Abstract
A robust epidemic-prone disease surveillance system is a critical component of public health infrastructure and supports compliance with the International Health Regulations (IHR). One digital health platform that has been implemented in numerous low- and middle-income countries is the District Health Information System Version 2 (DHIS2). In 2015, in the wake of the Ebola epidemic, the Ministry of Health in Guinea established a strategic plan to strengthen its surveillance system, including adoption of DHIS2 as a health information system that could also capture surveillance data. In 2017, the DHIS2 platform for disease surveillance was piloted in two regions, with the aim of ensuring the timely availability of quality surveillance data for better prevention, detection, and response to epidemic-prone diseases. The success of the pilot prompted the national roll-out of DHIS2 for weekly aggregate disease surveillance starting in January 2018. In 2019, the country started to also use the DHIS2 Tracker to capture individual cases of epidemic-prone diseases. As of February 2020, for aggregate data, the national average timeliness of reporting was 72.2%, and average completeness 98.5%; however, the proportion of individual case reports filed was overall low and varied widely between diseases. While substantial progress has been made in implementation of DHIS2 in Guinea for use in surveillance of epidemic-prone diseases, much remains to be done to ensure long-term sustainability of the system. This paper describes the implementation and outcomes of DHIS2 as a digital health platform for disease surveillance in Guinea between 2015 and early 2020, highlighting lessons learned and recommendations related to the processes of planning and adoption, pilot testing in two regions, and scale up to national level.
Highlights
The West Africa Ebola outbreak of 2014–2016 highlighted the need for public health systems strengthening across the region, including enhancing capacities to routinely monitor epidemic-prone disease trends and effectively and efficiently detect outbreaks (1, 2)
We describe the process and lessons learned from the planning, piloting, and scaling up of District Health Information System Version 2 (DHIS2) for epidemic-prone disease surveillance in Guinea from 2015 to 2020
In 2017, for a period of 6 months, a pilot implementation of DHIS2 for disease surveillance, consisting of aggregate weekly and individual case notifications in DHIS2, was conducted to assess implementation needs and challenges at the District and Regional Health Offices, hospitals, the National Agency for Health Security, laboratories, and the Expanded Program on Immunization for the list of reportable diseases and events that were included in the DHIS2 during the pilot phase
Summary
The West Africa Ebola outbreak of 2014–2016 highlighted the need for public health systems strengthening across the region, including enhancing capacities to routinely monitor epidemic-prone disease trends and effectively and efficiently detect outbreaks (1, 2). In 2017, for a period of 6 months, a pilot implementation of DHIS2 for disease surveillance, consisting of aggregate weekly and individual case notifications in DHIS2, was conducted to assess implementation needs and challenges at the District and Regional Health Offices, hospitals, the National Agency for Health Security, laboratories, and the Expanded Program on Immunization (see Table 1) for the list of reportable diseases and events that were included in the DHIS2 during the pilot phase. Based on the needs assessments and requirements identified, the pilot disease surveillance system with DHIS2 was designed to enable District Health Offices to enter their aggregate weekly case reports and individual case notifications in DHIS2. Timeliness of weekly disease surveillance reports was measured by the number of health facilities that submitted a report by Tuesday of that week, FIGURE 3 | Design of data flow for individual case notifications in DHIS2 tracker in Guinea
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