Maryam Bibi

December 2024 ANNUAL REPORT DHIS2 IMPLIMENTATION & PROGRAM ACHIEVEMENT HISP PAKISTAN | PAGE 02 TABLE OF CONTENTS Abbreviations 03 Executive Summary 04 Introduction 05 Technical Upgrades and Problem Solving 06 Custom Dashboard Development 11 Tracking Progress: Indicators and Reports 17 Advancing Goals: Program Achievements 20 Cloud-Based Support and Stakeholder Engagement 24 Tracking and Assessing Program Progress 25 Conclusion 34 Contact Us 35 HISP PAKISTAN | PAGE 03 ABBREVIATIONS TB Tuberculosis MC Mercy Corps HISP Health Information System Program CMU Control Management Unit PPM Private-Public Mix CS Case Surveillance WHO World Health Organisation UIO University of Oslo GP General Practitioner BMGF Bill & Melinda Gates Foundation HMIS Health Management Information System NTP National TB Control Program SOPS Standard Operating Procedure APK Android Application Package EPI Expanded Programme on Immunisation DHIS District Health Information System TEI Tracked Entity Instance HIV Human Immunodeficiency Virus HISP PAKISTAN | PAGE 04 EXECUTIVE SUMMARY The 2024 Annual Report highlights HISP Pakistan/UiO's transformative achievements in advancing the District Health Information System (DHIS2) to strengthen health information systems across the country, with a particular focus on the continued success of the TB Tracker initiative. Launched by the Common Management Unit (CMU) in collaboration with Mercy Corps (MC) in 2022, this initiative has significantly enhanced nationwide tuberculosis (TB) patient registration and monitoring. Key accomplishments for this year include the adoption of Apache Superset for advanced data visualization, focusing on real-time usage analytics, and the development of program-specific dashboards that streamline workflows to address critical data management challenges. HISP Pakistan/UiO has also emphasized capacity building through user training, consultative meetings, and field visits, ensuring effective stakeholders engagement and improving system usability. These combined efforts have strengthened health systems' ability to deliver accurate, actionable data, supporting informed decision-making and improving public health outcomes across Pakistan. HISP has provided continuous support throughout the year to ensure the effective functioning and enhancement of the DHIS2 platform. Key efforts included configuration upgrades, such as enhancements of the WHO Household Contact Module for efficient tracking of TB contacts, and the HIV section, addressing operational challenges like synchronization issues, and ensuring efficient system administration by resolving user creation problems. Additionally, HISP offered ad-hoc system support by developing and deploying tools to address specific needs. HISP PAKISTAN | PAGE 05 INTRODUCTION The 2024 Annual Report outlines the key activities, tools, and programmatic developments undertaken by HISP Pakistan/UiO in the implementation and enhancement of the District Health Information System (DHIS2). It highlights the concerted efforts to improve data management, resolve technical issues, and support programmatic workflow. Through the use of innovative tools and the refinement of workflows, HISP Pakistan/UiO has played a pivotal role in enhancing system performance, building stakeholder capacity, and fostering data-driven health program management across the country. This report outlines the systematic approach undertaken by HISP Pakistan/UiO to resolve critical data synchronization challenges, streamline workflows, and design tools for efficient metadata management and realtime data visualization. Additionally, HISP Pakistan/UiO’s work extended to expanding TB reporting indicators, bolstering the monitoring of household screening activities, and deploying scalable server infrastructure to ensure long-term sustainability. This report highlights the achievements of 2024 and lays the foundation for further progress in digital health systems, and HISP Pakistan/UiO’s dedication to fostering sustainable, data-driven enhancements in healthcare delivery and public health outcomes throughout Pakistan. HISP PAKISTAN | PAGE 06 TECHNICAL UPGRADES AND PROBLEM SOLVING TECHNICAL SUPPORT TOOLS IN DHIS2: ANDROID DATA SYNC ERRORS AND IMPORT SUMMARY ERROR: “ To ensure the smooth operation of the DHIS2 Android application and maintain data consistency across the platform, HISP Pakistan/UiO addressed critical issues related to data synchronization and import summaries. A detailed diagnosis revealed that many synchronization errors stemmed from metadata discrepancies caused by frequent updates made by partners without adhering to established protocols. These uncoordinated changes often disrupted the synchronization process, leading to incomplete or incorrect data uploads. Additionally, cache-related errors in the Android application further compounded these challenges, impacting the user experience and data reliability. “ To resolve these issues, HISP Pakistan/UiO implemented targeted fixes, including enhancing metadata management processes to ensure that updates followed proper standard operating procedures (SOPs) and aligning server-client communication mechanisms to handle changes more efficiently. Cache handling was optimized to minimize errors, improving the application's overall functionality. These measures significantly enhanced the synchronization process, enabling users to work without data interruptions or inconsistencies. HISP PAKISTAN | PAGE 07 TECHNICAL SUPPORT TOOLS IN DHIS2: TOOL FOR MANUAL SYNC OF UNSYNCED ANDROID CASES: “ ○ To address challenges arising from unsynchronized cases in the DHIS2 Android application—primarily caused by frequent metadata updates that disrupted the synchronization process when standard operating procedures (SOPs) were not consistently followed—a specialized web application was developed. This custom tool was designed to facilitate the bulk import of data stored locally on Android devices, providing a solution to ensure accurate data capture and synchronization without requiring manual intervention. “ Frequent changes to metadata often rendered the Android app unable to sync data correctly, posing a significant obstacle to maintaining the integrity and timeliness of health data reporting. The web application bridged this gap by extracting unsynchronized data directly from the devices and securely uploading it to the DHIS2 system. This innovation not only resolved existing synchronization issues but also enhanced the overall reliability of the data flow. Tool Access: Available for stakeholders at https://hisp.pk HISP PAKISTAN | PAGE 08 TECHNICAL SUPPORT TOOLS IN DHIS2: DATE POPULATION TOOL Due to an error in the registration date field, a critical challenge emerged, impacting the integrity and completeness of the data. To address this issue, a custom solution was developed to retrieve and correct the missing or erroneous registration dates. This innovative tool was specifically designed to align with the requirements of the line listings, enabling programmatic population of the missing dates based on predefined rules and logic. By automating this process, the tool not only resolved the immediate data gap but also ensured consistency across the dataset. CACHE CLEARING TOOL Frequent metadata changes often caused caching issues, leading to delays in system performance. A tool was developed to automate cache clearing, triggered at regular intervals, ensuring that users always accessed the latest metadata and system updates METADATA ASSESSMENT & RESOLUTION Metadata discrepancies causing login delays and synchronization failures were systematically identified and resolved. This included aligning metadata changes across instances and ensuring consistent application behavior HISP PAKISTAN | PAGE 09 IMPACT OF INCORRECT ‘DATE OF BIRTH ENTRIES’ ON ANALYTICS PERFORMANCE “ In the Household Contact Screening stage in the TB Case-Based Surveillance System, an issue arose related to the "Date of Birth" field, which impacted analytics accuracy. The system was designed to allow users to enter the age in years, with the system automatically calculating and generating the corresponding date of birth. For instance, entering "39" would translate into "-" as the date of birth. However, a data entry error occurred when a user mistakenly entered the year as the age. For example, instead of entering the correct date of birth as "-," the user entered "1984" as the age. This led to an invalid age calculation, subsequently disrupting the analytics and reporting processes. To resolve this challenge, HISP Pakistan/UiO implemented a solution using an SQL query to identify and correct erroneous data entries. The query systematically checks the affected data element and its values. If a value is found that does not conform to the ISO-specified calendar format, it is automatically replaced with the correct format. This approach effectively restores data consistency and ensures that analytics processes operate SUPPORT FOR METADATA CONFIGURATION CHANGES: “ ● Android application issues stemming from server updates and metadata modifications were resolved to maintain system integrity. ● Errors in user-defined search and capture scopes were addressed by redefining relevant parameters, ensuring efficient search operations and reducing user frustration. ● Comprehensive error analysis and resolution notes were shared with stakeholders. This documentation provided clarity on problem causes and resolutions, fostering transparency and promoting proactive issue handling. HISP PAKISTAN | PAGE 10 RECOGNIZING THE NEED FOR EFFECTIVE METADATA MANAGEMENT AND COLLABORATION HISP Pakistan/UiO has identified critical challenges in managing metadata updates across multiple DHIS2 implementations, which often led to inconsistencies and inefficiencies. To address these issues, we have initiated the development of a structured change management document designed to update processes and promote consistent collaboration among stakeholders. This comprehensive framework aims to standardize and document metadata changes, ensuring clear communication and enhanced accountability. It details systematic procedures for proposing, reviewing, approving, and implementing updates, aligning them with organizational goals and system requirements. This initiative not only enhances operational efficiency but also support a more collaborative and transparent environment for all stakeholders involved. HISP PAKISTAN | PAGE 11 CUSTOM DASHBOARD DEVELOPMENT APACHE SUPERSET INTEGRATION To maximize the utility of DHIS2 data and provide stakeholders with actionable insights, HISP Pakistan/UiO implemented Apache Superset, an open-source business intelligence (BI) and data visualization tool, to develop user-specific dashboards. DHIS2 traditionally operates on three core dimensions: time, place, and data, enabling the effective tracking and analysis of health information across these axes. However, a critical fourth dimension—user analytics—was previously missing. This limitation hindered the ability to track and understand how users interacted with the system, which is essential for optimizing system adoption and effectiveness. To address this gap, HISP Pakistan/UiO devised a custom solution that directly accessed the DHIS2 backend, pulling user interaction data to generate detailed visualizations in Superset. This integration provided a comprehensive view of system usage patterns, enabling the creation of dashboards customized to user needs. The solution fulfilled key requirements identified by Mercy Corps (MC) and the Bill & Melinda Gates Foundation (BMGF), ensuring that DHIS2 data was not only accessible but also actionable. With Superset’s intuitive web-based interface, stakeholders can now explore, visualize, and analyze data more effectively, transforming raw information into meaningful insights that drive evidence-based decision-making. KEY DASHBOARDS DEVELOPED: TOTAL USERS TREND SYSTEM MONTHLY Visualizes the growth and distribution of users over time. Provides insights into user engagement patterns across public and private sectors. HISP PAKISTAN | PAGE 12 CUSTOM DASHBOARD DEVELOPMENT TOTAL USER ENROLLING CASES BY MONTH Monitors user activity over time, including enrollment trends. Enables management to evaluate user engagement and workload distribution. TB TOTAL NOTIFIED CASES BY PUBLIC/PRIVATE Displays a comprehensive overview of TB cases notified by public and private users. Allows drill-down functionality to view individual user performance, aiding in accountability and targeted interventions. HISP PAKISTAN | PAGE 13 CUSTOM DASHBOARD DEVELOPMENT DATA ENTRY USERS TREND BY PUBLIC/PRIVATE OVER PERIOD Analyzes trends in data entry activities across public and private sector users. Supports strategies to enhance data quality and completeness. USER VS TB REGISTRATION RATIO Tracks the ratio of users to TB registrations, providing insights into operational efficiency. Identifies areas where user engagement can be optimized to improve registration rates. HISP PAKISTAN | PAGE 14 CUSTOM DASHBOARD DEVELOPMENT TB TOTAL NOTIFIED BY PUBLIC/ PRIVATE USERS AND DRILL DOWN TO INDIVIDUAL USER PERFORMANCE This dashboard visualizes the total number of TB cases notified by public and private sector users, providing a clear comparison across sectors. The drill-down feature allows stakeholders to analyze performance at an individual user level, enabling targeted interventions and enhancing accountability. HIGHEST CASE OUTCOME PERFORMERS (PUBLIC, PRIVATE) This dashboard highlights users with the best TB case outcome success rates, such as treatment completions and cures. It fosters accountability, recognition, and motivation by identifying top performers and sharing best practices. HISP PAKISTAN | PAGE 15 DEVELOPMENT OF 14 DAILY MONITORING INDICATORS The HISP team, in collaboration with Mercy Corps (MC) and the Coordination Management Unit (CMU), developed a comprehensive set of indicators customized to the TB program within DHIS2. These indicators enable real-time program monitoring, ensuring precise tracking of activities and improving program outcomes. Clear indicator expressions were designed to support the analysis of key performance metrics such as daily case notifications, treatment initiation rates, and data completeness. The following indicators have been successfully integrated into the system: TB-07 Indicators 1 TB - New, Relapse & UK Pulmonary Bacteriologically Confirmed 2 TB - New, Relapse & UK Pulmonary Clinically Diagnosed 3 TB - New, Relapse & UK Extra Pulmonary Bacteriologically Confirmed 4 TB - New, Relapse & UK Extra Pulmonary Clinically Diagnosed 5 TB - Notified TB Cases (New, Relapse & UK All Forms) 6 TB - Total Pulmonary Bacteriologically Confirmed 7 TB - Total Pulmonary Clinically Diagnosed 8 TB - Total Extra Pulmonary Cases Bacteriologically Confirmed 9 TB - Total Extra Pulmonary Cases Clinically Diagnosed 10 TB - Notified TB Cases (All Cases, All Forms) 11 TB - Patients Tested HIV-Positive 12 TB - Total New, Relapse, UK & Pre-Treated Bacteriologically Confirmed with DST Result of Rifampicin Resistant TB-09 Indicators 1 Total Number of Patients Evaluated 2 Treatment Success Rate (TSR) HISP PAKISTAN | PAGE 16 HISP PAKISTAN | PAGE 17 TRACKING PROGRESS: INDICATORS AND REPORTS TB07 AGGREGATE REPORT HISP Pakistan/UiO enhanced the TB07 aggregate report by incorporating 18 new indicators in alignment with CMU guidelines. These indicators were designed to provide a comprehensive overview of TB cases and program performance, ensuring data-driven decision-making. Key additions included tracking ‘bacteriologically confirmed TB cases with drug-susceptibility testing (DST)’, offering critical insights into treatment planning and resistance trends. The inclusion of indicators such as the ‘number of patients tested using GeneXpert machines’ enabled stakeholders to monitor diagnostic equipment efficiency and utilization. To ensure data quality, the percentage of cases with complete data fields was tracked, promoting consistent and accurate reporting. Proportionbased indicators segmented by facility type provided valuable insights into completed treatments or investigations, highlighting care quality across different health facilities. Additionally, case outcome rates—covering cured, failed, and lost-to-follow-up cases—facilitated targeted interventions aimed at improving treatment success. Together, these enhancements have strengthened the program's ability to monitor performance and optimize TB care in Pakistan. HISP PAKISTAN | PAGE 18 TRACKING PROGRESS: INDICATORS AND REPORTS HISP PAKISTAN | PAGE 19 TRACKING PROGRESS: INDICATORS AND REPORTS 2. TB09 AGGREGATE REPORT: The number of TB patients registered in TB09 form is derived from the TB07 from, which serves as the primary data source. TB07 captures detailed information on individual TB cases at the time of diagnosis, including demographics, type of TB, and treatment initiation. This data is then aggregated into TB09, which focuses on treatment outcomes and overall program performance. The TB09 Aggregate Report for 2024 provides a detailed breakdown of tuberculosis (TB) patient registration, categorized under the "X" column, which represents the total number of TB patients registered during the year. This column offers a comprehensive overview of patient enrollment by TB type and gender. This disaggregation highlights the gender-specific burden of TB, enabling targeted interventions. HISP PAKISTAN | PAGE 20 ADVANCING GOALS: PROGRAM ACHIEVEMENTS Staff Daily Workplan Configuration In collaboration with the UiO expert and the HISP Pakistan/UiO team, the MC team actively participated in review sessions aimed at evaluating the daily work plans of monitoring staff. These sessions provided targeted recommendations to better align the staff's activities with program objectives and operational efficiency. To streamline processes, the HISP team developed and shared a comprehensive set of working lists. Those lists approved by the MC team were deployed to the production server, while others remained on the test server for further review. Staff Daily Workplan 1 Bacteriological Confirm Patients 2 Follow-Up Overdue on Follow-Up and Monitoring Stage 3 Outcome Due (Date Listing) 4 Schedule Follow-Up of Patients (Today) 5 Schedule Follow-Up of Patients (Weekly) 6 Schedule Follow-Up of Patients (Yearly) 7 DFS Workplan/Job Aids 8 Patient Enrolled and Notify 9 Patient Whose Outcome is LTF 10 Patient with Any Outcome 11 Patient with HIV Infection 12 Index Patients with Positive HH 13 Missed Tablet Entry 14 Index Patients with Missed HH Screening 15 List of Pending Outcomes HISP PAKISTAN | PAGE 21 CUSTOMIZATION AND IMPLEMENTATION OF THE HOUSEHOLD CONTACT SCREENING MODULE: ENHANCING TB CASE TRACKING AND FOLLOW-UP The customization and implementation of the WHO’s Household (HH) Contact Module to meet Pakistan's specific requirements marked a major milestone in enhancing the DHIS2 system. In March 2024, an expert from UiO visited Pakistan, during which the HISP Pakistan/UiO team organized a scheduled meeting with the Common Management Unit (CMU) and Mercy Corps (MC) teams. This meeting highlighted the newly customized HH Contact Module, developed collaboratively by UiO and HISP Pakistan/UiO to address the country's unique needs. The module, a highly anticipated feature requested by both MC and CMU, successfully bridged critical gaps in tracking household contacts, significantly enhancing the system's capacity to support public health interventions. STRENGTHENING DATA SYSTEMS THROUGH METADATA MAPPING, HISTORICAL DATA INTEGRATION, AND ORGANIZATIONAL ALIGNMENT ● To enhance the quality and accuracy of program-specific reporting, a comprehensive metadata mapping initiative was conducted. This effort aligned all data elements and organizational units with the specific reporting requirements, ensuring that the data framework met program objectives efficiently. By standardizing metadata, the initiative streamlined data collection, analysis, and reporting processes, thereby improving decision-making and program management. HISP PAKISTAN | PAGE 22 ● Simultaneously, historical data for the Mardan district was imported in bulk, marking a significant milestone in the system’s ability to monitor long-term trends and evaluate performance comprehensively. The integration process adhered to rigorous validation protocols to maintain data integrity, ensuring that the imported data could reliably support analysis and planning. The availability of this historical dataset equipped stakeholders with actionable insights, enabling them to identify trends, assess progress, and make evidence-based decisions to strengthen program outcomes. ● Additionally, organizational unit mapping was conducted with precision, standardizing the structure of historical data imports across all levels of the health system. This initiative ensured consistency in data representation, facilitating seamless reporting from individual health facilities to national-level aggregation. By harmonizing organizational units, the project not only strengthened the integrity of the reporting system but also reinforced the foundation for future datadriven initiatives. ENHANCED HIV MODULE FOR COMPREHENSIVE DATA MANAGEMENT The HIV section of the TB Tracker has undergone significant updates to align with the new RR tool and improve the accuracy of aggregate TB07 reporting. These enhancements address the limitations of the earlier version by streamlining data entry, improving data granularity, and ensuring comprehensive reporting. Previously, the HIV section provided only basic information, such as whether a patient was tested for HIV, with limited fields for capturing detailed results or next steps. The updated version now includes fields to record HIV screening results (e.g., reactive or non-reactive), referral for confirmatory testing, and confirmation of HIV-positive status at designated centers. These additions ensure robust data capture and facilitate accurate aggregation for reporting purposes. Moreover, the new HIV section incorporates fields to track ART enrollment, including ART status, patient IDs, and start dates, which were absent in the earlier version. This allows for better monitoring of patient care pathways and adherence to treatment. HISP PAKISTAN | PAGE 23 SERVER CAPACITY AND UPGRADE Deployment of DHIS2 Server Tools for Enhanced TB Instance Management HISP Pakistan/UiO successfully deployed DHIS2 Server Tools to enhance the management and operations of the TB instance. These tools, available in the DHIS2 Server Tools GitHub Repository, have significantly streamlined administrative tasks, improved system reliability, and bolstered overall server management capabilities. HISP PAKISTAN | PAGE 24 Key benefits include: ●Automated Maintenance Tasks: Simplifying routine server maintenance, such as database backups, log rotations, and health checks, reducing the manual workload and ensuring seamless operation. ● Improved System Monitoring: Providing real-time insights into server performance metrics, enabling proactive identification and resolution of potential issues. ● Efficient Resource Utilization: Optimizing server resource allocation, enhancing system stability, and ensuring scalability to handle increasing data loads. ● Enhanced Security Measures: Integrating robust security protocols to safeguard sensitive TB program data, ensuring compliance with data protection standards. The deployment of these tools has been pivotal in ensuring the sustainability and scalability of the DHIS2-based TB case management system in Pakistan. CLOUD-BASED SUPPORT AND STAKEHOLDER ENGAGEMENT Stakeholder Support: ● On-job training sessions were conducted for the CMU and MC teams, focusing on using DHIS2 features effectively and troubleshooting common issues. Practical demonstrations were provided to build technical capacity and confidence. ● User manuals were developed for Android applications and analytics dashboards. These guides, tailored to the needs of the teams, facilitated better understanding and self-reliance in using the tools for data collection and reporting. Stakeholder Support: HISP is currently offering cloud support for training instances, demonstrating its commitment to facilitating effective training environments. This initiative involves leveraging cloud infrastructure to provide a scalable and accessible platform for educational purposes. By utilizing cloud services, HISP ensures flexibility, efficient resource allocation, and a seamless training experience, enabling users to engage with the training instances in a convenient and responsive manner. HISP PAKISTAN | PAGE 25 TRACKING AND ASSESSING PROGRAM PROGRESS To ensure the effectiveness and usability of the implemented systems, extensive efforts were made to gather feedback directly from end-users. These efforts included multiple field monitoring visits conducted by UiO experts, who engaged with users to identify challenges and areas for improvement. Additionally, valuable insights were obtained through in-depth discussions held during monthly coordination meetings and Principal Recipient/SubRecipient (PR/SR) forums. This collaborative approach facilitated a deeper understanding of on-ground realities, fostering a responsive and user-centered system development process. Field Visits by UiO Expert: Monitoring and Evaluation Field visits were conducted to evaluate DHIS2 implementation and gather user feedback on system usability. These visits focused on understanding field challenges and providing real-time solutions to improve system adoption. ● Dr. Olav Poppe, from the HISP Centre, University of Oslo, visited Pakistan as part of collaborative efforts. During his visit, Dr. Poppe explored one of the Referral aboratories for Tuberculosis, where he closely examined the DHIS2 TB Tracker system in action. The primary objective of this visit was to gather valuable feedback from laboratory personnel to identify potential issues or shortcomings in the existing TB Tracker system. HISP PAKISTAN | PAGE 26 HISP PAKISTAN/UIO AND MERCY CORPS JOINT MONITORING AND EVALUATION FIELD VISIT, LAHORE (24–26 SEPTEMBER 2024) In September 2024, the HISP team, in collaboration with the Mercy Corps (MC) team, conducted a detailed facility-level visit in Lahore to address various issues encountered in the DHIS2 Android application. The visit was prompted by feedback from field staff regarding challenges in data synchronization, user interface functionality, and workflow efficiency within the application. During the visit, the HISP team engaged directly with field staff, observed their day-today operations, and provided on-site support to resolve several critical issues. These included troubleshooting app crashes, addressing data validation errors, and optimizing the application settings for better performance. The team also conducted handson training sessions to enhance the capacity of the staff, ensuring they could effectively use the application for data entry and reporting. In addition to resolving immediate challenges, the HISP team systematically documented a set of persistent issues that required further development and customization. These observations were compiled into a comprehensive report with actionable recommendations and forwarded to the University of Oslo (UiO) for future application updates. This collaborative effort underscored the commitment to continuous system improvement and emphasized the importance of user feedback in enhancing digital health solutions. HISP PAKISTAN | PAGE 27 PR/SR COORDINATION MEETING – LAHORE, MAY 8-9, 2024 The PR-SR meeting held in Lahore on 8-9 May 2024 was a pivotal event for collaboratively addressing key challenges in the DHIS2 implementation. The meeting facilitated active engagement between the Principal Recipient (PR) and SubRecipients (SRs), fostering a shared understanding of program objectives and operational hurdles. During the session, the team discussed critical barriers, including data synchronization issues, program rule errors, and user training gaps Comprehensive presentations and open discussions enabled the identification of actionable solutions, which were later prioritized for implementation. This meeting not only resolved immediate concerns but also set the stage for planning upcoming milestones, ensuring sustained progress in the DHIS2 initiative PR/SR COORDINATION MEETING – MURREE, OCTOBER 1-2, 2024 In October 2024, Mercy Corps (MC) conducted a PR-SR meeting in Murree, where issues faced in DHIS2 implementation were discussed systematically using presentations. The HISP team diligently HISP PAKISTAN | PAGE 28 documented all concerns raised, addressing and resolving the majority of them, including issues with program rules, syncing errors, and data entry challenges. Some unresolved concerns were escalated to the UiO team for inclusion in a future patch release. These resolutions and updates were subsequently communicated to the MC team during the following Monthly Coordination Meeting, ensuring clarity and continuous system improvement. MONTHLY COORDINATION MEETINGS: Regular monthly coordination meetings were convened throughout 2024 to ensure alignment among key stakeholders, including the Common Management Unit (CMU) and Mercy Corps (MC). ● These meetings provided a platform for discussing progress, identifying challenges, and refining strategies to enhance the DHIS2 TB Tracker. ● Updates from field monitoring visits, such as insights into user feedback and system usability issues, were reviewed to guide actionable decisions. ● Special emphasis was placed on addressing system bottlenecks, such as data synchronization issues, and tracking the implementation of proposed solutions. ● Outcomes included a refined work plan, updates to the user-change document based on stakeholder feedback, and better synchronization of public-private collaboration efforts. ● The meetings also facilitated knowledge sharing on new tools and features, such as the cache-clearing tool and bulk data import applications, ensuring widespread adoption and improved system efficiency. HISP PAKISTAN | PAGE 29 BMGF-HISDU CONSULTATIVE SESSION ON INTEGRATION During the visit of the Bill & Melinda Gates Foundation (BMGF) team to Pakistan, a pivotal meeting took place in Lahore with the Punjab Health Information and Services Delivery Unit (HISDU). This meeting marked an important milestone in advancing health data management initiatives in the region. HISP Pakistan/UiO engaged in an in-depth consultation with HISDU to discuss the interoperability of their Electronic Medical Records (EMR) system with the case-based TB surveillance system developed on DHIS2. Two potential integration approaches were proposed: The first involved utilizing DHIS2 for direct data entry and subsequently pushing the data to the provincial EMR system second suggested using the EMR system for data entry and transferring the data to DHIS2 While the EMR system functions as a broad Health Management Information System (HMIS), DHIS2 is uniquely tailored for TB-specific data collection and surveillance, presenting certain challenges for the EMR system. These challenges could require significant additional development work to align with the specialized requirements of TB data management. Both parties acknowledged the complexities involved and emphasized the need for further technical discussions to evaluate these options comprehensively. It was agreed to convene a follow-up meeting with the HISDU development team to delve deeper into the proposed approaches. However, the follow-up meeting could not take place due to the unavailability of the provincial team, resulting in a temporary delay in this critical integration initiative HIGHLIGHTS OF PARTICIPATION: ANNUAL CONFERENCE: The program transitioned from a paper-based system to the DHIS2 platform in 2018, with HISP configuring the system to meet the specific needs of Mercy Corps (MC) in managing the TB PublicPrivate Mix (TB-PPM) program. Now, the program boasts over 14,000 general practitioners and 400 low-level private healthcare providers actively HISP PAKISTAN | PAGE 30 contributing data across Pakistan's provinces. By the end of the year, the system had recorded 11,233 cases during the pilot phase, trained 87% of its user base, and mapped 88% of health facilities. These achievements underscore the program's progress in fostering real-time data analysis, interoperability, and intelligent TB planning through advancements like AI-driven hotspot mapping and the Rx Tracker Pharmacy Intervention. HISP PAKISTAN | PAGE 31 PARTICIPATION IN THE ASIA REGIONAL CONFERENCE The CMU presentation at the DHIS2 Asia Annual Conference highlights Pakistan's remarkable progress in leveraging DHIS2 for its TB control program. Over the years, Pakistan has successfully transitioned from aggregate reporting to an advanced casebased system tailored to national needs, with the support of UiO and HISP Pakistan/UiO. Key achievements include training over 500 healthcare workers, integrating MATCH AI for analytics, and developing PPM dashboards for enhanced TB case management. By December 2024, the system boasts over 186,000 registered cases with 99% data completeness, covering 126 districts and engaging 437 facilities. Integrated dashboards offer real-time insights, empowering data-driven decisionmaking and showcasing Pakistan as a regional leader in digital health transformation. HISP PAKISTAN | PAGE 32 UIO EXPERT-LED REMOTE SERVER EVALUATION To ensure the optimal performance and sustainability of the DHIS2-based TB case management system, HISP Pakistan/UiO engaged a technical expert from the University of Oslo (UiO) to conduct a comprehensive server assessment through a remote online visit. This evaluation focused on identifying potential bottlenecks, optimizing server configurations, and aligning the infrastructure with international best practices for health information systems. KEY ASPECTS OF THE ASSESSMENT INCLUDED PERFORMANCE ANALYSIS SYSTEM CONFIGURATION AUDIT A detailed review of the server's capacity to handle concurrent users and large-scale data processing, ensuring it meets the growing demands of the TB program Identification of configuration gaps and recommendations for enhancements to improve system responsiveness and stability HISP PAKISTAN | PAGE 33 UIO EXPERT-LED REMOTE SERVER EVALUATION DATA SECURITY EVALUATION SCALABILITY PLANNING Assessment of current data protection mechanisms, with tailored recommendations to enhance encryption, access controls, and compliance with global data security standards Development of a roadmap for infrastructure scalability, preparing the system to support an increasing volume of data and users over time CUSTOMIZED RECOMMENDATIONS UiO expert provided actionable insights tailored to the local context, facilitating the integration of cuttingedge server management practices The expert’s report highlighted the strengths of the current setup while offering targeted recommendations to further enhance the system’s reliability and efficiency. Following the assessment, HISP Pakistan/UiO initiated the implementation of these recommendations, reinforcing the system's capacity to deliver uninterrupted services for TB case management HISP PAKISTAN | PAGE 34 CONCLUSION The advancements achieved in 2024 reflect HISP Pakistan/UiO's steadfast commitment to transforming health information systems through the successful deployment and continuous enhancement of DHIS2. The year saw a focused approach towards overcoming technical barriers, integrating advanced tools, and ensuring alignment with both local and national healthcare objectives. This multifaceted approach has driven substantial improvements in the system’s functionality, enabling more seamless integration with existing health programs and improving their operational efficiency. Key accomplishments include the optimization of data entry processes, the development of robust data validation mechanisms, and the creation of tailored reports and dashboards to meet the specific needs of stakeholders, such as the Coordination Management Unit (CMU) and Mercy Corps (MC). Addressing issues related to mobile app versioning, data synchronization, and platform usability has further enhanced system reliability and accessibility for end users in the field. Furthermore, these technical advancements have significantly bolstered data accuracy, enabling the generation of high-quality, real-time analytics. This, in turn, has provided stakeholders with the necessary tools to make informed decisions based on reliable data, ultimately fostering a more effective response to public health challenges. The integration of innovative data management solutions has also strengthened reporting mechanisms, ensuring that actionable insights are readily available for decision-makers at both provincial and national levels. In parallel, HISP Pakistan/UiO has continued to prioritize capacity building through targeted training sessions and on-the-ground support for program managers and field staff. This approach has contributed to enhanced data literacy and technical expertise, ensuring that stakeholders are equipped to effectively use DHIS2 in their daily operations and contribute to improved health outcomes. HISP PAKISTAN | PAGE 35 STAY IN TOUCH WITH US! www.hisp.org.pk-