Data use in a DHIS2-based Disease Surveillance system: Lessons learned from Sierra Leone

Sierra Leone adopted the Integrated Diseases Surveillance and Response (IDSR) system in 2007; But it was paper-based and generated poor quality of data which limited its use. In 2018, Sierra Leone enhanced implementing electronic IDSR and started Case-Based Diseases Surveillance (eCBDS) on DHIS2 platform to promote data use. By 2022, 90% of the public health facilities are reporting weekly surveillance data on priority diseases adopted from the IDSR 3rd Edition while about 20% report case-based data including COVID-19. In February 2020, eCBDS was expanded to cover COVID-19 cases and vaccination.

The weekly reporting tool is a dataset designed to report aggregate cases from health facility level while case-based data and COVID-19 vaccine registry were designed on the tracker program to capture individual cases for follow up. Program indicators, reports, charts, maps, and dashboards were configured and updated for analysis across all levels of the system. The system monitors the quality, completeness and timeliness of the weekly surveillance and case-based data reporting. The vaccine registry tracks vaccine stock and doses administered, schedules appointments for the next dose, sends appointment reminders through SMS, and tracks missed appointments.

Currently the Ministry of Health and Sanitation (MoHS) has established several strategies for surveillance data use at all levels since the roll out of the electronic systems. Pillar specific technical working groups composed of MoHS staff and partners have been setup to discuss technical matters based on data from lower levels of reporting.

The technical working groups (TWG) including Emergency Preparedness and Response (EPRRG) composed of all pillars, and partners meets weekly to discuss data reported from the lower levels, the impact and public health actions to be taken. During the EPRRG meetings, all pillars present updates based on data extracted from the electronic tools. Similarly, COVID-19 updates from all pillar are presented. The COVID-19 data extracted from the system and monitored on the dashboard is analysed to assess the positivity rate trend, contacts monitored and followed up, tests conducted, vaccination rate, and dropout rate. The technical electronic systems working group engages districts on monthly basis to monitor data quality, reporting status and use at the district level. The district leadership also hold regular meetings with facilities and chiefdoms to monitor trend and pattern of diseases, data quality, knowledge gaps in reporting platforms, and develop improvement strategies.

The data use strategies employed have improved the weekly surveillance data completeness and timeliness from below 50% in 2018 to over 90% in 2022 in all the 16 districts, likewise, the immediately reportable case-based diseases data quality has improved from 40% of the data elements to 95% across the reporting districts.

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Thanks for sharing the Sierra Leone use case at the conference :slight_smile: :+1: