Successes and Challenges of the District Health Information Software Version Two (DHIS2) Adverse Events following Immunization (AEFI) Tracker Application at the early implementation stage in Bangladesh

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In 2021, Bangladesh implemented the District Health Information System, version 2 (DHIS2), as the national platform for the surveillance and reporting of adverse events following immunization (AEFI). The study aimed to explore the existing AEFI surveillance systems functioning with the DHIS2 AEFI tracker by evaluating the strengths and challenges. We used an exploratory mixed-methods design to assess the existing AEFI surveillance reporting systems at the early implementation stage. Data were collected between March 2024 and June 2024 from Dhaka, Chattogram, Sylhet, and Rangpur divisions of Bangladesh. Qualitative data were collected through key informant interviews (KIIs) and focus group discussions (FGDs), and case-based data quality assessment (DQA) was analyzed by measuring quantitative data. Thematic analysis was conducted to analyze the data, and NVivo was used to facilitate data analysis. We obtained information from 28 KIIs, 6 FGDs, and 95 matched DQA forms from the selected sites. We organized our qualitative results into four thematic approaches: workforce capacity, system functionality, data quality, and sustainability. We found that the system enhances the accuracy of data collection, preventing late data submissions and limiting incorrect entries, which helps to reduce human error, ensure safe data storage, and real-time data synchronization across platforms. Through the DHIS2 system, AEFI data quality is improved through easy accessibility, which enhances data analytical capability, but there is still a system loss of data entry by designated staff, and technological difficulties delay the work. We identified some challenges, including interrupted internet connectivity, power outages, technical difficulties with system access, delayed data entry, insufficient training, and high workloads for the relevant staff. The DQA analysis revealed that the AEFI paper-based reporting forms (75.04%) were more complete than the corresponding entries in the DHIS2 AEFI Tracker Capture App (67.87%), and only 7% of data entries were completed in the electronic system within 24 hours. We have identified some major challenges related to infrastructure, operations, and human resources. A structured training program, supply of adequate devices, supporting qualified staff, and offline data entry are recommended to enhance data completeness and data timeliness for the DHIS2 AEFI application in Bangladesh.

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