Implementation of an electronic health information system using DHIS2 tracker to manage and evaluate the National...

The cervical screening programme in Bangladesh upgraded its electronic health information system (e-HIS) in 2019 using DHIS2 tracker application. The upgraded e-HIS collects individual level data and has useful functionalities like sending SMS reminders. Also, the system facilitates data linkage between community clinics, VIA (visual inspection with acetic acid) screening centers, and colposcopy clinics using a unique national identifier. Our present mixed-method study aimed to perform an in-depth assessment of functioning of the new s-HIS and recommend measures to overcome the implementation challenges identified.

In 2024, the Ministry of Health, Bangladesh and the International Agency for Research on Cancer, France, jointly formed a study team, which conducted desk review of documents, visited different health facilities to physically verify functioning of the e-HIS, engaged with health professionals and other stakeholders involved with the programme, and conducted in-depth interviews with e-HIS users and officials managing the system. Key performance indicators (KPIs) like VIA-positivity, colposcopy compliance, detection rate segregated by districts were derived from the e-HIS data for the years 2022 and 2023 for a selected division (Rajshahi).

Till April 2024, 14,213 community clinics (out of total 15,564 in the country) were using the e-HIS to register women and motivate them to attend any of the screening centers to undergo VIA. Due to establishment of a functioning linkage between the screening and the colposcopy centers it was possible to track the screen-positive women and remind them to undergo colposcopy. KPIs could be successfully estimated based on data collected in Rajshahi division. Unstable internet connection, inability to register women without national identifier, errors in manual entry of the identifier, not being able to capture histopathology diagnosis were some of the challenges identified.

A recommendation was made to prepare a quality improvement protocol specifying a set of KPIs for the programme and their benchmarks for the programme.