The Health Information System in Sudan : the Disease and outbreaks Surveillance System at the National Level and the State Capital: A Descriptive Study

Abstract

This thesis aimed at exploring means of integrating surveillance systems for disease and outbreak in Sudan; visiting both the national and the capital state, with emphasis on both the facility based statistics or Health Information system (HIS) and the program for communicable disease surveillance. A qualitative descriptive approach is adopted and main tools employed were document analysis and interviews with the staff of the Ministry of Health (MOH) both at the national and state, as well as informants at the locality and facilities levels. Quotations from findings were used to validate results, and the study received ethical approval from both the Norwegian and the Sudanese research ethical authorities. Main findings indicate fragmentation within the disease and outbreaks surveillance system. This is in particular evident when looking at the recent developments in disease surveillance. The Epidemiological Department (later called the program of communicable disease surveillance) emerged from HIS and created its own surveillance system. The establishment of disease-focused programs with own surveillance systems further added to the fragmentation. In spite of the fact that disease-focused programs took responsibilities for surveillance and control of some of the diseases, the communicable disease program is still collecting data and monitoring the situation as whole leading to data duplication. Several of these vertical programs share the same sentinel sites. In addition data for all programs are aggregated by the Department of Preventive Health at the level of the locality before being sent to the respective program at the state level. The program for communicable disease surveillance is using mobile phones for surveillance, coordination of intervention activities and feedback systems. A computer software program is under designing for the program to serve the purpose of surveillance and interaction with users. The health information system, on the other hand, is functioning through paper forms before entered into excel program at the state and national level. The capital State of Khartoum is an exception using a computerized software program for data collection from the locality level. With regard to technology in HIS and disease surveillance, the era is lacking cohesion and common vision for a collective approach for implementation within the organization. There’s a need for a common structure with modular capacity rather than the current piecemeal initiatives to build the whole. The feasibility study for a central data ware house together with the recently launched evidence-based practices plan, paved the path for information use and organizational restructuring. The 2009 influenza pandemic has added to the capacity of the program of communicable disease surveillance and widened its scope and partnerships both within the MOH and otherwise to meet challenges. It was a trial to meet emerging challenges in addition to its routine activities. Introducing technology to the organization seems to promote re-integration of health information system and the disease surveillance programs. It promotes organizational restructuring, decentralization and stakeholder’s participation in implementation of integrated surveillance and HIS. The District Health Information System (DHIS) has been presented as a vision for unifying use of technology and realization of evidence-based practices.