Flexible data collection
Aggregate and line-listed data can be implemented within the same platform using the Data Entry and Capture apps. During health emergencies or outbreaks, routine weekly surveillance can be adjusted to daily reporting.
Disease Surveillance, Early Warning & Health Emergencies
DHIS2 is widely used as an integrated electronic platform to prevent, detect and respond to infectious disease threats. Features and tools developed with WHO, CDC, implementing countries and subject matter experts are available to strengthen national and regional systems
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Overview
In public health, disease surveillance is the ongoing systematic collection, analysis, interpretation and use of health data. It is used as an early warning system to detect unusual disease patterns and possible outbreaks. Surveillance data also enables monitoring and evaluation of public health interventions, as well as providing routine epidemiological data to guide health program planning, priority setting and resource allocation. Initially prompted by the deadly Ebola outbreak in West Africa in 2014-16, HISP has partnered with global institutions like WHO and CDC to continuously improve the DHIS2 software to become a fit-for-purpose, national-scale disease surveillance platform and to support key information management and response functions during public health emergencies.
Lessons learned from the COVID-19 pandemic have led the WHO Health Emergencies programme to call for a collaborative, multi-sectoral approach to surveillance as a core concept of health emergency preparedness, response, and resilience (HEPR). During the pandemic, Ministries of Health in 55 countries used DHIS2 as a part of their COVID-19 surveillance and response strategies.
Leveraging decades of real-world implementation experience in establishing integrated health information systems, DHIS2 supports a comprehensive suite of software features, implementation tools and guidance, and standards-based metadata to help countries use DHIS2 as part of comprehensive national systems for early warning, disease surveillance and response to public health emergencies.
How can DHIS2 be used for disease surveillance, early warning & response?
DHIS2 has flexible data models that allow for customization of the system to meet a wide variety of functional requirements for routine disease surveillance and use during health emergencies. Countries and regional organizations like the West African Health Organization (WAHO) and the WHO Regional Office for Africa (AFRO) use the platform as an integrated surveillance and response system, bringing data streams together across diseases, triangulating with mortality statistics and other key data sources, and toggling between routine and enhanced
The following are some of the most widely adopted use cases:
Integrated disease surveillance
Integrated disease surveillance is a framework promoted by WHO that incorporates both Indicator-Based surveillance (IBS) and Event-Based Surveillance (EBS) approaches to early detection of priority diseases, conditions and events. DHIS2 is used in more than 40 countries as a national scale platform for routine syndromic surveillance, case notification and case-based surveillance for notifiable diseases. HISP has collaborated closely with the WHO Regional Office for Africa and WHO Eastern Mediterranean region to strengthen implementation of recommended IDS strategies leveraging the capabilities of DHIS2 as an electronic surveillance platform.
Our interactive map shows where DHIS2 is used for surveillance around the world:
Event-based surveillance & rumor monitoring
Event-based surveillance complements routine indicator-based surveillance to detect unusual public health events, illnesses, or deaths, that might signal an outbreak as early as possible (WHO, CDC). Data for event-based surveillance is often obtained through media sources, rumors, and community reporting. Non-formal and often unstructured data sources are routinely scanned to identify events of possible public health risk, which can then be triaged and verified by trained surveillance staff as a “signal.” Organizations such as Africa CDC have customized DHIS2 to function as part of an event-based management system, leveraging DHIS2 relative strengths and providing the possibility to feed data into other initiatives such as WHO’s Epidemic Intelligence from Open Sources (EIOS).
When implemented as part of a national surveillance platform, event-based surveillance data serves as a key early warning function that is further complemented by the structured indicator-based data that most facilities and CHWs report on a routine basis. The same functionalities can also be used for monitoring and classifying rumors in other use cases, such as programs to combat vaccine hesitancy.
Real-world examples:
Health Emergencies & Emergency Response
During health emergencies, the need for real-time surveillance data from hard-to-reach places is prevalent. DHIS2 surveillance data often serves as a key source of information for staff working in Emergency Operations Centers to rapidly analyze data and prepare responses. In humanitarian settings, DHIS2 is also used as an information management tool to measure the impact of health emergencies on routine service delivery, and ensure continuity and access to care such as through mobile health clinics operated by humanitarian organizations like ICRC and MSF. DHIS2 can be further customized to support response functions, such as contact tracing and serving as a roster for maintaining, updating and deploying rapid response teams.
Real-world examples:
OneHealth, animal health & zoonotic diseases
DHIS2 serves as an integrated information platform for sharing data across sectors and Ministries to advance multi-sectoral OneHealth approaches. Partnerships with CDC, FAO, WHO, WOAH and Ministries of Health and Agriculture / Livestock are furthering the use of the DHIS2 platform to strengthen surveillance of zoonoses and share information across sectors with the aim of early detection and prevention of zoonotic spillover events. The approach calls upon interoperable systems and strong governance frameworks, leveraging the global footprint of DHIS2 as a public health surveillance system and existing capacities in countries to expand the use of the platform.
Real-world examples:
Climate-sensitive diseases
The potential effects of climate change and related ecosystem disruptions are dramatic and wide-ranging, touching every part of life on our planet, including human health. In many health programs – such as infectious disease surveillance – health outcomes can be directly and indirectly impacted by environmental factors, including local climate variation and extreme weather events linked to global climate change. Urgent action is needed to protect at-risk communities and prevent negative health effects, particularly in low-and-middle-income countries (LMICs), whose populations are among the most vulnerable to the impacts of climate change and variation on population health. Planning and prioritizing that action requires accurate and actionable data on the specific correlations between climate and environmental factors and health outcomes. DHIS2 is able to import climate data sets, such as temperature and precipitation from global sources, and global climate data products have already been used in DHIS2 for spatial and temporal analysis of environmental factors in various health programs. In addition, the HISP network is supporting LMIC Ministries of Health (MoHs) to explore how to close this data gap and deploy sustainable digital systems that address local health priorities, provide evidence for national climate change adaptation and public health policies, and support effective health interventions to respond to climate-related health risks. Examples include climate-sensitive infectious diseases like malaria and dengue, malnutrition and food insecurity, and chronic and acute health outcomes related to heat and floods.
Real-world examples:
DHIS2 features & tools for surveillance, early warning & response
We support a comprehensive suite of software features, implementation tools and guidance, and standards-based metadata, to help countries implement DHIS2 as part of comprehensive national systems for early warning, disease surveillance and public health emergency response. Our decades-long approach to integrated system design supports surveillance of infectious diseases and triangulation with other sources, such as mortality and routine health service delivery data.
Several core features of the DHIS2 software support disease surveillance systems:
Case-based surveillance
Tracker supports the immediate notification and registration of suspected cases in the system, assigning a unique case ID (such as Epid number), linking laboratory results anc case investigation forms to the case report, and assigning a final classification and outcome.
Notifications, alerts & outbreak thresholds
DHIS2 allows you to configure outbreak thresholds for a given disease and send alerts to appropriate health staff. Immediate notification of a suspected case can trigger outbound communications via the messaging service, email, SMS or through interoperability with other tools such as RapidPro.
Offline tools
The DHIS2 Android Capture application can be used for offline data collection, such as to support field workers conducting case investigations nad using built-in mapping functionality. The SMS gateway can also be configured to allow reporting of suspected cases or possible public health events from communities with low connectivity.
Interoperability with lab systems
DHIS2 has a robust, open and well-documented API and integration tools that allows interoperability with other software, such as lab management information systems. Using the Tracker data model and a unique sample ID, lab results can be automatically linked to case reports entered into DHIS2.
Surveillance bulletins
Standard reports and push analysis features allow surveillance staff to pre-define and automatically populate daily, weekly or monthly surveillance bulletins that can be pushed to user groups at any level of the health system.
Analytics
Customizable charts and dashboards allow epidemiologists, surveillance staff, and emergency operations centers to visualize epi curves, distribution of cases and disease incidence on a map, and monitor key surveillance indicators like lab specimen adequacy.
The following components are available as part of the DHIS2 Health Data Toolkit to help fast-track your disease surveillance implementation:
Integrated disease surveillance & response (IDSR)
Design your system to support weekly indicator-based surveillance for epidemic-prone and notifiable diseases. Resources are aligned to WHO AFRO’s technical strategy for IDSR with standard metadata for 15 commonly notifiable diseases, surveillance indicators and dashboards.
Case-based surveillance
Use Tracker to support case notification, investigation, linkage of lab results and case classification as part of an integrated disease surveillance system. Resources include WHO recommended metadata for case-based reporting of 9 vaccine preventable diseases, triangulation of case-based and weekly syndromic data, and guidance for integrating additional diseases in the system.
Acute febrile illness (AFI) surveillance
Incorporate sentinel surveillance data on acute febrile illness cases to complement routine surveillance and improve the detection of emerging, unknown and re-emerging disease threats. Resources are available aligned to CDC recommended protocols for AFI surveillance.
COVID-19 surveillance & novel diseases
The flexibility of DHIS2 allows rapid configuration of the system to meet surveillance needs for emerging and novel diseases, such as for COVID-19 in early 2020. Resources provided here can be adapted and re-used for future emerging disease threats and cover emergency surveillance needs such as detailed case reports for new suspected illnesses, contact tracing, and daily situation reports from subnational levels.
Mpox surveillance
Integrate mpox surveillance into national DHIS2 systems for early detection and response. The DHIS2 Mpox Surveillance Toolkit supports both case-based and aggregate modalities and promotes adoption of WHO guidelines on mpox surveillance and case investigation.
Interactive demo: DHIS2 for Disease Surveillance
Try out some of the features and functionalities of DHIS2 as a disease surveillance system in our interactive demo database.
Impact stories
Read more about real-world implementations in countries that use DHIS2 to detect and respond to disease outbreaks and public health emergencies.
Connect with the HISP network and global community
The DHIS2 Community of Practice (CoP) is the primary forum for DHIS2 discussion and support. The CoP is a great place to ask questions and get support from the international community of DHIS2 experts. Join the discussion, share your use cases and ask questions about how DHIS2 can be used to strengthen disease surveillance, early warning and response systems on the CoP.
You can also contact the HISP Group in your region for support on national or regional disease surveillance projects.
Collaboration with global partners
The HISP Centre at UiO works with global public health partners to develop tools and guidance to support countries in implementing electronic surveillance systems with DHIS2. These include WHO Health Emergencies Programme, WHO Regional Office for Africa, WHO Eastern Mediterranean Region, Pan American Health Organization (PAHO), the US Centers for Disease Control and Prevention (CDC) with financial support from Gavi, CDC, The Global Fund and Norad.