Improving Grenada’s health information and disease surveillance system

Climate variability and change is likely to affect the prevalence and incidence of infectious diseases in Grenada. A project to digitise routine health information and disease surveillance is enhancing the country’s capacity to identify and respond to future outbreaks and epidemics.

DHIS2 training in St. George’s

Towards a climate-resilient health system in Grenada

In its first national communication to the United Nations Framework Convention on Climate Change in 2000, the government of Grenada drew attention to the health-related risks posed by climate variability and change for the more than 100,000 people who live on the country’s three islands. Rising temperatures, changes in rainfall patterns and more frequent extreme weather events are likely to lead to an increased incidence of vector-borne communicable diseases, such as Dengue, Chikungunya, Zika and leptospirosis, and to a rise in respiratory infections in the country.

As part of the National Adaptation Plan (NAP) process which began in 2015, Grenada’s Ministry of Health, Social Security, and International Business analysed the vulnerabilities and adaptive capacities of the country’s health system and identified measures which could be undertaken to build climate resilience. A Vulnerability and Adaptation Assessment (V&A) conducted by German Development Cooperation to inform the NAP process recommended strengthening the country’s health information and disease surveillance system.

Strong health information systems are needed to identify and respond to climate-related health risks

Records Room at Ministry of Health

A strong routine health information system is essential for health authorities to be able to monitor the incidence of climate-sensitive diseases, including the early identification of new disease outbreaks. At present, however, Grenada’s health information system is not well-suited for this purpose. Although the Ministry of Health has launched various e-health initiatives to strengthen the health information system, the disease surveillance system has not yet been upgraded. Weekly paper-based reports about cases of communicable and non-communicable diseases are prepared by public health facilities across the country, aggregated at parish level and then captured electronically at national level. This time-consuming process leaves little opportunity to analyse and interpret information and to plan timely, evidence-based public health responses.

Moreover, there are currently no linkages between the health information system and other important datasets, such as the vector monitoring system which tracks the Aedes aegypti mosquito population or the Grenada Water Information System, which monitors rainfall, temperature and humidity. This makes it difficult to analyse historical data about the connections between vector-borne diseases, mosquito populations, and precipitation levels, or to use the combined strength of these datasets to map the risk of potential new outbreaks.

A versatile solution for linking health, vector and climate data

To rectify these gaps, German Development Cooperation has supported an adaptation measure to streamline and digitise Grenada’s health information system through the introduction of the District Health Information System (DHIS2). DHIS2 is a free, fully-customisable open source software designed for capturing, managing, visualising and analysing routine health information. The core version of DHIS2 is maintained by the University of Oslo, which developed the software and makes it freely available to users worldwide. A global community of programmers and software developers continuously improves DHIS2 by adapting the source code for use in local settings and feeding modifications back into the core version. DHIS2 is currently being used to manage health information systems in 30 low- and middle-income countries and has been adopted by the World Health Organization (WHO) as part of its public health information toolkit.

The Ministry of Health and other key stakeholders in Grenada ultimately elected to adopt DHIS2, rather than upgrading one of the country’s existing information systems, when it became clear that doing so would be less expensive and offer a more comprehensive solution for bringing together the different sources of data needed to prepare for and respond to climate-related health impacts. Indeed, one of the many advantages of DHIS2 is its flexibility: the software is interoperable with other information systems, making it easy to import and work across multiple datasets within a single platform. It is also fully customisable: the core software can be extended to include new modules to meet the specific needs of end users.   

Bringing DHIS2 to Grenada

Experts from the University of Oslo meet with a nurse at Woburn Medical Station to discuss the move from paper registries to electronic data collection

DHIS2 was introduced in Grenada in May 2017 following several months of intense preparation. The effort was led by experts from the University of Oslo who worked in close cooperation with a core team from the Ministry of Health and with staff from the Adaptation to Climate Change in the Health Sector programme implemented by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, which supported the project financially and technically on behalf of Germany’s Federal Ministry for Economic Cooperation and Development.

During a three-week mission, the technical experts from Oslo prepared a customised version of the DHIS2 software for Grenada. This involved, among others, inputting the organisational structure and hierarchy of Grenada’s health system, translating standard data collection forms and registry books into electronic formats, and identifying and importing existing data sources into DHIS2. Training sessions were held for end users who will be involved in capturing, monitoring and using the data in DHIS2 once the system goes live.

At an intersectoral stakeholder workshop, representatives from the Ministry of Health, the National Water and Sewerage Authority, the Meteorological Office, the Land Use division of the Ministry of Agriculture, and the public health department of St George’s University learned how DHIS2 will be able to benefit Grenada far beyond the health sector and began discussing how to standardise the enumeration units they use in their individual reporting formats to make their datasets interoperable through DHIS2.

A new chapter begins

The adoption of DHIS2 in Grenada marks an important step forward in terms of climate resiliency of the health system. The system will greatly improve the capture and storage of various types of health information – thereby freeing up time for community health nurses to spend more time with patients – and will ensure the availability of accurate health data on a timely basis. This, in turn, will greatly enhance the ability to plan and implement evidence-based public health interventions. Of particular importance is the improved surveillance and monitoring of diseases, and the ability to map and analyse health data in relation to other datasets, such as that for vector populations, water quality and climate variables.

Further reading

BMZ glossary

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