On 29 and 30 April 2020, members of the core DHIS2 COVID-19 package development and implementation team, HISP Uganda, HISP Mozambique, HISP West and Central Africa, HISP Vietnam, HISP Sri Lanka, and MoPH Palestine/WHO gave presentations on their COVID-19 work at a webinar hosted by the Health Data Collaborative (HDC) and WHO.
A recording of the webinar from 30 April is available here: Watch the webinar
The slides from the webinar are available here: Download the presentation slides
Additional information on HDC resources is available on the HDC website
The HDC webinar included an online Q&A, which you can browse below. If you have additional questions or comments, please add them as replies to this topic!
Q: Which support is available to counties to implement the COVID-19 packages into their national DHIS2?
A: Global guidance and community platforms are available through the resources below. The regional HISP network also provides direct technical support to many MOH in their DHIS2 implementations.
- COVID-19 specific guidance: Visit dhis2.org/covid-19 for COVID implementation resources, including System Design Documentation and installation guides.
- General DHIS2 implementation guidance: visit docs.dhis2.org for complete implementation, user and dev documentation for the DHIS2 platform. Implementers are encouraged to visit Implementation guidance [General], Tracker Implementation Guidance and DHIS2 Android Implementation Guidance.
- Sign up for the DHIS2 Community of Practice (community.dhis2.org), an online platform for the global community of DHIS2 users. Here you can ask questions, share resources and get connected to other implementing partners in countries and regions.
- You may also contact us at covid@dhis2.org for country-specific support queries.
Q: How does the WHO COVID-19 tracker relate to the DHIS2 tracker and can it feed into it?
A: The COVID-19 surveillance tracker developed for the WHO’s technical guidelines for COVID-19 surveillance is built using the generic DHIS2 tracker. The metadata package can be used to install the tracker program into a national DHIS2 instance. The tracker program is designed to collect data elements (variables) that align to WHO’s recommended standards for case-based surveillance data collection for COVID-19.
Q: how was the issue of data confidentiality handled? Special authorization from the Minister of Health is required to access information
A: The DHIS2 COVID-19 surveillance is a package of metadata that can be installed into a country’s DHIS2 instance. However, UiO HISP does not actually collect any COVID-19 case data from countries. Implementation of the package is led by MOH in countries according to national policies about data confidentiality, privacy, and sharing. Within the COVID-19 metadata package, we have adhered to confidentiality standards. For example, personally identifiable data is configured as program ‘attributes’ which can be encrypted in the database. Access and ability for a user to search, capture and view personally identifiable data is configured according to national guidelines and HMIS governance frameworks that dictate who may be allowed to access what types of data (both for capturing data and for accessing data at individual or aggregated levels). Access to national HMIS is generally controlled by an MOH system admin.
Q: Is anyone doing cross-border data exchange yet?
A: In the Greater Mekong Subregion, DHIS2 is being used as a solution for sharing TB data across borders and enabling patients to have continuity of care despite traveling across country borders. We don’t know of an active use case for cross-border data exchange for COVID-19 yet, though several points of entry (POE) implementations are in place, including using a DHIS2 Android solution for generating travel passes at Uganda’s land borders.
Q: At DIAL, we’re exploring mobile operator data to supplement existing datasets in contact tracing, population density & movement for social distancing impact. Have you explored aggregating anonymized mobile data records to supplement DHIS2’s data sets in either Mozambique, Tanzania, Malawi, DRC?
A: DHIS2 is flexible and entirely configurable, so it would be possible for a country to take key aggregate data sets from mobile operators to layer into the system; or case-based data from DHIS2 may be anonymized and laid over mobile operator data with external data visualization tools. Sri Lanka has brought data together from case-based surveillance and mobile operator data for layered analysis. We’d love to hear more about the use case through this Community of Practice.
Q: Can you shed more light on assigning unique ID to cases?
A: There are multiple ways to assign unique ID to cases. In DHIS2, we uniquely identify entities in the system through ‘attributes.’ A national case ID can be used according to MOH coding systems for assigning a national unique case ID. In addition, it is possible to create a system-generated (i.e. generated by DHIS2 and guaranteed to be unique within the DHIS2 instance) case ID as an attribute. Both options are included in the standard COVID-19 case-based surveillance tracker metadata for MOH to adopt according to their context. Tracked entities in DHIS2 can also have more than one code (i.e. national ID, system-generated ID, and national case ID can all be assigned to the case to enable unique identification).
Q: How are you linking with lab systems? Is there something in the standard package to allow interoperability with lab systems? If so, what standards do you use?
A: The COVID-19 surveillance tracker package includes program stages that enable a health facility user to generate a lab request (i.e. linked to a patient); and for the lab user to update the program with lab results (that are then visible to the health care provider). This is a simple way to support the workflow between facilities and laboratories, particularly if there is no lab reporting system in the country. If countries do have a lab reporting system, DHIS2 can import the lab data and sync with the case list, following UID or unique codes. Interoperability with lab systems is being actively explored and we’d like to hear any use cases from the Community.
Q: I have seen another outbreak contact tracing system Go.Data supported by WHO. Can you compare and contrast it with DHIS2 contact tracing system?
A: The WHO-supported Go.Data contact tracing tool is specialized for contact tracing operations and has tailored, fit-for-purpose functionality. By contract, DHIS2 is an entirely generic and configurable health management information system, that allows for configuration of modules for contact registration and follow-up but may not have specialized contact tracing functionality as Go.Data. UiO HISP is collaborating with the WHO Go.Data team to explore interoperability scenarios that enable the contact-tracing tool Go.Data to share an organisational unit hierarchy as a reference with DHIS2 (i.e. ensuring administrative units, health facilities, etc. are the same across both DHIS2 and Go.Data) and to send key data points from contact tracing operations with Go.Data to a DHIS2-based HMIS.
Q: Zeferino, You spoke about some public dashboards. Could you provide a couple of examples and indicate which countries are using these.
A: Several countries are using DHIS2 for data collection and also generating/maintaining public dashboards. A few examples are below:
- Sri Lanka https://covid.iq.lk/
- Uganda: https://covid19.gou.go.ug/
- Malawi: http://covid19.health.gov.mw/
- Togo: https://covid19.gouv.tg/
Q: Do you collect coordinates of patient home address or hospital coordinate where the patient treated?
A: In general, health facilities and hospitals are included in a country’s organisation unit hierarchy in DHIS2 with GPS coordinates of the facility. This enables geographic analysis at facility level through DHIS2 Maps App. In addition, it is possible to record GPS coordinates of a patient’s home address (this could be recorded in DHIS2 as the coordinates of the Tracked Entity Instance, of a particular event, or captured otherwise as a Data Element with type ‘coordinates’). This enables analysis in maps of cases that present at a health facility and where these patients live. In some implementations, village of residence coordinates are substituted for the patient’s home address. Any implementation that wishes to record coordinates of patient home address should follow national policies in place for protecting patient privacy and confidentiality.
Q: What is the engagement processes to access and extract country level data from DHIS2, that is assuming approvals from MoH & other Ministries have been provided?
A: If approvals and permissions are given by MoH and relevant Ministries, data can be extracted in multiple ways. Data can be exported as Excel or .csv file; or it can be pushed from one system to another using the API. The COVID-19 metadata package codes the data elements according to the standard variable codes provided by the WHO Data Dictionary for COVID-19 case-based reporting to facilitate data sharing.
Q: Palestine, Lao and Sri Lanka already had strong experience in Tracker and strong support team. What is experience for countries with less Tracker experience?
A: Some countries have tracker experience in certain health programmes (i.e. the TB or HIV programme might have been using DHIS2 tracker, while the national epidemiology unit responsible for notifiable diseases may not). In these cases, often Tracker implementation support can be sourced within the Ministry and supplemented by external support as needed. For countries just getting started with Tracker, we recommend visiting docs.dhis2.org and reading the Tracker Implementation Guidance for considerations around planning, technical support, hardware, scale-up strategies, etc. We have found that implementing tracker at a more centralized level (i.e. national level, epi units or national laboratories) can be done faster and with less resources, while decentralizing tracker implementations to lower levels (e.g. facility, community) generally requires more time, resource allocation for training and support mechanisms, and hardware.