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GLOBVAC-Global helse- og vaksin.forskn

Information Systems for Emergency Diseases Emergency Response to the Covid-19 Pandemic – supporting global and national surveillance

Alternative title: Informasjonssystemer for COVID-19 - global og nasjonal sykdomsovervåkning

Awarded: NOK 5.0 mill.

The main objective of this research project has been to find out how to adapt information systems to countries in different cultural regions so they can respond quickly to COVID-19 and future disease outbreaks. Together with the UiO and NIPH, there are 4 countries engaged in this project-Ghana, Kenya, Mozambique, and Sri Lanka. The work has been intense over the last year and some early findings are available in here. The qualitative data collection has been done with health workers in different levels of interaction with COVID-19 surveillance systems in each country. The first and second phases have been the qualitative data collection and analysis with four categories- simplicity, flexibility, acceptance, and the existence of conditions that facilitate the use of the system. Discussion with NIPH has also been held about the data quality evaluation protocol, the final stage, and soon to be applied in each country. - In Sri Lanka, the COVID-19 Surveillance System was implemented in January 2020 as the first application of DHIS2 for COVID-19 surveillance in the world. The system consists of 2 categories, COVID-19 Surveillance System and COVID Immunization Tracker. The data collection is still ongoing. The data analyzed so far were received from the participants who were serving as, i.e., national-level implementers, district-level data entry staff, and others. The early findings are, i.e., use of DHIS2 for routine use from past made the task of adapting to new forms much simpler; some staff experienced issues adapting to online training sessions which made initial engagement difficult; no major change in workflow; issues in timeliness are well-observed, but easy to monitor and engage with health facilities due to monitoring/analysis functionalities. - In Mozambique, the team had to conduct the interviews electronically using an online form, due to issues coinciding with the many restrictions in the country due to the pandemic. From 182 contacted health workers, they received 47 responses. Some of the findings are: most users are familiar with DHIS2 and think it is easy to use; a slight difference between the electronic and the paper system, which made it difficult in the initial stage; easy access and data entry, without many variables to fill. Regarding training, it was mostly online which brought some difficulties for some users. Many users were able to carry out their analysis for the preparation of their reports using the system; almost all users see the system's functionality as adapting to their practical work. - In Norway, the system is called FIKS Smittesporing- based on the DHIS2 COVID-19 surveillance system. For the qualitative data collection, so far 6 in-depth interviews were conducted with contact tracers, chief municipal physicians, and others. The early findings are: contact tracers still use manual techniques to conduct their work (pen, paper, etc.); the used system depends on general IT competence and interest. Regarding training, most interviewees got training either from webinars or from other experienced users; many use the expression "learning by doing". Another pattern for new contact tracers is to take down information on paper and later input it into the system, mainly use the system to input data. - In Kenya, the COVID-19 response team depends on several digital solutions to gather, analyze, and present data. Due to coordination challenges and the assurance of security to the highly sensitive health data among the fragmented ISs, the MoH decided to adopt the DHIS2 digital package. Still, the package has not been fully adopted in the country. Regarding data collection, Kenya experienced a prolonged delay. Despite this, the team assigned the semi-structured interview guide to 2 research officers to pilot it. The initial findings are: DHIS2 was easy to use but required training since many were not used to aspect of it; the system was not flexible and depended on data being pushed from another system not allowing flexibility of data entry; it was acceptable because DHIS2 is the national reporting system. - In Ghana, SORMAS are being used for the COVID-19 outbreak management.10 qualitative in-depth interviews were conducted with, i.e., Surveillance/Disease Control Officers. The preliminary findings are: most respondents found the system generally easy to use, but the majority cited the internet and server connectivity as challenges. Participants easily adapted to the incorporated COVID-19 component. The system has improved the process of reporting data in the outbreak response. However, most of the officers interviewed could not download data from the system at their level. Generally, they stated that data quality has improved, but some respondents gave a different level of completeness of data in the system. About training, some officers interviewed had no resources to train since it is mostly done at the regional and national level through an online means when necessary.

During epidemics from emerging diseases, WHO guidelines and local circumstances change rapidly. Hence, information systems for operative health workers as well as epidemiological managers should change at the same speed. A consortium for supporting less developed countries with a COVID-19 information system, funded by NORAD, has been set up and is working with 40+ countries. The consortium delivers updated versions every week based on new requirements from the countries and WHO. The research project will generate knowledge on how a consortium can manage such rapid changes to be carried out effectively when there are thousands of end-users, travel restrictions, a high-performance pressure, and in countries where there is a shortage of skilled health workers, health information systems specialists, unstable electrical power and internet. The research will investigate the system and its development and change process in three countries; Ghana, Kenya, and Sri Lanka, representing different cultural regions. The project will have partners in these countries. Also, the global consortium will be studied. The first evaluation will address all direct users with a survey and all members of national and global teams with qualitative interviews. Based on this data and computer logs, an assessment of the system and of the rapid development process will be carried out. Research papers and reports to the consortium and countries including recommendations for changes in the system and in the development process. will be written. This assessment will also be presented to the consortium national teams and selected users after 6 months. A repeated evaluation will take place month 12-18, and a second round of dissemination back to the developers and users will take place. Since no research of such rapid system development cycles has been found in the literature, the conclusions from two evaluations will constitute new knowledge.

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GLOBVAC-Global helse- og vaksin.forskn