Disease Surveillance

Created May 19th, 2011 | Modified June 23rd, 2011 | Posted by gmc

Photo showing Ministry of Health and Child Welfare staff learning to use the new disease surveillance system. The Zimbabwe Ministry of Health and Child Welfare (MOHCW) began a new national health information and surveillance system (NHIS) in 1985 and developed training materials and held courses on the interpretation and use of the system’s data. By the beginning of the next decade, Zimbabwe’s health care system was being hailed as a model in the region.

The current disease surveillance system relies on fixed-line telephone, radio, or other means for reporting. However, data indicate low availability of fixed-line phones and functional radios in health centers. Only 12% of health facilities surveyed have functional VHF radios or fixed-line phones. The MOHCW reports that disease surveillance data do not accurately represent the population due to incomplete and delayed reporting. Obtaining data from remote border areas is a particular problem. Malaria and cholera are known problems in these areas, but problems accessing communications make timely reporting a challenge.

The RTI team is working closely with HHS/CDC Zimbabwe, the MOHCW, and other local organizations to improve their capacity to disseminate and utilize systems-generated health data at national, provincial, district, and clinic levels.

Solution

Phone screen image showing list of avaiable forms. The RTI team has helped the MOHCW to create a new disease surveillance reporting system based on mobile phone technology and open source software tools.

Each health center is assigned a mobile phone.
A JavaROSA application is installed on each mobile phone handset.
Clinicians use the mobile phones to collect and transmit data for weekly surveillance reports.
Data reported from the mobile phones are received and managed by ODK Aggregate.
The data are imported into DHIS for analysis.

Mandatory reporting of diseases and other health issues in Zimbabwe includes the following:
Clinical malaria under 5 years Clinical malaria 5 years and over Mal lab test Mal lab test pos Clinical malaria death under 5 years Clinical malaria death 5 years and over Diarrhea case under 5 years Diarrhea case 5 years and over Diarrhea lab test	Diarrhea lab test pos Diarrhea death under 5 years Diarrhea death 5 years and over Dysentery under 5 Dysentery 5 years and over Dysentery death Influenza under 5 Influenza 5 and over Influenza death Dog Bites

The handset software can store data on the phones when there is no access to a mobile phone network. It also has the capability to select GPS or SMS data transmission based on availability. Since GPS data transmission is less expensive, the application will attempt to use this for transmission first.

The mobile handset attempts to transmit data via GPRS to a server running ODK Aggregate. A Data Manager at MOHCW downloads the data and imports them into DHIS.

Diagram showing disease reporting system using GPRS for data transmission.

The phone handset application keeps the user informed concerning data transmissions. Data remain stored on the handset until they can be transmitted to the ODK Aggregate server.

If GPRS transmission fails, the application switches to SMS text messaging. The SMS Server will use software such as FrontlineSMS to send the SMS message to a simple PHP script that serializes the data in a format that can be accepted by the ODK Aggregate server.

Diagram showing the disease reporting system falling back to SMS text messaging.

Data received by the ODK Aggregate server can be exported for analysis in other software, such as Microsoft Excel. In Zimbabwe the data are also being exported to DHIS.

Example disease report in Excel format.