2.1 Key implementation challenges

With a small time frame to get a DHIS2 epidemiological surveillance pilot project implemented and deployed in the whole Kurdish region of Iraq, many challenges are ahead for the teams involved.

Racing against the clock. The first challenge lies in building a solution that works in a short time and satisfies the basic needs of the regional health system in collecting data. So far, a subset of the regional health centers, approximately 30 establishments, made up of rural and urban centers, family health centers, hospitals, hospital colleges, and general health centers have been involved in testing the system.

Pulling in data from other systems. Another challenge lies in making it possible to import existing data from hospitals into DHIS2 while also making it achievable to enter data from mobile devices. Additional challenges lie in preparing reports equal to those requested by the health authorities, and building a DHIS2 system for people who don’t necessarily have a background in health.

Testing using a small, live version of DHIS2. The testing phase covered two areas: creating data sets with aggregate data entry and making programs with disaggregate event data capture. After analyzing the data reports produced by the tests, the project managers decided to use programs without registration using the Event Capture app.

Capturing data with the Event Capture app. In this region of Iraq, people do not have identification numbers. It’s therefore almost impossible to follow patients’ visits to different health centers. Bearing this in mind, the team built a system to record basic health events such as births, deaths, immunizations, disease diagnoses and hospital discharges using the Event Capture app.

Why the Event Capture app? On the one hand, this app allows you to import existing data from hospital databases, while adhering to the same data structure. On the other hand, physicians or health technicians can enter data in real-time during a visit, without having to complete further data aggregation tasks. These two key areas combined were very helpful to our teams.

Hosting. Without the means to implement a dedicated server, we chose to use an outsourced hosting solution through a recommended company called BAO Systems . With this solution, it will be possible to scale up the DHIS2 instance in the future.

Translating the UI into Kurdish-Sorani. With the help of the DHIS2 community, DHIS2 developers and a translation team, the DHIS2 user interface is now available in Kurdish-Sorani, a language spoken by 6 million people in Iraq.

Some parts of the data model do not have translations. For example, the description of report dates were added in English, Arabic and Kurdish-Sorani consecutively: Date of birth / تاريخ الولادة / بةرواري لة دايك بوون. Another problem is the lack of ISO 639-3 ckb , or the Kurdish-Sorani language, in the underlying Java library.

The screen captures here show the DHIS2-KRG Health Monitoring System user interface in both English and Kurdish-Sorani: