Tuberculosis (TB)

A new digital platform for timely analysis and use of TB data

A handheld DNA sequencer being used in Madagascar to identify TB resistance in sputum samples
Institut Pasteur de Madagascar

The WHO Global TB Programme has developed and is supporting country implementation of a new digital platform to store, analyze and visualize national and subnational TB surveillance data. The platform will facilitate timely planning and programmatic action.

“The need for this platform has been one of the most consistent messages coming out of 75 national TB epidemiological reviews conducted over the last few years to strengthen national tuberculosis surveillance,” said Katherine Floyd, Coordinator, TB Monitoring and Evaluation, WHO Global TB Programme.

Map 1. National TB epidemiological reviews conducted between 2012 and March 2019, and others planned before the end of 2019

Note: Two reviews have been completed in 27 countries: Angola, Bangladesh, Botswana, DR Congo, Egypt, Eswatini, Ethiopia, Fiji, Ghana, Indonesia, Kazakhstan, Kenya, Lesotho, Madagascar, Malawi, Mongolia, Mozambique, Myanmar, Nigeria, Pakistan, Papua New Guinea, Philippines, Rwanda, Thailand, United Republic of Tanzania, Zambia and Zimbabwe.

The data platform is based on the free and open-source District Health Information System 2 (DHIS2) and designed upon WHO standards for service delivery and programme implementation. It stores a minimum set of aggregated data (e.g. quarterly reports from districts) for core TB surveillance indicators, based on the WHO case definitions and reporting framework for TB. Accompanying standard dashboards (Figure 1) are also available and designed according to best practice standards for the analysis and visualization of results (in the form of graphs, tables and GIS maps). For a full demonstration of the platform, see here.

“A wealth of subnational level data exist in-country but are seriously underused leaving strategic planning and decision making by national TB programmes at a serious disadvantage,” said Babis Sismanidis, Team Leader for surveillance, surveys and data for action, WHO Global TB Programme.

Figure 1. Example graphs and maps from standard dashboards

Between 2016-2018 the TB DHIS2 platform was used in a series of regional and national workshops for TB data analysis and use in Africa and Asia, as well as to facilitate the conduct of national TB epidemiological reviews. Data has so far been uploaded to the platform by about 50 countries (Map 2) for national and subnational planning by in-country teams.

“We are proud to be the first who piloted this platform as part of the WARN-TB activities involving 16 countries in West Africa. The implementation of this system and the associated training have strengthened our national TB surveillance systems through better understanding and using of our data. This supports informed decisions for improving our programmatic, as well as operational research, activities,” emphasized Dissou Affolabi, NTP Manager Benin/Executive Secretary West and Central African Regional Networks for-TB control.

Map 2. Countries covered by regional or national workshops on analysis and use of TB data held since 2016 or planned within the next year

The TB DHIS2 data platform has evolved as part of GTB’s collaboration with other departments in WHO such as Health Information Systems, Hepatitis, HIV, Immunization, Malaria, Neglected Tropical Diseases, Reproductive, Maternal, Neonatal, Child and Adolescent Health and the Special Programme for Research & Training in Tropical Diseases. GTB has also collaborated with partners outside WHO such as US CDC, KNCV, Public Health England, University of Oslo, USAID and the Global Fund, under the auspices of the Health Data Collaborative. The aim of this collaboration is to develop integrated health data solutions based on WHO standards for service delivery and programme implementation, and comprehensive country packages (Figure 2), both cross-cutting and disease specific, to support the transition from paper-based to electronic surveillance and the routine analysis and use of data for action.

“This represents an important step forward in our collective efforts to strengthen routine health information systems in a way that increases impact at country level and improves efficiency in investments,” said Kathy O’Neill, Coordinator, Global Platform for Measurement and Accountability.

For National TB Programmes the implementation of these comprehensive packages in priority countries is supported through the Global Fund’s Strategic Initiative on Data (2017-2020) as well as country grants, and USAID. To date, the TB DHIS2 package for aggregate data has been installed and is being used in 5 countries (see here), with another 25 countries expected to do so by the middle of 2020.

“The advances made through this excellent collaboration represent a real breakthrough that enables countries to use disaggregated data in a timely manner to improve programmes and outcomes. The move toward real-time data systems that are integrated, efficient and responsive to the needs of TB and other disease programmes is a critical priority now and in the future,” said Peter Hansen, Head of Technical Advice and Partnerships, The Global Fund.

“This effort to strengthen national TB surveillance systems, as well as the analysis and use of the data they produce, is a global success story involving major TB partners, as well as all levels and multiple departments of WHO. Next steps, with funding currently under negotiation with major funding partners, include making individual level data available for patient monitoring and surveillance (for countries that are ready) and further strengthening of routine analysis and use of data including through the establishment of national data repositories,” said Tereza Kasaeva, Director, WHO Global TB Programme.