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Leveraging existing systems to develop an efficient and effective electronic system for TB; Tanzania example of using the DHIS.

From program review to action: Leveraging existing systems to develop an efficient and effective electronic system for TB; Tanzania example of using the DHIS.

The Tanzania National TB and Leprosy Program (NTLP) followed a recommendation from the program review to decide on the electronic TB surveillance system (ETR.Net), which was found to be the primary challenge of the surveillance system at the time. It was recommended that to address identified gaps, a system needed to be built that could accurately measure TB incidence and mortality. To leverage on existing systems for efficiency and effectiveness, partners, with leadership of the Ministry of Health, agreed to utilize the DHIS platform to build an electronic platform for TB. Utilizing existing capacity in the country, the University of Dar es Salaam, provided technical assistance to support the NTLP to build the electronic TB and Leprosy (ETL) electronic platform, the first ever patient tracker on the DHIS platform. 

Fig  1: Dr Zuweina Kondo-Sushy , NTLP M&E officer Presenting to the GF & WHO officials at GHC 5th Dec 2019

In December 2019, The NTLP team were invited at the Global fund health Campus (GHC) in Geneva to share their experience regarding this journey. Dr. Zuweina Kondo-Sushy the Program’s Monitoring and Evaluation officer explained that the challenges with previous electronic system, necessitate an informed decision on which system to embark on.  Taking on the account that costs is among the major factor in this process, then the Program in collaboration with their in-country stakeholders opted for a system which can be developed locally and able to be flexible enough to adapt to the vast growing digitalization in Tanzania.

DHIS2 was already used by the National HMIS and proved to be successfully by improving timely reporting and other quality factors. The University of Dar Es salaam provided a local expertise which can be easily at reach and easy negotiated. “These were among the major factors which made successful implementation across the country in fairly a short period” stresses Dr Beatrice Mutayoba- The Program’s Manager.

The journey has not been smooth one, as explained by Mr Emmauel Nkiligi the Program’s data Manager. The TB program had needs which could not be easy accommodated by the DHIS2 version that time. And so, the UDSM had to develop an application to cater for our needs. We also had to make sure that the quality of data will be maintained and therefore we  made sure that the whole process is being guided by the key stakeholders and partners such as WHO, KNCV_Challenge TB and others.

As DHIS2 is a flexible and interoperable system, it is currently linked with the National HMIS Web Portal, the Program’s mobile phone USSD system application for adherence (TAMBUA  TB) and matched the CDC/PEPFAR DATIM reporting and hence omitted the double reporting which the Healthcare workers has been facing for a long time. The system now provides the Program with a wide range of opportunity for analyses to understand the burden in the country.

Fig 2:Mr. Claud Kumalija the head of the Ministry’s Health Management Information System provides further explanations during the discussions

“The country has other digitalization initiatives of which the Ministry is coordinating using the existing eHealth Strategy and guidelines.” Mr Claud Kumalija, the head of HMIS added. “Therefore, the DHIS2 ETL is currently working on interoperability with the existing relating systems such as  TB and Leprosy eLMIS, National Laboratory system and at a bigger picture the National EMR system – the GoTHOMIS.

The Program Manager Dr. Beatrice Mutayoba, appreciated the support from the GF which had made this journey possible by providing the support for the development of the system, training, mentorship and hardware (laptops to the district coordinators) timely.