Digital systems for surveillance

Right to Care (RTC) continues to implement innovations that decrease the time between data collection and data utilization for program improvement through technology and processes that shift the perspective of data from retrospective program analysis to that of real-time surveillance and response. RTC has partnered with Qode Health Solutions to implement the RTC Knowledge Centre (KC), a centralized data integration, warehousing, and access portal, that allows for global access to customizable analytics and visualizations of program data. The KC is integrates with existing in-country capabilities to increase operational efficiency. In South Africa, the KC has been used to track the performance of 254 facilities in two provinces supported by RTC HIV clinical operations. RTC collects daily data from automatically generated templates emailed to facility-based data collectors. The forms are emailed back and automatically processed into the central warehouse and populate the pre-programmed analytics and visualizations. Additional data from facility ART clinical data systems and the National Health Laboratory Service are matched and merged into a longitudinal patient record accessible in the Knowledge Center. This data is accessed during “situation room” data review meetings to stratify facilities into over/under- performing based on key indicators with targeted interventions prioritized to meet the identified gaps. During the “Siyenza” push in South Africa to rapidly accelerate program performance in HIV testing yield, case identification, and treatment initiation and retention, RTC increased average daily case finding by 35% from baseline and observed a 32% increase in average daily ART initiations. The accessibility of near real-time data at field and headquarters level allow for a rapid response to program performance concerns. Regularly holding management meetings to discuss the data contributes to the behavior change necessary to institute routine data for decision making and improve program performance at a very granular level.

Abstract The National Cancer Control Program (NCCP) maintains the Sri Lanka Cancer Registry (SLCR). This registry contains socio-demographic, histologic and some staging data on cancers. Currently, there is no systematic process to gather outcome data of any cancer in Sri Lanka. The National Cancer Institute, Sri Lanka (NCISL) is the only dedicated cancer hospital in the country. This provides a unique opportunity to create an inception cohort that can be studied and followed up over an extended period. Our objective is to create an inception cohort of patients to study the patterns of cancer care at the NCISL. Detailed information on patient demographics, cancer diagnosis, treatment delivery, outcomes, comorbidities and health-seeking behaviour is captured using an electronic database. This database was developed based on District Hospital Information System (DHIS 2) software platform. Standard protocols are adhered to ensure data security. To ensure reliable and valid data capture the data abstractors were trained by board-certified physicians. Approximately 2900 patients with breast cancer and 800 patients with colorectal cancer have been collected both prospectively (February 1st 2018 to June 30th, 2019) and retrospectively (January 1st, 2016 to June 30th, 2019) with planned prospective follow-up for all patients at 6-month intervals. Future for the data repository includes coverage of cancers beyond breast and colorectal, expansion to include data from other public cancer treatment centres and linkage to the SLCR. This cancer care registry has the potential to form the cornerstone of cancer plans in Sri Lanka and to inform the delivery of care and health policy decision-making enriching the SLCR. For instance, this will facilitate an understanding of how new expensive anti-cancer therapies are being delivered in a low resource setting and whether the outcomes achieved are as expected.

The Ebola outbreak in West Africa has brought the consequences of a possible pandemic to the forefront of public health concerns in Senegal. The country has embraced a “one health” approach to surveillance, and community-level data are a key element of this approach. We developed and tested a community event-based surveillance system for 8 priority infectious diseases of human origin and 6 of zoonotic origin. Community workers use Short Message Service (SMS) messages to transmit possible cases from the field to a district health or veterinary post. Theses “signals” are then followed up for verification by a nurse or livestock agent. Data are captured through a RapidPro application called mInfoSante and can be viewed through a dashboard. More than 1,700 alerts have been received since November 2017. Nearly 1000 of these were verified and over 600 were classified as suspected cases by nurses or livestock agents upon follow-up. This session will present our experience with the system in six pilot districts. We will also feature a live demonstration of the mInfoSante dashboard. We will discuss our challenges in developing and implementing the community-based surveillance system, including the technology and its use by community health volunteers, nurses, livestock agents, and veterinarians.