Egypt deploys DHIS2 for emergency and humanitarian response

Health workers training on the DHIS2 system in Egypt

Egypt has a strong, diverse healthcare system comprising a mix of governmental, university, insurance system and private sector facilities serving more than 110 million nationals in addition to foreigners living in the country.

The Ministry of Health and Population in Egypt (MOHP) expressed initial interest in the digital health information management system DHIS2 in the second quarter of 2023 as a possible component of its digital health ecosystem.

At the beginning of the Sudan conflict in May 2023, the Egyptian MOHP and UNICEF reached a shared understanding of the need for nutritional screening for children under the age of five, as well as pregnant and lactating women, targeting displaces Sudanese in Egypt.

The goal was to detect and manage any cases of acute malnutrition among the most vulnerable people, given Sudan’s pre-crises prevalence of malnutrition.

With support and guidance from HISP, a global network to support DHIS2 implementation, an event tracker was developed, configured, and implemented on the DHIS2 platform, and hosted on national servers.

The first DHIS2 platform was rolled-out within 45 working daysinvolving eight experts from MoHP, the Ministry of Planning, UNICEF Egypt and HISP MENA. The system was set up to screen for malnutrition among the displaced Sudanese in Egypt.

As of January 2024, the system is operational in 16 primary care facilities across two governorates. Two additional governorates will launch the system soon, with plans for further expansion. There are also plans to include NGOs as service providers, integrating both public and private sector activity in the same system.

To date, over 4000 children and women have been screened and identified cases have been referred to the appropriate management facilities.  

One of the most important features of the nutrition tracker is the automatic Z-core calculation, a statistical method based on anthropometric measurements like weight and height to evaluate a child’s nutritional status. This feature acts as an effective decision support system, removing possible errors from the assessment.

In addition, the developed dashboards give management at different administrative levels the ability to evaluate the efficiency of the services and pinpoint facilities that need on-the-ground support.

The DHIS2 follow-up dashboard in Egypt’s nutrition tracker program. 

With the start of the conflict in Gaza, Egypt’s emergency response included treating complex referred medical cases from Palestinian hospitals overwhelmed by the unprecedented number of wounded and injured civilians and repeated military attacks.

The MoHP of Egypt announced that more than 30 hospitals were being prepared to receive injured Palestinians across more than eight governorates. The MOHP also identified a need for a unified platform to monitor simple patient records that can be accessed from different facilities and specialists at the national level.

After the DHIS2 already successfully deployed for the Sudan response, UNICEF and HISP MENA agreed to extend DHIS2 utilization to the hospital level. A series of technical meetings were conducted with the MoHP DHIS Country Team, UNICEF and HISP MENA to discuss the business requirements, emergency workflows, challenges on the ground, and system architecture design.

The DHIS2 tracker was rolled-out in less than 10 working days to be used at hospitals receiving injured Palestinians. The focus was on documenting, monitoring, and analysing health data related to patients.

The DHIS2 registry comprises a registration page capturing demographic data and various stages including admission details, diagnosis, surgeries, X-ray orders, lab tests, treatment processes, and outcomes. The system embedded ICD10 coding within it to ensure unifying diagnosis (a system used to classify and code all diagnoses, symptoms and procedures) - and included a referral functionality to be able to monitor services in different facilities. The registry has been successfully implemented across the 30 designated hospitals receiving individuals from Gaza.

An example of a patient medical file in Egypt’s tracker program.

From the first point of contact at the healthcare facility, health care providers were able to utilize DHIS2 to register patients and provide initial diagnosis, subsequently referring them to one of the 30 hospitals based on their medical evaluation and need. To enhance monitoring, a dashboard was created, featuring reports, indicators, visuals, charts, and line lists containing registered patient details and their transactions between allocated hospitals.

In the face of the ongoing crisis in Gaza, the collaboration between the Egyptian MoHP, UNICEF Egypt and HISP MENA remains steady, with continuous efforts to refine and adapt the system to support the health sector and support government initiatives. Looking ahead, the MOHP, UNICEF and HISP MENA are planning for further large-scale implementation in the primary healthcare system.

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