COVID-19 Vaccine Delivery Webinar - Q&A and Discussion

This thread is for questions & answers and general discussion about the DHIS2 COVID-19 Vaccine Delivery Toolkit.

With several promising vaccines for COVID-19 in development, health authorities worldwide are faced with the challenge of how to facilitate equitable and safe distribution. The DHIS2 toolkit for COVID-19 vaccine delivery builds on established DHIS2 systems and tools to offer a modular, scalable and customizable approach to vaccination campaign management at the national and subnational level.

DHIS2 experts held a presentation and discussion on the DHIS2 toolkit for COVID-19 vaccine delivery on Thursday, 3 December 2020. You can watch a recording on our YouTube channel.

A second webinar to present the new metadata packages was held on Thursday, 28 January at 2pm Oslo time (UTC+1). The recording can be viewed on YouTube: https://youtu.be/kj1ZtHtPKz0

If you have questions for the DHIS2 team about the vaccine delivery toolkit, please post them in this thread.

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Here are the questions and answers that were covered during the webinar:

Q: If a country is to initiate the Routing Immunization module, what would be the next steps?
A: This depends on where countries are with the current setup of their routine immunization systems; whether they are already using DHIS2 for immunization and/or HMIS, and whether they have already adopted the WHO modules. If countries are already capturing routine immunization data through DHIS2 at facility level, the next steps would be to define what data will be captured from different service delivery points for COVID-19 – we will also be working toward a DHIS2 standard metadata package that aligns to WHO/global standards/recommendations, but these are not yet available. We will also try to release some prototype packages on a demo site before end of year to give countries a sense of how the data entry forms, indicators and dashboards may look. The most critical part is to understand how the data flows will work within the health system according to your national plan. If you do not already have a system in place, or need support, contact the HISP group in your region, or if you do not already have a HISP contact, email the core DHIS2 team at covid@dhis2.org.

Q: In regards to scale, for nationwide implementations in large countries (like India), is DHIS2 able to perform at large scale (thousands to millions of records per day)?
A: There are already several countries with DHIS2/Tracker systems at national scale, with millions of records. We are going to be doing more critical load and stress testing over the coming weeks to have a better idea of where the limits are, and will include this in the documentation. This is also very dependent on the configuration and the specs and of the server. We will provide guidance on hosting and server configuration to address these topics.

Q: The presentation has covered supply chain and implementation and rollout of the solution. Does the toolkit also cover capacity building for vaccinators, including certification?
A: We are not focused on capacity building for the workers / end users at this time. A lot of this will depend on the specific country implementation, and is best carried out by an implementation partner within a given country. At a global level, DHIS2 will provide generic training guides for end users that cover data entry and other operations, but these will need to be adapted by each country to align with local languages, system configurations, and work practices.

Q: Is there a way for the public to interact with the DHIS2 system to request a vaccine in varying supply and demand scenarios (more people who need vaccines than people, or vice versa)?
A: We have not really explored this use case yet, so it has not yet been built out in a generic way. DHIS2 is a very flexible platform that is interoperable with other platforms, which could be a way to link service delivery to the DHIS2 system. There are definitely areas where additional apps or tools may need to be implemented to complement the system. Figuring out the harmonized framework is an important part of country planning.

Q: Which version of DHIS2 supports the COVID-19 immunization module?
A: For aggregate components, we want to be able to support countries even it they are running a lower version. We are planning to support version 2.30 and newer, up to 2.35. For the Tracker data model, our recommendation is to upgrade to a more recent version of DHIS2 to take advantage of newer features and performance improvements, particularly those that have been introduced in 2.34 and 2.35. Since a lot of countries upgraded to 2.33 for the COVID surveillance packages, we are planning to make the COVID vaccine toolkit work with that version, but would recommend upgrading if possible. We would not recommend trying to run a large-scale Tracker implementation on 2.30.

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Thanks for sharing these, @maxk!

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Is it possible technical Assistant to get exchange between DHIS2 instances and external instances? Thx in advance!

Greetings from Honduras!

Hola Carlos! DHIS2 is quite flexible when it comes to interoperability but it always depends a bit on the ecosystem. We could set up a call with our team in Colombia and see what the options are. We have an interoperability lead that can provide support as well.

The recording from the 28 January webinar is now available on YouTube: https://youtu.be/kj1ZtHtPKz0

Here is the Q&A from the webinar on 28 January 2021:

Q: We are considering to collect tracker data for the two dose regimen for a population of over a million. What will be the server requirements for the implementation of this toolkit in this context.
A: Server specifications are a context specific requirement which should developed be a technical person familiar with the proposed scope of the implementation. Generic requirements can be found here (9.2 Server specifications), and we are currently conducting rigours performance testing efforts to provide additional information about limits, which will be added to the package documentation.

Q: It’s great to see entity matching in the enrollment. An element to de-duplicate patients is a key element of a patient/client registry. The portal looked like patient registry is associated by program or facility. Can you share how this module can support synchronizing client IDs with an external SHR or non DHIS2/module application?
A: The first line of defense against duplicates is the search, which is configurable and tied to the specific fields that the country uses for positive identification. The package generically has a field for national ID, as well as a generated unique covid vaccination identifier, along with specific attributes such as first name, last name, date of birth, etc. The country should identify the fields that they want to use for identification, and ensure that those fields are searchable, and perhaps required.

In order to connect to other systems containing client IDs, it is important to identify at least one shared identifier field, and mandate its use. The actual connection between the systems depends on the technical requirements – it can be a direct interaction between systems using the API, an external service, or even an external data warehouse or interoperability layer which multiple systems feed into.

Q: In order to use the Immunization module, is the Surveillance module a prerequisite to be installed/ used?
A: No, the toolkit is designed in a modular way. Countries can take any or all of the components they would like according to their needs and context. One advantage for countries who have used the Surveillance modules in their national systems is the ease of data triangulation across Covid surveillance and Covid vaccination.

Q: Is it possible to have an open report for all citizens of AEFI? I mean separated from the secured form for reporting AEFI
A: This is a new use case to us. DHIS2 is entirely configurable, and so it is quite flexible in what you can do. The current AEFI modules supports the more traditional adverse event reporting and investigation workflows.

Q: What technical support is available to countries that would like to adopt this platform?
A: We encourage countries to reach out to their regional HISP group as a first line of support. If you are not sure if there is a HISP group already providing support, please contact us at covid@dhis2.org and we will connect you with a regional partner. Please also join our Community of Practice at community.dhis2.org to connect with partners and receive updates from DHIS2.

At the global level, HISP UiO provides support for the toolkit itself, including the installable metadata packages, technical guides for installation, demo databases, implementation and training resources.

Q: Does all this module uses WHO Drug standard and/or Pharmaceutical identification standards?

A: These supply chain data points and indicators do follow WHO drug standards. We have not incorporated GS1 standards into DHIS2 yet, but we are working with our development teams and partners to do this.

In addition, the QR/Barcode reader in the DHIS2 Android Capture app supports the following formats (I think most of them are related to the GS1 standard):

Barcodes:

  • CODABAR
  • Code 39
  • Code 93
  • Code 128
  • EAN 8
  • EAN 13
  • Interleaved Two of Five (ITF)
  • PDF417
  • RSS 14
  • RSS EXPANDED
  • UPC-A
  • UPC-E
  • UPC/EAN extension format

QR:

  • QR Code
  • Data Matrix
  • MaxiCode
  • Aztec

This is the library in charge of reading QR/Barcodes. It has more info on the supported formats.

Q: Is this tool available for all?
A: Yes, the DHIS2 software itself is freely available for anyone to install and use. The Covid-19 vaccine toolkit is also freely available. To learn more about the toolkit, please visit dhis2.org/covid-vaccine-delivery and for package downloads dhis2.org/who-package-downloads

Q: is it possible to download and practice on it?
A: Yes, you can download the packages from dhis2.org/who-package-downloads and install in your own test instance of DHIS2 or you can visit our demo site: https://who.sandbox.dhis2.org/covax_demo

Q: Are these all part of the same toolkit? What are the pre-requisites for a country to adopt (hardware specs, etc)?
A: Yes, the solutions presented are part of a toolkit but can be implemented in modular way (a country can pick and choose which components they are interested in). In countries that already use DHIS2, we recommend that these packages can be integrated into the existing infrastructure. DHIS2 is a web-based platform so it can be used on any desktop and the DHIS2 Android app also allows offline data capture on Android devices. Android specs can be found here: DHIS 2 Android App Implementation Guidelines

Q: Where will the package will be published?
A: You can find information about the package and how to download them here:Covid Vaccine Delivery | DHIS2

We will update the package downloads continuously as we create packages, update packages and generate for DHIS2 version support here: WHO Package Downloads | DHIS2

Q: Is is possible to have a desktop version if needed?
A: Yes, DHIS2 is a web based platform so users can access from desktops. DHIS2 is generally not deployed as a local database on a desktop, though it could be. There are also a number of offline data entry solutions including the DHIS2 Android Capture App.

Q: Will your organization be able to provide support the implementation remotely such as the Pacific region due to travel restrictions?
A: The HISP network does provide remote implementation support. We have seen successful remote support during the pandemic to 37 countries who implemented the COVID-19 surveillance toolkit. We have also improved our digital training resources and increased learning opportunities such as webinars and online DHIS2 Academies to help. Several countries in the Pacific use DHIS2, such as Vanuatu and the Solomon Islands.

Q: what is the min internet bandwidth required ?
A: Data can be captured offline using the DHIS2 Android Capture app in low bandwidth settings. A reasonably stable internet connection is generally needed to sync data to the server, however there are some solutions such as submitting data via SMS (this requires the implementing country to set up an SMS gateway with DHIS2).

Two new COVID Vaccine Delivery packages have now been published on the DHIS2 WHO Downloads page