected by the international community. Our objective is to provide evidence to support a new vision for future global and national investments in RHIS.Methods: We carried out a mixed methods study: a synthesis of RHIS frameworks, country RHIS case studies and an economic analysis (supported by a methodological scoping review on health systems economic analyses) relating RHIS investments to lost welfare due to quality of care.Findings: We described the RHIS conceptual background and spelled out the extension of RHIS and the workload to health workers. Countries per-capita running costs of RHIS ranged between USD 0.02 and 0.46. Most of the costs were due to health workers’ time contributions. The number of annual person-time spent on RHIS ranged from 1 to 52 million hours. The estimated proportion of RHIS costs in relation to forgone welfare ranged between 0.002% and 0.057%.Interpretation: RHIS are mainly designed for reporting data to higher levels of the system neglecting their primary purpose to inform clinical and public health decisions at the point of care. We need more but also better investments: in RHIS that are truly linked to decision-making; bringing human-centred design approaches; and able to serve two masters: health care and systems performance.Funding: This study was funded by WHO / Health Data Collaborative - 2022/1295688-0.Declaration of Interest: We declare no competing interests.Ethical Approval: Though no human participants were involved in this research, ethical clearance was received from WHO (ERC0003876). In addition, South Africa (EC002-2/2023) and South Sudan (no case number) issued ethical clearance.