| Indicator ID | H12 |
|---|---|
| Indicator full statement | # of health districts with a functioning surveillance and early-warning system supported by digital health information and community participation. |
Purpose
| Importance | This indicator measures the extent to which health districts have established effective digital surveillance and early-warning systems with active support and involvement of Tdh and from local communities. These systems are designed to enhance the detection and response to potential health threats, including disease outbreaks, by integrating digital health tools and engaging community members in surveillance activities (i.e., Community Health Workers (CHW) digitally register community cases). The use of digital tools aims to improve the timeliness and accuracy of health data collection and analysis, leading to more effective public health responses, and therefore strengthening the health systems. |
|---|---|
| ToC pathway | This indicator directly refers to the TdhTheory of Change (ToC) as it aims to contribute to three inter-related pathways of change, namely 1) local health system, 2) communities, and 3) mothers, children, and their families. |
| Related services | It is used depending on the service provided by Tdh. This indicator is often used in emergency response, according to Tdh Package of activities. |
Definition
The count of health districts that have operational surveillance and early-warning systems which incorporate digital health technologies supported by Tdh and actively involve community members in data collection and reporting.
A functioning system is one that 1) utilizes digital tools for data collection, analysis, and reporting, 2) includes mechanisms for early-warning and outbreak detection, and 3) engages communities in monitoring and reporting health events.
How to collect & analyse the data
| What do we count? | Number of health districts that have implemented a functioning surveillance and early-warning system utilizing digital health information systems supported by Tdh, with active involvement from local communities at a specified reporting time. |
|---|---|
| How to calculate the indicator's value | Percentage of health districts with digital surveillance systems = (Number of health districts that have implemented a functioning surveillance and early-warning system utilizing digital health information systems, with active support and involvement from local communities at a specified reporting time. / Total number of health districts in the catchment area) x 100 |
| Data sources | Health district surveillance system data sources: Administrative-based data capturing all consultations using digital health tools, where available. Digital health platform records: Data from digital health platform that track the number of digital entries in the system (i.e., National Health Information System (HIS) tracking active users and able to provide a complete count). Community feedback (through survey and/or reports to collect feedback on the adoption of the early-warning system tool functionality and use, as well as the level of community involvement. Program documentation: internal and partners’ reports related to the project’s implementation in between two reporting time limits. |
| Data collection methods and tools | Secondary data review (monthly, quarterly, and annual reporting from health district and HIS. Baseline, mid-term and endline (or annually) studies through community survey/report and project documentation to supplement routine data. |
| Disaggregation | By type of digital tool : e-learning, digital protocol, other |
| Important considerations |
Limitations and precautions
Ensuring that surveillance systems are operational, rather than merely implemented, is crucial. This can be assessed by analyzing collected data, correlating it with the number of early warnings issued per district, and tracking the number of regular users. Care must be taken regarding geographical coverage within districts, as some communities may resist or neglect the tool despite its implementation.
Measuring Community Engagement and Involvement (CEI)—including representation from target groups, such as mothers and children, and their influence on improvements—is essential for interpreting this indicator, as CEI levels can vary across districts. Sustainability and the long-term impact of the digital surveillance system also depend on community engagement and local ownership. Districts benefiting from capacity-building initiatives and involving more stakeholders often see enhanced relevance, monitoring, and supervision of the surveillance system.
A comprehensive context analysis is vital, as changes in local and national governance, health funding priorities, or external factors like climate events can disrupt CEI and the continuity of improvements. The effectiveness of digital surveillance tools may also hinge on infrastructure availability and the quality of user training. Regular updates to the surveillance system are necessary for it to effectively monitor events and diseases, and it should be integrated into health systems for emergency response and decision-making.
What further analysis are we interested in?
This indicator allows the assessment of the extent to which the tools are integrated into the national surveillance system and, when crossed-analysed with the number of entries in the system and epidemiological trends (i.e., communicable diseases measured by the early-warning system, number of cases from the districts’ HIS), it can demonstrate its effectiveness in preventing further health consequences on the target population. Comparing coverage across different areas or periods allows for trend and equity analysis of the proportion of health districts within a state and/or a region with access to digital surveillance systems. It also highlights the impact of interventions aimed at improving the implementation of a functioning system with CEI. The evaluation of the role and impact of the CEI in the effective deployment of the surveillance systems can also be analysed via this indicator.
Additional guidance
Under the technical assistance of HQ, Tdh M&E and operational teams in each delegation should work closely with health authorities and local communities to collect and interpret the data. Countries with limited health system infrastructure may consider partnerships with international organizations (e.g., WHO, UNICEF) and academic institutions to support capacity-building for data collection.
Delegations with limited resources to conduct surveys and interviews should consider using a consultant and/or a reliable local partner involved at the community level.
World Health Organization. (2022). Early warning alert and response in emergencies: an operational guide. World Health Organization. Available at: https://iris.who.int/handle/10665/365730 (Accessed: 15 September 2024)
Recommendations on digital interventions for health system strengthening,
WHO Guideline, 2019. Available at: https://www.who.int/publications/i/item/9789241550505 (Accessed: 15 September 2024)
Digital adaptation kit for child health (0-59 months) in humanitarian emergencies: operational requirements for implementing WHO recommendations in digital systems, 2024. Available at: https://www.who.int/publications/i/item/9789240089907 (Accessed: 15 September 2024)
An Introduction and Practical Guide to Community Engagement and Involvement in Global Health Research, Global Health Training Centre. Available at https://globalhealthtrainingcentre.tghn.org/introduction-and-practical-guide-cei-health-research/ (Accessed: 15 September 2024)