Dagu. Report PDF

REPORT
ANNUAL
OCTOBER, 2019–SEPTEMBER, 2020

DIGITAL HEALTH ACTIVITY
Cover photo: DHA staff using the Master Facility Registry (MFR) Dashboard
Content
Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . III
Message from the Chief of Party . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Digitization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Electronic Community Health Information System (eCHIS). . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Electronic Medical Record (EMR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
District Health Information Software 2 (DHIS2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Human Resource Information System (HRIS). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Vitas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Dagu 2.0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Electronic Regulatory Information System (eRIS). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Track and Trace. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Data Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Capacity building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Governance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
COVID-19 Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Improving functionality of HealthNet Ethiopia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Success Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
ANNUAL REPORT II |
Acronyms
CBMP Capacity Building and Mentorship Program
CoE Center of Excellence
DHIS2 District Health Information Software 2
DHA Digital Health Activity
DUP Data Use Partnership
eCHIS Electronic Community Health Information System
eHA Electronic Health Architecture
eHMIS Electronic Health Management Information System
EFDA Ethiopian Food and Drug Administration
EMR Electronic Medical Record
EPHI Ethiopian Public Health Institute
EPSA Ethiopian Pharmaceutical Supply Agency
ERIS Electronic Regulatory Information System
GTIN Global Trade Item Number
HEW Health Extension Worker
HIT Health Information Technician
HMIS Health Management Information System
HRIS Human Resources Information System
HSC Health Science College
ICT Information and Communication Technology
IR Information Revolution
IRR Information Revolution Roadmap
IT Information Technology
JSI John Snow, Inc.
LAN Local Area Network
LMIS Logistics Management Information System
MDR-TB Multidrug-resistant Tuberculosis
MFR Master Facility Registry
MOH Ministry of Health
NPC National Product Catalog
OS Occupational Standard
POE Port of Entry
TVET Technical and Vocational Education and Training
USAID United States Agency for International Development
VPN Virtual Private Network
ANNUAL REPORT III |

Message from the Chief of Party

It is a pleasure to share with you the major achievements of the Digital Health Activity (DHA) in its first year,
October 2019 to September 2020. The DHA is a five-year, USAID-funded Activity implemented by John Snow,
Inc. (JSI) to support Ethiopia’s Health Information Revolution (IR) Agenda. While the team worked to implement
our approved work plan, we are proud to say that the DHA (also referred to as the Activity) was in place to
provide supplemental support to the Ministry of Health’s (MOH) efforts to fight the COVID-19 pandemic.
One of the pressing challenges of the health system in Ethiopia has been recording and accessing high-quality
data for decision making. In response to this challenge, the MOH determined and launched the IR as a critical
transformative agenda of the health system.
The DHA is designed in response to and in support of the IR Agenda.
To this effect, the Activity has been supporting the MOH in digitization, data use, and governance of the health
information system. The DHA team is building on JSI’s prior experience in supporting health information
systems (HIS). Our staff partner with talented local and international experts to achieve results.
During the first Activity Year, DHA, in collaboration with the MOH:
• Scaled up the implementation of the electronic Community Health Information System (eCHIS) in 270
health posts.
• Piloted an electronic medical record (EMR) system.
• Built the capacity of thousands of health professionals on the second edition of the District Health
Information Software (DHIS2).
• Developed new systems and added features to existing systems used by the MOH, the Ethiopian
Pharmaceutical Supplies Agency (EPSA), and the Ethiopian Food and Drug Administration (EFDA).
• Developed dashboards and trained health managers and health service providers to promote data-
driven decision making.
• Drafted policies, strategies, and guidelines to create conducive legal and policy environments for the
rollout of the IR agenda.
In response to the consequences of the COVID-19 pandemic on the country as a whole and specifically our
activities, the Activity developed and implemented various digital tools to manage the public health response
by tracking COVID-19 cases and their contacts; informing the public about the disease; and summarizing
surveillance and epidemiological data using dashboards for decision makers.
ANNUAL REPORT 1 |
We established and financed ten youth grants to

help sustain the DHA’s interventions. The youth
At the heart of DHA is sustainability grants train staff, provide troubleshooting support
and local ownership of gains. and ensure smooth functionality of digital tools
used by health facilities within their designated
catchment areas. The long-term vision is for the
youth groups to provide paid services to health facilities. In the subsequent years of the Activity, we plan to
provide an additional 40 youth grants. Moreover, to ensure sustainability of DHA’s capacity-building efforts, we
revised training curriculums for last-mile health workers and trained academic staff in selected Health Science
Colleges (HSCs).
While we celebrate the achievements of Year 1, I would like to take this opportunity to thank USAID for its
technical and financial support to implement the DHA. I thank the MOH, regional health bureaus (RHBs),
Ethiopian Public Health Institute (EPHI), EPSA, EFDA, and the Data Use Partnership (DUP) for their unreserved
support and collaboration. Our subcontractors (Dimagi, Websprix, Intrahealth, and OrbitHealth) and the DHA
staff also deserve our gratitude for their diligence and creativity in delivering results. We are committed to
engaging more with MOH, RHBs, federal agencies, and other stakeholders to overcome challenges and achieve
even greater results in the years to come.
Loko Abraham, MD
Chief of Party
ANNUAL REPORT 2 |
Background
The IR is one of the transformational agendas of the national Health Sector Transformation Plan. The IR
agenda is driven by diversified and increased demand for health information and opportunities presented by
advancements in information and communications technology. Digitization of the HMIS and promoting data
use culture are two pillars of the IR.
DHA with the Government of Ethiopia and other donors aims to develop a suite of electronic health management
information systems (eHMIS) that the MOH, EPSA, EFDA, and designated partners will maintain and manage
beyond the life of the Activity.
Health professional using the Dagu software to dispense, track & record medicine & patient history.
ANNUAL REPORT 3 |
The DHA supports the IR under the following areas:
DIGITIZATION
In collaboration with the MOH and other relevant partners, DHA has been designing,
developing, deploying, operationalizing, maintaining, and growing different
electronic HISs and building the capacity of public sector staff to use them through
training, supportive supervision, and mentoring.
DHA has set up Helpdesk centers to triage system problems and transfer actionable
issues to MOH’s innovation lab. The innovation lab is a center established at Saint
Peter Hospital to serve as a center of excellence for developing new systems and
maintaining and updating existing HISs in Ethiopia.
DATA USE
Once the health information system is digitized, quality data must be made available,
accessible, and usable to MOH staff in particular and the public in general. DHA has
been strengthening MOH and affiliated agencies (EPSA, EFDA, and EPHI) and regional
structures (Regional Health Bureaus, woreda health offices, hospitals, health centers,
and health posts) for flexible and adaptive management. Data use activities include
building staff capacity through training, mentoring, and supervision. DHA has been
building the data visualization capacity of the MOH to help staff easily interpret and
use data for decision making.
GOVERNANCE
To create an enabling policy environment for the rollout of the Information Revolution
Roadmap (IRR), DHA has been working with the MOH in producing different policy
and strategy documents to build HIS capacity and ownership at all levels, targeting
the most critical barriers to developing and scaling HIS within the health sector.
COVID-19
The Activity quickly pivoted its work to help Ethiopia respond to the COVID-19
pandemic. DHA supported the development and operationalization of the national
COVID-19 surveillance and tracking system, which expedited dissemination of
laboratory results and facilitated performance monitoring of the COVID-19 follow up
and tracking system.
This brief report covers DHA’s major achievements in these four major areas of support during its
first year.
ANNUAL REPORT 4 |
Digitization
Digitization is the process of converting information into a computer-readable format. In the
past year, DHA supported the digitization of the following.
1 Electronic Community Health Information System (eCHIS)
The eCHIS is an application that digitized the paper-

based family folder and service workflows to record eCHIS
and report household health data. The eCHIS is

primarily a mobile-based application that works
in an offline environment and allows electronic
referral and feedback. It also enables health centers
to monitor and support the effective use of eCHIS at
the health post level. During the reporting year, DHA:
Trained almost
1,000
Supported the MOH to deploy eCHIS in almost
270
health posts in six regions. health extension workers to use
eCHIS.
Undertook more than 50

Supported 65 health posts to submit platform-level enhancements
household and individual records and stabilizations covering a
electronically through eCHIS. range of updates.
Built MOH staff capacity to

Set up a national eCHIS technical
ensure eCHIS performance at
working group.
current and future scale.
ANNUAL REPORT 5 |
2 Electronic Medical Record (EMR)

The EMR is a computerized system that captures, stores, and
shares patient information enabling the delivery of quality health
services to patients. It improves health care service quality by
improving workflows, reducing medical errors, and minimizing
cost and waiting time; and improves patient care by creating
linkages among all caregivers, reducing the need for file space
and supplies and for workers to retrieve any records physically.
During the year, DHA piloted EMR at Tirunesh Beijing Hospital and
trained 220 health care professionals at the hospital on the
use of the system. Based on the result of the pilot, the EMR will be
scaled up to additional hospitals in subsequent Activity years.
Staff at Tirunesh Beijing Hospital using the Electronic Medical Record (EMR) to access
comprehensive patient data for better decision making.
ANNUAL REPORT 6 |
3 District Health Information Software 2 (DHIS2)
DHIS2 is an open-source software used by the HISs of

many countries around the world. Ethiopia uses it to
transform the way health data is collected, validated,
analyzed, and visualized.
In its first year, DHA:
Provided supportive supervision to over
3,000 health facilities,

woreda health offices, and RHBs.
Provided on-the-job DHIS2 training to more than
1,100 health professionals.
Developed and implemented a COVID-19 case tracking system and

piloted a web-based multidrug-resistant tuberculosis tracking tool
using the DHIS2 platform.
4 Human Resource Information System (HRIS)
In collaboration with the MOH, DHA has been working

to replace the existing HRIS used by MOH by developing
and implementing a system that is interoperable within
Ethiopia’s eHealth architecture and meets international
standards. The new HRIS enables users to manage HRIS
human capital and track the health system workforce.

This includes the use of information and communication
technology for the efficient and effective management
of the human capital of MOH, its agencies, and MOH’s
regional structures including health facilities. The system
enables MOH and its various health institutions to gather,
store, and analyze information about its human resources
dynamics.
ANNUAL REPORT 7 |
5 Vitas
EPSA uses Vitas to control inventory. The
software helps monitor pharmaceuticals from
procurement to distribution, and manage
movement and storage within the agency
and its regional hub warehouses. During the
year, DHA:
Added new features to ease and accelerate putaway, procurement, restocking,

distribution, and finance and fleet management. ‘Putaway’ refers to the process of
moving incoming inventory from the receiving zone to an optimal location for storage.
Trained
147 Following the training, EPSA IT staff were able to support

end users at all branches of the agency.
EPSA staff on Vitas.
Developed an online ordering system that lets health facilities process orders
through a website without any paperwork, reducing time and use of other resources.
6 Dagu 2.0
Dagu in Afar language means “information.” The
Dagu software was developed for supply chain
management and inventory control for hospitals
and health centers. Previously, the first version of
the Dagu software (Dagu 1.0) was used in hospitals
and health centers. With Dagu 2.0, health facilities
can produce aggregate inventory reports for
decision-making. Health facilities can also produce
report and requisition forms electronically.
Dagu 1.0 was upgraded to Dagu 2.0 in
126 health facilities and
130 Health Information Technicians (HITs) were trained in its use.
ANNUAL REPORT 8 |
7 Electronic Regulatory Information System (eRIS)

The eRIS is a set of systems that are used by EFDA and the general public. The EFDA is the national
regulatory body responsible for ensuring the quality, safety, and/or efficacy of medicines, food,
cosmetics, and medical devices; the standards of health and health-related institutions; the health
care practice; and health professionals’ competence and ethics.
DHA supported the following eRIS activities:
Added new features into the i-Register, an application that allows importers to
apply for market authorization and certification, to help users access information
about their application process.
Added a new feature to i-Import, which allows importers to apply for and receive
permits to import medicines and medical devices, to allow EFDA and clients to access
most product types in the same place.
DHA, in collaboration with EFDA, developed and deployed i-Verify, a mobile

application designed to track and trace health commodities from the manufacturer
to the point of issue and verify product authenticity at any point in the supply chain.
Gave eRIS access to Provided refresher training to
10,334
new users. 38,000 logins were reported.
114
staff of the five EFDA
branch offices in
Ethiopia.
EFDA staff logging into the eRIS system on a tablet.
ANNUAL REPORT 9 |
8 Track and Trace

EFDA, in collaboration with the MOH, led
the pharmaceutical traceability project QR SCANNING
to combat counterfeit pharmaceutical

products by increasing visibility of the
status of stock en route and ensuring SCAN
secure transactions of products throughout

various systems and processes. Track and Discover Scan Acces Use
QR code QR code information information
trace activity monitors products entering
the country and traces product transaction processes throughout different parts of the supply chain.
DHA is developing the National Product Catalog (NPC), a single repository of products, pricing, and data applicable
across all product categories, to support the need for standardized, supplier-managed data across the whole
health care value chain - to ensure accuracy and efficiency.
The development of the NPC will help Ethiopia start using a global standard for product registration and
identification, based on learning from the experiences of other countries. The NPC ensures that Ethiopia uses a
global standard for product registry and identification. This makes data exchange for pharmaceutical and other
products easier at a national and global scale.
During the year, DHA started developing a mobile-based NPC to help scan barcodes and identify if a product is
available in the NPC to guarantee authenticity. In addition, DHA collected products with a Global Transaction
Identification Number (GTIN), a unique key used to identify trade items from warehouses across the country.
A total of
340 products with GTINs

were found 144 unique GTIN products
were identified.
EFDA staff using the iVerify application on a phone.
ANNUAL REPORT 10 |
Data Use
One of the pillars of the national IR agenda has been to
promote data use. To transform the culture of data use
Without data, we are usually guessing.
in planning, performance management, and decision
making, DHA built capacity of leaders at all levels of the
health system through training; availing tools for data visualization and analytics; and conducting supportive
supervision to improve availability and accessibility of quality data for data driven decision making. Moreover,
DHA supported the implementation of the IR by supporting the creation of model digital woredas and hospitals.
The following are major activities and achievements of DHA’s first year.
Rollout of data use strategies:

The health system is producing a growing volume of data that is receiving increased attention, particularly
since the emergence of the COVID-19 pandemic. The Activity conducted a desk review on data use strategies
and based on the findings, identified critical steps to improve data use strategy rollout at different levels of the
health system.
To generate real-time data, DHA has been working in collaboration with the MOH and other implementing
partners at national and regional levels. The Activity worked with the national data use technical working
group and helped analyze current and historical data.
A total of
21
indicators from maternal
and child health,
communicable diseases,
and supply chain were
analyzed, updated
monthly, and shared on a
regular basis with the MOH
Tirunesh Beijing Hospital staff using Improved Patient Registration. to inform decision making.
ANNUAL REPORT 11 |
Health Management Information System (HMIS) data quality assessment:

DHA conducted data quality assessment on selected HMIS indicators (TB, skilled birth attendance, and
immunization) covering several regions. DHA shared assessment results on site and with the respective RHBs
and made recommendations for improvement.
Connected Woreda: The Connected Woreda program is a way of translating the

IR into operational and measurable goals, with a focus on the lower-level of the health
system. The program aims to transform woredas into data hubs by enabling health
facilities to generate and use quality data through the use of electronic health information
systems. A Connected Woreda is achieved when health facilities have attained better data
quality and use practices and progressed and matured through the following well-defined
levels:
Emerging facility: A facility that, at the minimum, has started setting-up an M&E
infrastructure and is working to improve its M&E practices. 01
02
Candidate facility: A facility with an appropriate M&E infrastructure in place, and,
although not fully and satisfactorily, has started using it.
Model facility: A facility with improved-quality health data collection, consumption, and
communication. At the very least, this facility communicates data offline using the HMIS. 03
04
Connected facility: A facility that accesses and shares data online, the ultimate goal of
the program. When all the facilities within a woreda are connected, it is referred to as a
Connected Woreda.
HRIS-HRA testing session with FMOH staff.
ANNUAL REPORT 12 |
During the reporting year, DHA conducted baseline assessments in 17 of the 20 woredas. A costed intervention
plan was prepared to support the 20 woredas. Gap-filling support included procurement and distribution of
furniture and computers; capacity-building training; and supporting data use review meetings and mentorship.
By the end of the reporting year, eight woredas became Connected Woreda candidates.
DHA, with MOH, uses the Connected Woreda dashboard to monitor progress along the Connected Woreda
pathway. The DHA uses geospatial data to identify adjacent woredas that can serve as cross-learning sites.
Dashboard content is shared continuously with MOH and RHBs for monitoring progress along the Connected
Woreda pathway.
Information Revolution model hospitals:

Internet
DHA, in close consultation with RHBs, established 10 model
hospitals to serve as role models for IR implementation
for the remaining health institutions in Ethiopia. The
hypothesis behind the IR model hospitals is that
“When fully supported by the woreda health office and

sufficient mobilization of resources, model hospitals can
be a key component to achieving the Connected Woreda
strategy.”
During the reporting year, eight IR hospitals were identified

and baseline assessment was conducted. In the following
year, DHA will provide gap-filling support to make them
model hospitals.
ePHEM
eHMIS EMR
DHIS2 eLMIS
eHRIS eCHIS
ANNUAL REPORT 13 |
Capacity Building
DHA has been working to make the HMIS up and running in a sustainable manner. This included:
Capacity building of Health Science Colleges

The Activity worked with the federal Technical and Vocational Education and Training
(TVET), MOH, RHBs, and universities to build the capacity of the HSCs to support the
IR through pre-service training to prospective health care managers and service
providers; training for academic staff; improving the HSCs training approaches; and
reviewing pre-service training curriculums. The support is aimed at improving the
health system’s capacity to collect, interpret, share, and use quality data in a digitized
health ecosystem. The capacity building mainly focused on last mile-health care
providers such as health extension workers, and pharmacy and health information
technicians. Accordingly, DHA, in partnership with DUP, supported the MOH and the
federal TVET in the review of health information technician occupational standards,
which MOH and the federal TVET endorsed and approved.
Incorporate blended learning approaches into pre- and

in-service training
To equip HSCs with blended learning tools, DHA, in collaboration with MOH, TVET,
HSCs, and DUP developed blended learning for specific subsystems. The priority
subsystems identified are DHIS2 and Dagu. The modules will be used for pre-service
training at the HSCs and for in-service training for health care workers.
Capacity building and mentorship program

Framed within the context of the Connected Woreda initiative, the MOH established
a capacity-building and mentorship program (CBMP) and formed partnerships with
six universities (Addis Ababa, Haromaya, Hawassa, Jimma, Mekelle, and Gondar). The
universities are expected to become centers of excellence for different HIS subsystems
and provide technical assistance to RHBs and zonal health departments by creating
model health facilities and woredas. The CBMP builds upon the universities’ experience
in training, mentorship, and research services to build a sustainable digital health
system. To support CBMP, DHA provided grants to Mekelle and Jimma Universities in
electronic Health Architecture and interoperability and eCHIS, respectively.
ANNUAL REPORT 14 |
Governance
Governance for digital health aims to strengthen the capabilities and skills for countries to advocate, innovate,
and scale-up digital health technologies. DHA supported the health system to establish and operationalize
HMIS governance at all levels, including development and approval of overarching and subsystem-level
governance policies, guidelines, protocols, and standard operating procedures.
This included work on:
Governance documents developed by MOH with the support of DHA.
Health data access and sharing policy

The DHA, in consultation with DUP, drafted the health data access and sharing
policy to establish procedures for accessing health-related data (clinical, financial,
administrative, and demographic) by users. It stipulates that data be anonymized
and made available to users to benefit decision making and addresses conditions
and manners in which data files may be released to users for research and policy
making while maintaining confidentiality. The draft policy is under review by MOH.
Upon completion and endorsement, the document is expected to accelerate
achievement of IR objectives.
Information Technology Infrastructure Management

Guideline
This guideline is drafted to help manage IT infrastructure to ensure appropriate
resource utilization. This guideline contributes to proper management and
maintenance of information technology (IT) infrastructure across the health sector
making it reliable, robust, secure, and consistent through facilitating efficient and
effective business processes.
ANNUAL REPORT 15 |
National Health Information Act

The DHA, DUP, and other stakeholders supported MOH in the development of the
National Health Information Act to establish a minimum national standard that sets
out the rights and interests of a patient or health service user, and the associated
national health care systems that support the health system.
Support to the innovation lab

DUP in collaboration with MOH established the innovation lab at Saint Peter Hospital
as a center of excellence for developing new systems and maintaining and updating
existing HMIS. During this reporting year, the innovation lab was inaugurated. The lab
is a place for building implementation and support capabilities to ensure government
ownership of the systems. DHA supported the development of the lab’s creative
strategy and developed two infographics that depict the maturity and transformation
path the innovation lab should follow and major steps to help it evolve. The
infographics also promote systematic creativity to turn insights into customer values;
incorporate basic components for value realization and adaptability purposes; play
a crucial role in transforming the innovation lab culture; and position the lab as an
incubation center to implement sustainable digital health solutions.
HRIS-HRA Dashboard review discussion with MOH staff.
ANNUAL REPORT 16 |
COVID-19 Response
After the first COVID-19 case was reported on March 13, 2020, the government’s response was swift, and DHA
has been applying its expertise in digital health and supply chain to support that response ever since. Across
the globe, digital health has been brought to the forefront as a crucial tool to combat the COVID-19 pandemic.
The use of digital tools such as contact-tracing apps to monitor outbreaks and online communication of cases
are some of the ways that the potential of digital health was tapped.
DHA helped MOH and EPHI analyze data on surveillance performance, and identified gaps in surveillance and
made recommendations to fill them. The Activity produced information on the effect of COVID-19 on program
service coverage and utilization. Dashboards were prepared to display results in ways that are easy to interpret
and use. The Activity also organized a workshop on the national status of essential services before and after
COVID-19, at which lessons from high-performing woredas were shared with low-performing woredas fostering
cross-learning among the woredas. DHA, in collaboration with DUP, also supported the development and
implementation of the following critical digital tools to mitigate the effects of the pandemic:
Sample COVID-19 monitoring dashboard developed with the support of DHA.
Hand sanitizer quality control

The Activity developed a system to allow EFDA to monitor and control hand sanitizer quality.
Manufacturers that received a temporary license to produce alcohol-based sanitizer now use
DHA’s quality control system to track the quality of their products in accordance with World
Health Organization standards.
Expedited product registration

Previously, it took manufacturers three or more days to obtain licenses from EFDA. Thanks to
DHA’s intervention, an app that expedited the product registration and licensing, alcohol-based
sanitizer manufacturers can now get their license the same day they apply for it.
COVID-19 surveillance and tracking system

EPHI and MOH use this DHIS2-based application, which supports the enrollment and tracking
of suspected cases; captures symptoms, demographics, risk factors, and exposures; creates lab
requests; links confirmed cases with contacts; and monitors patient outcomes. It is intended for
health facility users, lab users, and national and local health authorities. The application also
supports active case detection through contact-tracing activities, such as identification and
follow-up of contacts of a suspected or confirmed COVID-19 case.
ANNUAL REPORT 17 |
Surveillance follow-up app

This application builds on the case surveillance and tracking system of COVID-19 and facilitates
registration and follow-up of suspects and contacts of confirmed cases who will be followed for
14 days.
Health facilities reporting app

Health workers use this app to report suspected cases at health facilities to the rapid response
teams.
137
rumors reported from
health facilities.
Port of entry health declaration

This is an app that travelers use to record personal identification information including phone
number, travel history, illness symptoms, and place of residence. The form is generated via QR
codes at all ports of entry to provide unique traveler identification. Screeners from EPHI digitally
record travelers’ temperature and attach it to their digital record for 14-days monitoring and
follow-up. This application automates the Travelers’ Health Declaration Form for COVID-19 that
all passengers are required to complete upon entry to Ethiopia.
1,070,911
travelers screened and registered on
this application.
Toll-free recording app

This app records and stores data from individuals who call 8335 and 994 short codes to report
their COVID-19 status and/or concerns.
Provided COVID-19 health information to
9,228 1,261,229
rumors reported through this app. callers of the hotline.
Community house-to-house screening app

This is a mobile app for Health Extension Workers that help in data collection and serves as a
job aid for nationwide door-to-door COVID-19 screening campaigns.
The app is being used by
173
health workers in
Addis Ababa alone.
ANNUAL REPORT 18 |
Data analytics and visualization for COVID-19

This is a dashboard for EPHI and MOH to monitor the COVID-19 situation in the country. The
dashboard visually presents epidemiological information to inform preparedness and response
measures. DHA’s support included preparing a daily report on COVID-19 for the general public.
The Activity also improved Dagu 2.0 software to adapt and produce a customized report to assist
in the distribution of personal protective equipment and related products in response to the
pandemic.
29,896
COVID-19 cases captured through the application
which have been added on DHIS2
Supply chain dashboard

The dashboard gives data visibility across the distribution center from
EPSA to a service delivery point. It enhanced visibility of stock levels
and consumption, and data flow from all EPSA branches, EPHI, and
health facilities in Addis Ababa. The dashboard aggregates reports from
different administrative units for monitoring purposes.
WhatsApp helpline
In collaboration with Praekelt.org, DHA and DUP developed a WhatsApp-based helpline to
support users on health queries or concerns and direct them to accurate information sources.
It provides automated information responses with answers to most frequently asked questions.
This helped relieve traffic to call center helplines that were already overwhelmed. The application
uses machine learning and natural language understanding to enable automatic triage helping
to manage conversations at scale.
Rumor and suspected cases reporting and investigation

This application was developed for community members to self-report COVID-19 symptoms. It
also provides information about where people can volunteer, request help, learn more about the
pandemic, and report rumors. Communities can report their COVID-19 status on WhatsApp and
via SMS as well.
9,228
rumors were reported using
this application.
ANNUAL REPORT 19 |
Improving functionality of HealthNet Ethiopia

HealthNet Ethiopia is a VPN system that has been instrumental in providing a communication network for
health professionals throughout Ethiopia. The main goal of HealthNet program is to provide a functional
infrastructure and connectivity for all health institutions in Ethiopia to allow real-time data transfer within the
health system. It facilitates data use at each level while improving quality and timeliness of care by improving
referral and other linkages across the continuum of care to help achieve the Connected Woreda vision.
DHA’s support on malaria

Through the use of mBrana, a system used to track distribution of bednets in malaria-prone areas, DHA
supported data capturing for insecticide treated bednet distribution campaigns in 49 Woredas and three
regions ( Afar, Benishangul-Gumuz and Gambella).
DHA conducted a HealthNet functionality assessment in 300 facilities, of which 150 (50%) did
not have a functional system, mainly due to installation problems. DHA installed new LANs and
provided maintenance support for 35 of the health facilities, and developed several health IT
infrastructure management and operation documentations.
Staff at Tirunesh Beijing Hospital using Improved Patient Registration.
Local youth grants

DHA recruited, trained, and provided grants to 10 youth enterprises to provide sustainable and readily available
HMIS support to health facilities. The enterprises are run by new university graduates who participated in a
nine-month internship program at DUP. DHA assessed the youths’ interests and capacities and trained them
in grant writing and entrepreneurship. DHA will continue to monitor and support the youth grants until they
are self-sufficient.
ANNUAL REPORT 20 |
Success Stories
Going the Extra Mile: The Case of Michael Health Center
During our regular supportive supervision, one of our data use field officers visited Michael Health Center.
Although the health center had a dedicated computer, it did not have the proper technology setup. No staff,
including the health center director, had received training on DHIS2, the software used at health centers and
hospitals for data capturing, storing, transmitting, and analyzing. The computer produced incorrect results,
which the director perceived as a software malfunction.
The director had hired a local IT professional to solve the problem, but just before the consultant was scheduled
to arrive, a DHA field officer arrived at the health center to conduct regular supportive supervision. After being
briefed on the issue, the field officer repaired the computer, installed DHIS2 offline version 2.30 and trained
the team to use it, which saved them the expense of a consultant. Subsequent monitoring visits at the health
center showed improvements in report quality. In gratitude, the director said,
“ The support you provided was crucial, and allowed me to use DHIS2, which improved my health
center’s report timeliness and completeness. Additionally, the support has saved the health
”
center from extra costs of computer troubleshooting. Thank you and keep up your good work.
Transforming customer service, saving staff time: the case of Wada Health Center
“ I am very happy to be able

to serve my clients with
better customer service,
”
with speed and in an
organized manner,
said Bereket Anteneh, one of the

many HITs who benefitted from DHA
supportive supervision During the
visit to his health center, DHA staff
identified a medical catalogue system
Bereket uses the revitalized/maintained computer in the health center’s card failure, which had led Bereket and
room (Photo by: Belachew Kebede, DHA field data use officer. 9/10/2020.) his colleagues to return to manual
registration. This incurred additional
cost, staff time, and client wait time.
DHA field officers re-installed the application and conducted proper troubleshooting, which allowed the
system to start working. They also trained Bereket to troubleshoot. After these interventions, the health center
ANNUAL REPORT 21 |
staff were able to resume online client registration, which reduced waiting time significantly and allowed staff
to spend more time with clients and less on administrative tasks As Bereket remarked, “My work does not
exhaust me anymore.”
Dagu 2.0: Digital innovation brings remarkable change to hospitals

Mr. Shushay has been head of the pharmacy unit at the Ayder Comprehensive Referral Hospital for about
three years. Having 10 years of experience in various positions, he has seen the highs and lows of the hospital’s
performance. Ayder, the only comprehensive referral hospital in the Tigray region, provides services to
hundreds of thousands of people.
Dagu 1.0 software was introduced to improve the record-keeping at the hospital. Dagu is a revolutionary and
cost-effective digital system that helps facilities manage daily commodity transactions. In 2020, DHA upgraded
the system to Dagu 2.0 at Ayder and more than 15 other hospitals in Tigray, but because of skills gap, staff
workload, and lack of a clear process for all dispensing units, Ayder was unable to use all the critical features of
the upgraded system so resorted back to Dagu 1.0.
In response, DHA provided training, mentoring, and technical assistance to the hospital’s pharmacy staff. As
a result, all pharmaceutical operations—inventory control, logistic management, scheduling, and reporting
systems—improved.
Since the relaunching of Dagu 2.0, Mr. Shushay’s frustration in the use of data from the manual logistics
management information system has subsided. Dagu 2.0 has helped him produce faster and more accurate
reports of supply chain data, which he uses to prevent stockout of health commodities. “Dagu 2.0…has
simplified the life of our pharmacy and logistics staff. It is a quality software program that enables our hospital
to see all the very important reports,” said Mr. Shushay.
Ethiopia’s Digital Health Response to Combat COVID-19

Mesoud Mohammed Ahmed, the COVID-19
Emergency Operation Center Digitization
lead, is at the heart of the national COVID-19
response in Ethiopia. As he explained,
“When this pandemic hit, there was an
immediate need to look within the MOH to
identify the best way to respond.”
Since reporting the first COVID-19 case

on March 13, 2020, the EPHI, one of the
technical agencies under the MOH, has
been taking steps to contain the pandemic.
The pandemic response needed reliable
information and raised questions about
how data could be collected efficiently, and
Mesoud displays his visuals to demonstrate live COVID-19 data.
DHA stepped in to help MOH/EPHI digitize
its systems to facilitate this.
ANNUAL REPORT 22 |
Over the past six months, DHA has accomplished much. During the initial response to the pandemic, the labo-
ratory work process was not integrated with any system, which meant its data was subject to loss, duplication,
and inaccuracy. DHA developed nine applications to streamline data collection, enhance administrative tasks,
and improve the overall productivity for better surveillance, logistics, and case management.
DHA’s immediate response also included hands-on technical and on-the-job training to end-users, monitoring,
and supportive supervision. MOH/EPHI staff have improved data quality, reduced data loss and duplication,
and streamlined the laboratory information system to feed into DHIS2. Progress in turn-around time and better
use of scarce resources have consequently improved overall patient care.
As Mesoud said,
“
It’s a government-led and -driven information system, but frankly, without
”
DHA’s support, it would have been difficult to realize it.
ANNUAL REPORT 23 |
HRIS-HRA Testing session with FMOH team
Contact info
Dr. Loko Abraham

Chief of Party, Digital Health Activity
[email protected]
Noah Plaza Building

Bole Main Road (Africa Avenue Street)
Floors 3-4
Addis Ababa, Ethiopia
+251 116-672-284
[email protected]
Disclaimer:
This report is made possible by the support of the American people through the United States Agency
for International Development (USAID). The contents are the sole responsibility of JSI and do not
necessarily reflect the views of USAID or the United States Government.

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REPORT

OCTOBER, 2019–SEPTEMBER, 2020

Message from the Chief of Party . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Electronic Community Health Information System (eCHIS). . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Electronic Medical Record (EMR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

District Health Information Software 2 (DHIS2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Human Resource Information System (HRIS). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Electronic Regulatory Information System (eRIS). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Track and Trace. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Improving functionality of HealthNet Ethiopia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

ANNUAL REPORT III |

Message from the Chief of Party

The DHA is designed in response to and in support of the IR Agenda.

We established and financed ten youth grants to

The DHA supports the IR under the following areas:

1 Electronic Community Health Information System (eCHIS)

The eCHIS is an application that digitized the paper-

and report household health data. The eCHIS is

Undertook more than 50

Built MOH staff capacity to

2 Electronic Medical Record (EMR)

3 District Health Information Software 2 (DHIS2)

DHIS2 is an open-source software used by the HISs of

In its first year, DHA:

Provided supportive supervision to over

3,000 health facilities,

Provided on-the-job DHIS2 training to more than

1,100 health professionals.

Developed and implemented a COVID-19 case tracking system and

4 Human Resource Information System (HRIS)

In collaboration with the MOH, DHA has been working

human capital and track the health system workforce.

Added new features to ease and accelerate putaway, procurement, restocking,

147 Following the training, EPSA IT staff were able to support

Dagu 1.0 was upgraded to Dagu 2.0 in

126 health facilities and

130 Health Information Technicians (HITs) were trained in its use.

7 Electronic Regulatory Information System (eRIS)

DHA supported the following eRIS activities:

DHA, in collaboration with EFDA, developed and deployed i-Verify, a mobile

Gave eRIS access to Provided refresher training to

EFDA staff logging into the eRIS system on a tablet.

8 Track and Trace

to combat counterfeit pharmaceutical

secure transactions of products throughout

340 products with GTINs

EFDA staff using the iVerify application on a phone.

Rollout of data use strategies:

Health Management Information System (HMIS) data quality assessment:

Connected Woreda: The Connected Woreda program is a way of translating the

HRIS-HRA testing session with FMOH staff.

Information Revolution model hospitals:

“When fully supported by the woreda health office and

During the reporting year, eight IR hospitals were identified

Capacity building of Health Science Colleges

Incorporate blended learning approaches into pre- and

Capacity building and mentorship program

This included work on:

Governance documents developed by MOH with the support of DHA.