Enhancing functionality and scaling up of the electronic Integrated Diseases Surveillance and Response system in Uganda, 2020-2023: Description of the journey, challenges, and lessons learned (Preprint)

BACKGROUND In 2017, Uganda implemented an electronic Integrated Disease Surveillance and Response System (eIDSR) to improve data completeness and reporting timelines. However, the eIDSR system had limited functionality and was implemented on a small scale. The Ministry of Health (MOH), with support from the Infectious Disease Institute (IDI) and Health Information Systems Program Uganda (HISP-Uganda), upgraded the system functionality and scaled up its implementation. OBJECTIVE We describe the upgrade of the eIDSR system, its rollout, and its effect on disease surveillance in Uganda. METHODS We used the human-centered iterative process to upgrade eIDSR. The eIDSR rollout followed a consultative workshop to create awareness of the system among stakeholders. A curriculum was developed, and a national training of trainers (TOT) was conducted. These trainers cascaded the training to the District Health Teams (DHTs), who later cascaded the training to health workers. The training adopted an on-site training approach, where a group of national or district trainers would train new users at their desks. RESULTS The eIDSR system was upgraded to the DHIS2 2.35 platform, featuring faster reading and writing tracker data, handling over 100 concurrent users, and enhanced case-based surveillance features on Android and web platforms. From October 2020 to September 2022, eIDSR was rolled out in 68% (100/146) districts. Additionally, the system permitted prompt reporting of signals of epidemic-prone diseases. CONCLUSIONS Improving the functionality and the expanded geographical scope of the eIDSR system enhanced disease surveillance. Stakeholder commitment and leveraging existing structures will be needed to scale up eIDSR.