Join us for the Malaria session at DAC 2021 (Thursday, June 24 • 14:00 - 15:00)

This post is an overview of the Malaria session at the 2021 DHIS2 Annual Conference. More details on this session are available here.

You can watch a recording of this session on the DHIS2 YouTube channel

This session will focus on using DHIS2 for malaria use cases, including presentations on the Digital Solutions for Malaria Elimination project, LAC and Africa country implementations using DHIS2 for malaria elimination, and updates from WHO on metadata packages for malaria case-based surveillance and vector control.

Session program
Session program:
14:00-14:10 - Intro to the session and the DSME project - achievements, progress and results (Karoline Tufte Lien, UiO)
14:10-14:20 - WHO malaria case-based package (Mwalenga Nghipumbwa, WHO)
14:20-14:30 - WHO modules for entomology and vector control (Lucia Fernandez Montoya, WHO)
14:30-14:40 - Best practices and lessons learned from a selection of LAC malaria implementations (Honduras, Panama) (William Aviles, CHAI)
14:40-14:50 - Best practices and lessons learned from a selection of African malaria implementations (Namibia and Mozambique) (Iitula Iitula, NMCP Namibia and Sameen Babur, CHAI)

Please feel free to review the presentations and video and add your comments or questions for the presenters below!

To help highlight some of the stories about the use of DHIS2 for Malaria elimination that were presented in this session, I am going to add short summaries from each of the countries’ presentations. Feel free to add you comments and questions for the presenters!

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Honduras DHIS2 implementation
Presented by William Aviles @waviles , Health Informatics Technical Advisor Mesoamerica & Hispaniola, Clinton Health Access Initiative (CHAI)
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DHIS2 was initially adopted for Malaria in 2017 and is now the national HMIS (which also includes modules beyond Malaria), covering 20 regions within the country. The Malaria program is focused on five prioritized endemic regions.

The Honduras Malaria system includes case notification and identification forms (Tracker) and lab results. Work is ongoing with the MoH on adding entomology and vector control modules. The system uses DHIS 2.34 and Android Capture 2.1 (60+ mobile users, including VCTs, Data Entry, Epidemiologists and microbiologists.)

Successes:

  • Full-scale implementation of DHIS2 at national level, including adoption of DHIS2 as national HMIS, which helps ensure long-term sustainability. The combination of Malaria with other programs (such as HIV, TB) has led to a patient-centric system with an electronic clinical file for patients that combines health information in a holistic way.
  • The MoH has committed to regular updates to the software, which helps them take advantage of new features, which helps to simplify workflows, automate some tasks, and results in better visualizations and better data validation. All periodic reports (such as the EPI bulletin) can now be generated directly from DHIS2, with no need for other software such as Tableau.
  • Training adaptation using Moodle, implemented remote training and support using Zoom during the pandemic, and integrated geographic information on Malaria cases.

Challenges:

  • Need to adapt and simplify processes, improve documentation and better define processes (SOPs for user support, form modifications, etc.).
  • Infrastructure and connectivity in some regions, which affects synchronization of data.
  • Keep improving QA of data.
  • Some challenges with technological literacy.
  • Staff turnover leads to constant need for training, including staff turnover in the tech/IT team.
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DHIS2 in Panama Vector Control Data Collection Tools
Presented by William Aviles @waviles , Health Informatics Technical Advisor Mesoamerica & Hispaniola, Clinton Health Access Initiative (CHAI)
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Timeline of DHIS2 deployment in Panama:
Development of the DHIS2 system began in 2020 with testing and validation in Q1 2021 and pilot deployment in Q2 2021 (this year) in Comarca Ngabe-Bugle region. This pilot includes Direct Data Entry: 11 VCTs, Household (HH) Enumeration and IRS campaign data collection. Now in Q3 2021 we are working on scaling up, using the Training of trainers model in 3 additional regions with 46 VCTs. The system uses DHIS2 core 2.36.1 andDHIS2 Android Capture 2.4.1. Future modules that are planned are Bed net distribution and evaluation, and CHW supervision.

Successes

  • 72% SUS (usability score) - Everybody likes the user interface and user experience with DHIS2
  • Focus group comments: Helpful tool, avoid the use of paper which facilitates the work in the field, reduces the risk of data loss.
  • As per field interviews conducted, spray operators consider the use of the mobile tools as an improvement in their ability to do their jobs.
  • The implementation is led by MOH at the regional level.
  • The regional level MOH recognizes DHIS2-based analytics tools are helpful instruments for real-time remote tracking of the HH enumeration and IRS campaigns
  • Panama’s MoH has also begun using data from DHIS2 for other health projects, not just Malaria programs.

Challenges

  • The major challenge is the lack of connectivity.
  • Data summary on the mobile side.
  • Stronger enumeration
  • Include field trainings
  • There needs to be more time between enumeration completion and IRS planning and execution.
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Namibia Malaria System
Presented by Iitula Iitula - Insectary manager, National Vector-Borne Disease Control Programme (NMCP), MoHSS Namibia
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Malaria is endemic in the northern part of Namibia.Namibia is pursuing malaria elimination, with improvements in surveillance constituting a core part of the national strategy. The DHIS2 Malaria Information System (MIS) was initially introduced in 2017 to provide a simple mobile-compatible platform for case-based surveillance (notification, investigation and classification), with built-in visualization capabilities and options for future integration

DHIS2 MIS was first rolled out in 2017 for case surveillance, but we have slowly been
adding modules. The system is operational in all the 9 endemic regions of the country. Recently new modules have been added to the system with the latest being the Entomological Surveillance module. So far, the system has >400 users across health facility, district, regional and central levels

Timeline of DHIS2 rollout:
2017/18: Initial roll-out: Health Facility weekly reporting, Case-based surveillance forms
2019 Expanding of modules: Supervision, Vector Control, Community Health Workers
2020/21 Roll-out of Entomological Surveillance module, expansion of Vector Control module

Vector Control Module
Vector control module in the DHIS2 MIS has 5 forms under it, largely reported through the Android Capture app: IRS Weekly District Report, Annual Targets and Insecticide Tracking, Larviciding, LLIN Campaign. By replacing a paper > Excel-based system, the module has substantially improved the program’s ability to monitor campaign progression (Indoor Residual Spray and LLIN distribution) in a timely manner. IRS data is organized into village categories for campaign monitoring purposes. Each village has its own annual IRS target. Scorecard Dashboard easily shows the progress against targets. Mop-up needs are more easily flagged when the campaign progress is far below the set target of 90% per village.

Entomology Module
The Entomology module has been added recently to Namibia’s DHIS2 MIS, and has 6 forms,
largely to be reported using the Android Capture app: Vector Collection, Human Landing Catch, Pyrethrum Spray Catch, Larval Collection, Insecticide Resistance Monitoring, Mosquito PCR Results, and Human Behavior (where people and what they are doing when possibly infected)-- – these data can be combined for analysis with other programs in DHIS2 to analyze and improve effectiveness of work with spraying, net distribution, etc. and forecast to direct response to relevant places.

Historical data stored in MS Excel was imported into the system using user-friendly import apps available on the DHIS2 app store (Data Import Wizard and Bulk Load). With the program moving to use Android Capture, users can accurately capture GPS coordinates while in the field
for mapping purposes. Dashboards allow users to visualize vector composition & distribution, biting behavior, and insecticide resistance.

Successes
Most malaria data has been integrated into a centralized repository, allowing for combined
analysis of case, supervision, vector control, and entomology data. Data review meetings, continuous dashboard iteration & use of descriptive textboxes, and creation of reference sheets with definitions/calculations of Data Elements, Indicators, Program Indicators has slowly improved data interpretation by end users. A series of instance-specific training videos have allowed for easily deployable and decentralized trainings (for refreshers, staff turnover, etc.).

Next Steps
• Continue phased switchover from legacy DHIS2 Android apps to integrated Capture app
• Decentralize Data Review Meetings to regional level to foster the culture of data use at
regional levels
• Upgrade DHIS2 from version 2.29 to the latest version (awaiting full Android switchover due
old Android apps not being compatible with later DHIS2 versions)
• Enhance capacity-building to the Ministry of Health staff in readiness for full transition of
system from partner (CHAI)

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Developing a Malaria Data Repository in DHIS2 in Mozambique
Presented by Sameen Babur, CHAI - @Sameen_Babur
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The initial challenge: Mozambique was dealing with a lot of data fragmentation both within national Malaria program departments and across a large partner landscape. To address this, a project was initiated to consolidate data, in partnership with the Malaria Consortium and Saudigitus.

The National Malaria Control Program in Mozambique relies on many different data sources for effective planning, program implementation, and monitoring & evaluation: Commodities, Health facility cases, Community (cases, surveys, census), Supervision, Data quality, Entomological surveillance, Bed nets, Indoor residual spraying. A national surveillance assessment in 2016 noted significant challenges with data management, leading to the inclusion of an integrated Malaria Data Repository (iMISS) in the National Strategic Plan for 2017-2002

Key surveillance assessment findings:

  • Multiple sources of data with different definitions
  • No standardization in reporting tools and indicators
  • Poor accessibility and integration of data
  • No automated outputs

First, the National Strategic Plan was used to scope out the desired indicators to be housed in iMISS. Second, worked to get partners aligned on indicator definitions & standardized iMISS reporting tools through a series of design sessions with thematic Technical Working Groups.

Scoped Indicators were then mapped to all possible data sources across the NMCP, NGO partners, and research institutes that collect crucial data. For routine MoH information systems, integrations using the API were developed. For Excel-based reporting, data entry forms in iMISS were configured following extensive stakeholder workshops to harmonize indicators and design standardized reporting tools.

DHIS2 is well suited for this, because for any routine existing MoH information systems and the DHIS2-based LMIS, these could be directly integrated into the DHIS2 iMISS. For all of the other modules which were reliant on ad hoc systems and excel forms, it took work to design standardized data entry forms and aligning processes for data entry via web capture in DHIS2, Android Capture App, or Excel import apps, creating processes for entering data based on common definitions and indicators. The WHO DHIS2 modules for entomology and vector control were useful here, because they could be adapted for the local context and then plugged right in to iMISS with standards that partners could agree on.

Progress and next steps

➢ Components in black have been rolled out nationally as part of Phase 1 with ongoing refinements

➢ Components in red are currently under development as part of Phase 2

➢ New data entry forms for supervision, data quality audits, entomological surveillance, and vector control are newly being reported directly into the system via Android/web capture by provincial and district focal points with supportive supervision initiated in March 2021 to emphasize routine reporting, data quality and data use

➢ Processes for academic/NGO partners to report data into iMISS are currently being defined, with Excelbased import apps like Bulk Load paving the way for easy routine importation, reducing the need for duplicate data entry.

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