DHIS2 Tracker for a Cervical Cancer program in West Africa

Setting up the DHIS2 Tracker to prevent cervical cancer through the SUCCESS project

Cervical cancer is one of the most preventable and treatable forms of cancer, yet, it is the fourth most common cancer among women globally. It is a leading cause of death among women living with HIV (WLHIV). It is particularly fatal to those not on antiretroviral therapy (ARV) or who initiated ARV late. The global divide in access to cervical cancer information, prevention, and control services is at the root of the disparity in global burden, with nine out of ten women who die from cervical cancer living in low and middle-income countries (LMICs). This represents a significant public health challenge in these settings, significantly impacting household and national economies and threatening the survival of families and local communities.

The SUCCESS project (Scale Up Cervical Cancer Elimination with Secondary Prevention Strategy) aims to reduce cervical cancer morbidity and mortality in four countries: Côte d’Ivoire, Burkina Faso, Guatemala, and the Philippines. The focus is improving access to optimal products to diagnose and treat cervical cancer.

By reducing barriers to accessing efficient new technologies, SUCCESS should allow the screening of approximately 180,000 women, 40% of whom are living with HIV.

The SUCCESS project is funded by Unitaid and implemented by Expertise France in collaboration with a consortium with experience and expertise in cervical cancer prevention and control: Jhpiego and UICC. The project also relies on the technical support of national cancer institutes: the French National Cancer Institute, the National Cancer Institute (USA), the National Cancer Center (Japan), and the National Cancer Institute (Brazil). [Bluesquare] works with the consortium to pilot an m-health platform to improve patient follow-up.

Strengthening the follow-up of women over time

In Côte d’Ivoire and Burkina Faso, SUCCESS uses the DHIS2 Tracker application of the District Health Information System (DHIS) 2 to digitize the data system of cervical cancer (CC) activities. At the start of the project, in addition to the need to organize a data system on new indicators for CC, the inefficiencies of a paper-based data system and significant delay in the transmission of HPV test results required a solution to share the results for a timely follow-up and treatment of patients.

Collaborating with service providers and relevant Ministry of Health(MoH) bodies, SUCCESS gained a unique experience using the Tracker module of DHIS2 for digitalizing CC data in 64 health centers and 12 laboratories in Burkina Faso and Côte d’Ivoire.

The SUCCESS project, in collaboration with the MoH, adopted the DHIS2 Tracker to strengthen the follow-up of women over time, from routine HPV testing to clinical treatment and management of complications. While involving the MOH IT departments and Cancer programs in countries ministers of health, the SUCCESS project:

  • Digitized the patient pathway in a single patient record platform
  • Set up an SMS reminder system plugged into the patient record platform
  • Provided built-in dashboards for patient tracking and automated monthly reporting
  • Integrated the DHIS2 Tracker tools in the MOH data environment and built local capacity to manage these tools autonomously

The SUCCESS project digitized the clinical procedures and formalized the care pathway and the data collection forms. To move forward, the SUCCESS project conducted a scoping analysis of both countries’ existing technical architecture and data environment. This allowed for assessing the needs for data entry, analysis, and visualization.

During the initial analysis, SUCCESS provided technical assistance for digitizing the paper-based data collection tools while using the existing patients’ clinical WHO algorithm. The project finalized the necessary tools in a collaborative approach to engaging national stakeholders and end-users.

The Tracker digitizes CC data between health centers and laboratories, enabling faster communication of CC test results from laboratories back to the health facilities and eventually to patients. In both countries, the SMS feature sends reminders to patients to pick up test results and remind them of the next appointment.

The built-in dashboards provide critical information to the service providers to reduce loss to follow-up and prepare automated monthly reports to the districts. These dashboards also help monitor, during supportive supervision, the quality of the data entered.

Integrating digital tools in the countries’ data environments

The SUCCESS project proposed a solution based on DHIS2 Tracker, a feature of the DHIS2 open-source platform that allows the collection and tracks individual-level data of numerous patients over time. With the DHIS2 Capture mobile application, the service providers can collect data directly from a tablet.

On top of that, the project has set up an SMS server plugged into this platform to communicate the patients’ results and remind them of their upcoming appointments. This architecture based on the open-source DHIS2 technology is relatively standard but requires particular attention to detail in DHIS2 Tracker configuration, tablet memory management, and SMS server setup.

Finally, the data platform hosts personal and sensitive data. The project has thus implemented a clear data-sharing policy security procedures to regulate access to data.

In Burkina Faso, the acquired tablets integrated the centralized storage and management of the MoH IT unit. The cervical cancer surveillance platform is fully integrated into the national system. The application is hosted on the G-Cloud (government cloud) of Burkina Faso, more precisely on the disease surveillance [platform of the Ministry of Health]. The SMS reminders for appointments and results retrieval are sent through the SMS gateway acquired by the Ministry of Health, allowing centralized and standardized management of airtime, data, and contracts by the MoH.

Approximately 100,000 women are directly affected by this program

This data platform positively impacts the women SUCCESS follows over time and the medical staff. It is estimated that more than 100,000 women in Côte d’Ivoire and Burkina Faso will directly benefit from the solution set up by Bluesquare.

Clinical operations will also greatly benefit from it. The medical staff will access all patients’ information in one place. It will also improve the communication between laboratories and health centers that can now look at the test results through the platform. Moreover, thanks to this solution, patients will get reminders for their routine HPV testing. However, patients and medical staff are not the only ones that will benefit from this platform. The database created will constitute a unique national data source for research and policymaking on cervical cancer in West Africa.

A change management strategy to ensure ownership and sustainability

A change management strategy was critical to enhance user adherence to the Cervical cancer Tracker. This strategy was thought through from the design to the deployment and the follow-up of the Tracker. Through a phased approach of testing and adapting the Tracker to clinical and laboratory sites, the DHIS2 Tracker has been deployed to all SUCCESS sites. Using a tool based on national DHIS2 systems offers solid ground for integration. In health facilities, healthcare providers were trained to enter data on tablets. In some laboratories with internal software for data management (e.g., SIMB in CDI), the project worked on the acceptability of using a new platform, and data clerks were trained to use the DHIS2 Tracker module properly. In Burkina Faso, local solutions for troubleshooting were designed, such as a WhatsApp group for all actors and site users in Burkina Faso where support is provided in case of a system bug.

Essential sustainability elements were embedded in the deployment of the Tracker. In both countries, there was close collaboration with critical national health and data institutions, as in Burkina Faso. There was an early engagement of the MoH in the activity through initial brainstorming and developing a roadmap for the deployment of the Tracker. A DSIS e-health expert was associated with the deployment of the app and its integration into the MoH platform. In Burkina Faso, SUCCESS also worked to ensure MoH participation through dashboard creation and capacity building of the MoH for data monitoring and virtualization. Despite efforts, bottlenecks persist at the level of health providers, which consider data entry into tablets as an additional burden in a context where the paper-based data system is also maintained in parallel, creating double work for providers. More support from health management teams and health authorities is needed, and an incentive system could be envisaged.

The following steps in deploying the Tracker in Côte d’Ivoire include the plans to organize further sensitization of providers with support from MoH, including issuing a technical note reaffirming CC data entry as a core routine activity. There are also plans to strengthen data quality by implementing a quarterly quality assurance mechanism comparing data input and paper-based tools to verify coherence and inconsistency and correct data as needed. In Burkina Faso, the subsequent efforts should support the MoH to be more autonomous with data validation by encouraging its leadership to organize data validation and supervision. Continuous attention is maintained on providers’ capacities to report correct data and analyze it to assess system performance, including tracking Loss to Follow-Up (LTFU).


A great and brilliant initiative. Thanks for sharing @ndaceney


Great job… Thanks for sharing


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