District health information management system as a tool for enhancing integrated disease surveillance and response in Ghana, 2017

Introduction : globally, the use of electronic database is increasingly becoming important for public health surveillance. Ghana adopted the web-based District Health Information Management System (DHIMS2) platform as its nation-wide health information system software for collection, collation, analysis, and dissemination of public health surveillance data. Since 2012, Integrated Disease Surveillance and Response (IDSR) data has been reported through DHIMS2. We evaluated the performance of the DHIMS2 system using completeness and timeliness of reporting. The DHIMS2 system attributes too were assessed. Methods : we assessed trends in completeness and timeliness before and after the introduction of DHIMS2. We retrieved 2012-2016 monthly IDSR reporting rates in the DHIMS2 system for all 216 districts in Ghana. We generated percent completeness and timeliness for all reporting districts as well as the ten regions of the country using the DHIMS2 pivot table module. Timely reports were reports received in the DHIMS2 system at the national level on or before the stipulated deadline while completeness was defined as the number of reports received at the national level as a proportion of the number of reports expected from reporting units. For the period before the introduction of DHIMS2, IDSR reporting rates were computed from data retrieved from available archived paper-based monthly summary sheets. The system’s simplicity, flexibility, acceptability, and stability were assessed using CDC guidelines for evaluating public health surveillance systems. Results : a total of 12,960 monthly IDSR reports were received from 216 districts of the 10 regions of the country for the period. Compared to the 18% highest annual timeliness before adoption of DHIMS2, timeliness of reporting improved to 84% in 2016. Completeness of reporting improved from maximum of 60% for the period before DHIMS2 to 91% in 2016. Of the ten regions, six (60.0%) had completeness above 90% for each year after adoption of DHIMS2 platform. DHIMS2 was found to be simple, flexible, stable, and well accepted by stakeholders. Conclusion : though not optimal, use of DHIMS2 has improved IDSR report completeness and timeliness. We recommended a special study to assess the system’s data quality, sensitivity, predictive value positive and representativeness to enhance surveillance indicators under the IDSR strategy.