Challenges in the Implementation of a COVID-19 Module for the District Health Information System 2 (DHIS2) in South Sudan

Part of the Integrated DHIS2 platform for routine & emergency disease surveillance DAC2021 Session: Tuesday 22nd June 14:00

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Challenges in the Implementation of a COVID-19 Module for the District Health Information System 2 (DHIS2) in South Sudan

Authors: Talya Shragai1, Aimee Summers1, Helen Chun1, Kennedy Muni2, Carl Kinkade1, Habtamu Worku2, Alex Bolo1, Duku Ivan Dumba2, Acaga Taban3, Sudhir Bunga1

  1. Centers for Disease Control and Prevention, Atlanta, GA, USA; 2. ICAP at Columbia University, Mailman School of Public Health, Columbia University, Juba, South Sudan; 3. Ministry of Health, Republic of South Sudan, Juba, South Sudan.

Effective response to the COVID-19 pandemic requires high-quality surveillance data. South Sudan’s COVID-19 surveillance system is operated by Ministry of Health (MOH) entities and implementing partners using a range of health information systems. Funding for the COVID-19 response enabled South Sudan to begin configuration of a COVID-19 District Health Information System 2 (DHIS2) module for integration into the existing national DHIS2 system, which was initially rolled out in 2019 for HIV/AIDS. South Sudan’s goals in implementing a DHIS2 COVID-19 module were 1) improving the COVID-19 response and 2) making progress on using DHIS2 to strengthen the health system by standardizing data management, increasing technical capacity, and improving data accessibility. Through information collected from key informant interviews (KIIs) with COVID-19 surveillance stakeholders, we describe challenges of implementing the COVID-19 module, lessons learned, and progress made towards strengthening the country’s health information system.
Despite starting to configure the DHIS2 COVID-19 module developed by the University of Oslo in mid-2020, roll-out has not begun. Between October 2020 and March 2021, 13 KIIs were conducted and common themes describing important challenges and successes were synthesized. Key informants (KIs) reported that because multiple, independent groups implement COVID-19 surveillance, it has been difficult to garner buy-in and obtain data sharing agreements necessary to adapt to a unified data management platform. Because different partners use numerous (>10) data management systems, it has been challenging to standardize non-interoperable data, exacerbated by high partner turnover. KIs further reported that insufficient funding for DHIS2 has led to inadequate technical capacity for back-end support and staffing to facilitate roll-out. Finally, poor infrastructure and security have impacted the access and communications necessary to utilize DHIS2. However, while DHIS2 is not yet used for COVID-19, KIs reported that the transition process has strengthened long-term systems including creation of a MOH data management unit, training MOH staff to develop technical capacity, and setting precedent for mandated centralized data collection tools.
Many countries use DHIS2 for COVID-19 surveillance as a high-quality health information system. In South Sudan, the system lacked the support to quickly utilize DHIS2 for COVID-19; rapid deployment of DHIS2 during a public health crisis in resource-limited settings may require a minimum of in-country technical capacity for back-end development, stakeholder buy-in to utilize a central surveillance system, and sufficient trained human resources. Despite these challenges, the transition process in South Sudan has led towards progress in improving the underlying health information system.


@tshragai Thank you for the presentation, and the analysis of both the problems and the positive outcomes. You mentioned the need for DHIS2 backend development. To me that means Java programming in the core system, but I’m not sure whether you meant that or not. Did you mean middleware development, as has been done in other countries? Or configuring the DHIS2 system?
–Jim Grace, DIHS2 backend developer

[This question was subsequently answered in the session. They had nobody in-country to configure and customize the DHIS2 implementation in the backend.]

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