When the COVID19 outbreak began in December 2019, health officials of Bangladesh and development partners including us (HISP Bangladesh) are preparing under the command of our honorable prime minster. The first try was to prevent COVID19 suspect cases to isolated or quarantined to stop spreading throughout the country. By this time, we, HISP Bangladesh was trying to develop port of entry system using DHIS2 and other tools. We were also exploring and found global HISP under the leadership of University of Oslo working on the COVID19 surveillance package. After first COVID19 case detection in Bangladesh on 8th March MOH realized the need for external assistance and we (HISP Bangladesh) are asked to support customize and deploy a national COVID19 surveillance system and build interoperability with all the external COVID19 apps.
The COVID-19 surveillance system of Bangladesh is based on DHIS2 COVID-19 package developed by UIO. HISP Bangladesh customized for MoHFW of Bangladesh as per national requirements in consultation with the national COVID-19 technical committees, IEDCR and Director General of Health Services. HISP Bangladesh team is customized and developed of COVID-19 surveillance system as per DGHS, IEDCR and other stakeholders’ requirements from March 2020 and WHO Guideline released in February 2020. Though designed as surveillance system, we build additional components and systems which is now being used as core COVID19 system. It is continuously updating and supported by the HISP Bangladesh team.
The Flow diagram is given below:
We setup a common gateway for COVID19 screening applications and encourage all partners and vendors to support government. This way we ensure a central repository for COVID19 surveillance and providing data electronically to national dashboard and international platforms. We also setup COVID19 certificate verification with security systems which is still being used by Immigration and Airlines.
The highlights of COVID19 Surveillance System are given below:
- All COVID19 information’s in one place; including vaccination, ICU, and associated logistics.
- More than 6.23 million ‘Tests’ (20th June) are completed and counting. The COVID19 sample ae collected and being entered in the systems from 1034 public and private sample collection facilities/hospitals. Those are tested through 126 PCR test laboratories, 46 GeneXpert lab and 356 RAT test facilities and data are entered into the system.
- The ‘Test’ results are notified to the suspects though SMS automatically from the surveillance systems immediately after test done. A self-service report printing systems is available in the DGHS web portal.
- Providing COVID19 certificates with secured electronic verification system (QR Code).
- The test Certificate Validation are integrated and being widely used by Civil Aviation, Ports, Airlines, and immigration authorities worldwide.
- The test result and certificate are providing within 48 hours for the outbound traveler.
- Epidemiological analysis, geo distribution and GIS are providing critical aid to the policy makers to take various decisions.
- Feeding National COVID19 dashboards portals in DGHS, MoHFW and to the Honorable Prime Minister’s Office.
DHIS2 COVID19 Surveillance systems – Challenges
There are lots of challenges. But the main challenges are:
- Moving target – Continuously changing of requirements
- Some of the LABS & Hospitals have different type of system and almost every day there are new Apps for ‘COVID19.’
- Due to change in requirement keeping historical data and metadata clean is become a challenge.
- Identification of ‘Tracked Entity’ is challenge as Government decide to use mobile number and one mobile can be used by a family.
- Visualization requested not available in current Data/Event Visualizer
- How to visualize – many requirements we cannot fulfill; so, using web portal for solution.
- Deciding on attributes, data elements – for analysis/filtering through API and Visualizer.
- Tracker Performance issue is the most challenging part.
COVID19 Vaccination support
For COVID19 vaccination MoHFW are using ‘SHUROKHA’ app. There are few reporting issues and due to that we must incorporate few reporting requirements into this COVID19 Surveillance system. They are:
- Vaccine reporting by age-sex disaggregation and geo location
- Vaccine logistics management system
- Aggregate Reporting of AEFI.
There is a plan to integrate ‘SHUROKHA’ through API when available at their end. This data is also feeding electronically to the national dashboards of MoHFW.