For the citizens of war-torn Iraq, as well as for the hundreds of thousands of refugees stranded in camps and sheltered by the Autonomous Region of Kurdistan, getting access to regular health care is not a straightforward procedure.
Refugee camp in Iraqi Kurdistan © IPRO, Oct. 2016
In June 2015, a DHIS2 Health Information System was set up to assist the Kurdish health authorities in collecting population data and improving the access and quality of public health care.
A KRG-DHIS2 pilot project, funded by the Italian Ministry of Foreign Affairs and International Cooperation, led by the University of Rome Tor Vergata in cooperation with the Ministry of Health of the Kurdistan Regional Government, and realized by I-PRO and EuResist Network was deployed across a set of pilot health centers and hospitals in the Kurdish governorates of Duhok, Erbil and Slemani.
With 60 registered users spread across 30 health centers, 700 Kurdish medical professionals can now follow a staggering 180,000 health events! Indeed, just 18 months into the pilot project, there are now 7 primary/family health centers, 9 hospitals, and 14 general health centers. There are currently 10 health centers in rural areas such as small towns or villages, and there are 20 health centers in major towns.
Since January 2017, 110,000 cases have been imported via periodic uploads from existing and running databases, and 70,000 cases have been recorded by DHIS2 users. This great progress is enabling health professionals to gather statistics for disease diagnoses, hospital discharges, and registrations of births, deaths and immunizations.
The project is also using the WHO’s International Classification of Diseases (WHO ICD-10), which is the standard diagnostic tool for epidemiology, health management and research purposes. This classification defines the universe of diseases, disorders, injuries and other related health conditions, listed in a comprehensive, hierarchical way. The data can be:
Easily stored, retrieved and analysed for evidenced-based decision-making;
Used for sharing and comparing health information between hospitals, regions, settings and countries;
Making data comparisons in the same location across different time periods.
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:
Creating national health numbers for all citizens of the Autonomous Region of Iraqi Kurdistan. The first focus for the upcoming years is to introduce a national health identity (HNID) for each citizen accessing health services provided by the hospitals and health centers monitored by and coordinated with the MOH of the KRG. Once this is in place, the HNID will be integrated into the Kurdish DHIS2 platform.
Expanding the system for a complete coverage of the Autonomous Region of Kurdistan. The second major goal set for 2021 is to involve at least 300 health centers in the KRG-DHIS2 platform, in order to reach a complete coverage of the territory.
Setting up a high-quality epidemiological health surveillance system in the Autonomous Region of Kurdistan. While achieving this goal, the teams hope to extend their DHIS2 expertise to other areas besides health, such as programs of demographic or environmental interest.
If you'd like to view a presentation of the DHIS2-KRG project to the Kurdish government and Italian Ministry of foreign Affairs, here’s a recent video.
Kurdistan Region, DHIS2 Health Monitoring System, © IPRO Research, Oct. 2016
We're very keen to give feedback about the progress we're making with our KRG-DHIS2 project. If you’d like to ask us questions about our work, please reach out to us as follows:
|Mr. Leonardo Emberti Gialloreti|
Project leader and medical supervisor
University of Tor Vergata, Rome, Italy
|Mr. Dario Corsini |
Project management and team coordinator
IPRO – Informapro, Rome, Italy
|Ms. Antonia Bezenchek|
IT management, DHIS2 implementation, translation, IT support
IPRO – Informapro, Rome, Italy
|Mr. Iuri Fanti |
DHIS2 implementation and statistics
IPRO - Informapro, Rome, Italy
|Mr. Faiq Basa |
Kurdish local management and medical supervision
|Mr. Revan Khorany |
Kurdish local management, DHIS2 implementation and translation
|Ms. Francesca Incadona |
International relations and documentation
Euresist Network GEIE, Rome, Italy
|Mr. Vincenzo Jorio |
International and government relations
Ital Consult, Rome, Italy
Opening a DHIS2 training center in KRG. © IPRO 2016.