With the help of HISP Uganda the NTP has already established DHIS2 environment which has the core infrastructure in terms of database and deployment environment. It has built the DHIS2 expertise and capacity which acts as a strong foundation for executing the vision of implementing a comprehensive and integrated real-time case-based TB surveillance and notification system.

It is recommended that this existing capacity is leveraged for expanding the DHIS2 tracker app. While the current tracker has been planned to cover the details for creating case-based notification system for both DS TB and DR TB patients , the application should also include monitoring of entire continuum of care including presumptive screening, referral, treatment initiation, treatment adherence, treatment outcome and contact tracing in real-time.

The solution architecture should support adding all the above components in phases supported with versioning to ensure seamless upgrades and continuity.

Some of the existing templates already built on DHIS2 tracker systems currently being used by other countries such as WHO’s prevent TB tool or other DHIS2 tracker-based systems can be explored for fast-tracking the software development processes. ^[6]

Tentative timeline: Month 0-12

One of the challenges reported by the NTP during the data collection processes is the lack of availability of real time data for stakeholders. One effective way to overcome this is to support the current data collection processes by introducing a mobile application, which is in line with the country’s efforts of improving the overall digital ecosystem.

As a recommendation, the latest DHIS2 mobile app version (already being piloted by Uganda for eCBSS and contact tracing from outreach) which has additional features on data collection, security, offline data collection, encryption ,version management etc should be extended for use even for aggregate data reporting, specially from facilities with limited IT infrastructure should be reviewed.

This would also ensure that the data structures are consistent. Also, the app is supported with a configurable set up to support any updates / changes to the program.

Additionally, the DHIS2 mobile framework uses open-source technologies like Java, Postgres, React and Android, there are easily supported by country IT teams also the standard best practices of mobile development like version management, data encryption etc which make this as more robust solution. ^{[6.1] [6.2]}

Tentative timeline: Month 6-12

One of the limitation highlighted by NTP is the need to improve the data collection processes at the facility level. To streamline this, procurement, distribution and maintenance of the required data entry equipment like laptops, mobile/tablet devices should be done on an urgent basis. Improving the current infrastructure at the facilities is crucial for a complete transition to digital notification.

Tentative timeline: Month 0-6

One of the challenges highlighted by NTP is the leveraging the data collected from the multiple sources into the main DHIS2 systems as a central system for effective use.

The current EDRWeb / TIER.Net system infrastructure needs to be extended to support bi-directional integration and interoperability with external systems like National EHR, NHLS, GeneXpert, TruNat, Digital X-Ray outputs, Pill boxes and other adherence tools which help in using the data effectively for the patient continuum of care as highlighted by the National program.

Recommended exchange / ETL tools like Talend and Informatica can make the data management task much easier and simultaneously improve data warehousing. ^[8]

The data exchange process should follow and comply with FHIR , GDPR standards for more secured and seamless data exchange supporting standard data taxonomy and meta data management processes.

The DHIS2 platforms architecture is easily compatible with these standard tools and processes making this an effective solution. ^{[8.1] , [8.2]}

Tentative timeline: Month 12-18

To strengthen the TB surveillance efforts of the country and for reaching out to all TB positive individuals, an active focus on contact tracing becomes crucial. The standard guidelines for household screening can be incorporated as a module in the national TB notification tool and be implemented to fast track the country’s efforts to eliminate TB and target the initiation of preventive treatment for all TB contacts.

Tentative timeline: Month 6-12

To make sure that paper based patient records data is integrated with the DHIS2 tracker systems technical solutions like OCR ^[10] can be reviewed.

The DHIS2 platform supports reading from these structures. This would help in data upload of all historical data with less difficulties.

Tentative timeline: Month 6-12

Digital training packages to train health professionals on DHIS2 data entry, information use, M&E and workflows:

To address the challenges with periodic training of facility level staff to orient them on using TIER.Net and EDRWeb for real time data reporting, the MoH must engage in development of an eLearning module for application training.

While DHIS2 offers standard training modules on the application , training tools like Moodle ^[7] built on standard Learning Management System ( LMS ) framework should be reviewed for application rollouts.

Additionally, for training and updates on the latest manual of procedure and continued medical education on TB care, modules can be developed for TB Health providers, administrators at facility and district level to develop and enhance M&E competencies for ensuring a consistent program oversight, specially for the case-based tracker roll out within the existing applications.

Guide TB platform developed by WHO Philippines is a good example of eLearning module for health staffs involved in TB care.

Tentative timeline: Month 0-3

Tracking lost to follow-up cases and enabling real time notifications for patients is highlighted as one of the main challenges. Establishing a direct and secured mechanism for engaging with patient has potential for drastic improvements in tracking lost to follow-up patients.

Auto generation of notification and messaging by the system through communication channels like Social Media channel, IVRS and SMS outbound messages should be explored. Open-source applications like Open MRS can be used for these activities. ^[11]

Tentative timeline: Month 12-24