Linking school-based and national Covid-19 surveillance in Uganda

The COVID-19 pandemic has greatly affected the education sector in Uganda. The first country lockdown that was instituted in March 2020 saw over 15 million learners kept out of school for over 5 months. Despite government interventions that included the distribution of self-study materials and the use of online, televised, and radio classes, most learners — especially in rural areas — could not access these learning alternatives due to the limited availability of power and internet connectivity, as well as the engagement of learners in domestic work during school hours.

In July 2020, Uganda’s learning institutions were re-opened in a phased manner starting with the candidate classes. The reopening of schools was conditioned to the establishment of and the strict adherence to the standard operating procedures in schools for preventing the spread of COVID-19, such as social distancing, mandatory wearing of masks, and hand washing. However, there was  a surveillance gap in schools especially reporting of suspected and confirmed COVID-19 cases and linkage to further investigation and linkage to treatment: Schools were not able to carry out routine school surveillance, reporting, and referral of suspected cases to the nearest facility, given that the systems in place in the education and health sectors were not linked to each other.

Leveraging existing capacity to link COVID-19 surveillance data between education and health with District Health Information Software 2 (DHIS2)

Building on the experience of implementing the DHIS2 electronic Integrated Disease Surveillance and Response (eIDSR) system for COVID-19 surveillance in the health sector and the DHIS2 for Education system (known locally as DEMIS) in the school sector, Health Information Systems Program (HISP) Uganda and Save the Children Uganda worked in partnership with the Ministries of Health and Education to pilot the use of DHIS2 for school-based surveillance in the Wakiso and Ntungamo districts. The proof of concept for this research was funded by the Norwegian Agency for Development Cooperation (NORAD) in 2019. Through new funding from  the Global Partnership for Education Knowledge and Innovation Exchange under the project titled Data Use Innovations for Education Management Information Systems in The Gambia, Uganda, and Togo, this project is now being scaled up.

The schools, on a daily basis, were able to screen learners, staff and visitors for COVID-19 related signs and symptoms and send aggregated numbers using the short-coded SMS to a toll-free number to facilitate data submission into DHIS2 in areas with limited internet access. A dashboard was created in the DHIS2-DEMIS and accessed by the COVID-19 surveillance teams at the district and central levels. The surveillance teams then followed up on suspected cases with school administrators for referral of suspected cases to the nearest facility for further screening and management.

In addition to data reported directly into the DHIS2 system, data from those schools that used an alternate school-based system (called XULDIME) was integrated into the DHIS2-DEMIS and visualized on the school surveillance dashboards to give a more complete picture. By the end of June 2021, two additional districts of Gulu and Mayuge were included in the pilot and trained on school surveillance reporting.

Planning national scale deployment based on pilot results

The pilot of DHIS2 for school-based COVID-19 surveillance was limited to primary schools in four districts in Uganda. Findings from this pilot were shared with the different working groups at the Ministry of Health and Ministry of Education and Sports. Based on these results, the ministries tasked the team with developing a national scale-up plan to inform expansion of DHIS2 school-based surveillance to all learning institutions across the country and further guide re-opening of these institutions starting January 2022.

Want to know more? You can ask questions and add comments about this project on the DHIS2 Community of Practice.