Malaria Research Center is a young site that wants to establish a very powerful and dynamic DSS department in order to be able to produce every information within its catchment area.
We therefore need help on how to go about it. Things needed for the set up including logistics including budgeting advice as well as the training of staff for this big project
Thank you for your post, this is an excellent question and I am sure there are many people who can advise on how they initiated their DSS, and how they gained funding for one.
In the meanwhile, I have contacted INDEPTH. There are several INDEPTH networks in Ghana who may be able to help. INDEPTH themselves provide a number of toolkits to help you with the initiation stage, for example:
Unfortunately they don't provide funding, but perhaps others can advise on that. It does look like INDEPTH themselves will help you to manage your funding effectively, plan, and budget.
The Editorial Team
Most national health authorities have some sort of a disease surveillance program. It is important to understand the requirements in your country, so that you develop and implement a system, which captures all the necessary information.
Here is some information that you should consider.
1. You will need to design collection tools for field workers, (paper or electronic);
2. You will need to develop and implement standard operation procedures (SOP);
3. You will need to train all users of the system, as appropriate;
4. Monitoring should be done, to ensure that data from the field is accurate;
5. If using paper, you will need personnel to input data into a database;
6. The electronic system should capture all required information per health authorities requirements;
7. The electronic system should be searchable, and have the capability to produce printed reports, especially if you have to submit hard copies the the health authorities.
8. Ensure that the electronic system is developed and validated according to accepted software development standard, and that all documentation is maintained, in case of an audit or inspection.
9. Ensure that the system supports patient data protection, and has all the necessary security provisions.
I am not sure what the budget would be for implementing this type of system, or where to obtain funding, but you may want to start at your local WHO office, USAID, and other similar organizations for guidance.
I hope this information is helpful.
Thank you very much for your response especially Barbara.The next question is how do we start and from where do we start from? Thus aside developing of SOP and the training
You may be interested in the following link, which shows how the Navrongo HDSS was set up, and also contains information about how it was funded, how many people are in the team and what their roles are, the area covered, and so on:
Hopefully this should help to give you some ideas.
Do you have a clear idea of the distance/number of individuals you want to cover, and what sort of data you'd like to collect?
The Editorial Team.
Everyone has given some very useful insights and I would like to add a few things based on my experience in data management.
1. I think it is ok to have a hybrid system depending on the infrastructure available in your area. For example, if you have an area where electricity is a major problem then paper might be useful or if you are in an area with good mobile network coverage then a solution that uses mobile devices will ensure accurate and quick data collection. I think there are software solutions that allow for this.
2. Consider a solutions that allows for scalability. By this I mean that you might want to start with a few areas and then include more areas as you establish the site implying that whatever data management solution you settle on should be able to handle more and more data and users without forcing you to change over to another system
3. Depending on the solution you choose, consider the personnel available to you and how much training is required in terms of time.
4. Linked to point number 3 is that you need to adequately prepare in terms of training time and piloting. You are better of spending more time getting things laid out appropriately rather than fighting fires later. In other words training is a key thing together with all the documentation that goes along with it eg SOPs and detailed manuals.
5. If you do choose to use an electronic solution then you will need to consider the hardware and software side of things. I usually recomment using linux based systems as they offer a more stable environment(in terms of virus infections).
6. Consider the personnel you have available to manage your whole system ie IT support and data managers. That also determins the solutions that you will settle on.
7. In terms of logistics...all the above apply. Consider how far out data collection points will be spread out, how many monitoring/supervisory visits per site? Or would phone calls work just as well? How much can you invest in terms of monitoring so as to reduce field visits that might be costly?
I think the above matters then affect your budget in one way or another. So for example if you choose to purchase a software solution thern there are licensing costs to that or depending on how much time you have allocated for training and piloting then there are cost implications and so on (that's my input in terms of budgeting). I would say first deciding on what you wold like to see happening then put a cost to the items...it can be an iterative process.
Frank Baiden of the Navrongo HDSS has kindly provided the following information:
About the setting up of DSS. The first question to satisfy is why set up a DSS. That question must be answered unambiguously to justify and motivate progress in so doing. This is because it is quite expensive and involving to set up and maintain. Donors hardly give support to "just" support the running of a DSS.
In many instances, DSS are established primarily to meet the need of a project, usually well-funded projects. Eg. vaccine studies, large prospective studies that require clear population-wide denominators to evaluate its outcomes, with minimal loss to follow-up.
Having satisfied the above, the next thing to define the area within the DSS is to cover. The size is dictated by the motivation for its establishment. Personnel critical to DSS establishment include demographers, field epidemiologist, data managers and a large number of field staff.
The field workers (minimum of high school graduation) need to have a map of the area and systematically plan how they will go from household to household to enumerate all persons living within all households. The tools for such enumeration are available through the INDEPTH network. Each household should be given a unique identification code, and further to that each person enumerated should have a unique ID. It is during this baseline enumeration that you incorporate questions that peak to the reason the DSS is being established. e.g. if the interest is to do work related to family planning, you will include questions about family use, desired family sizes etc. The database constitute the baseline.
You will need to decide how many rounds of survey you will have to update the baseline. Some DSSes do twice yearly, others thrice. Once a year is usually considered too long and not effective to keep track. It is the continuous updating of the database that defines the DSS. And of course also makes it expensive to maintain well.
Once established and well-maintained however, it is attractive for researchers because it gives good denominators and the IDs makes it possible to track study participants. The database can also be used to generate representative samples for field research work.
I need however to add (importantly) that in between surveys rounds, vital events i.e. births, deaths, pregnancies, in and out-migrations need to be picked and the information used to update the database. In Ghana these events are picked by by community-based volunteers who receive a token as they pick such events and report them.
Well! This this is a snapshot. Some further details can be obtained by getting in touch with the INDEPTH network.
Osman Sankoh, Executive director of the INDEPTH network (and based in Accra) has kindly given the following information:
To establish an HDSS in Ghana where INDEPTH has its headquarters and where three HDSSs are located across the country, the best is visit either the INDEPTH Secretariat or any of the existing HDSSs.
Otherwise we can send Buabeng on CD our HDSS Strater and Resource Kits. All his questions will be answered.
How do you hope to obtain funding for such a project? Even though this is not for profit, it may be worth taking a leaf out of some business principles and writing out a vision / business plan. A few thoughts ( by no means exhaustive):
- how much will such a scheme cost within a specific unit of time? Please be detailed with the training required, size of catchment area, staff, filed workers and public health professionals needed, etc.
- how any volunteers would take part in the project, and what's in it for them?
- Frank Baiden above touched on the project bring well run when established. How will you ensure that this would happen, and what skills do you possess that would ensure this ?
- how would you use the funding, and how do you intend to utilise the collected information and data?
- such a plan, if well written and laid out, will be your foundation for the implementation of the entire project, and your document to obtain funding.
Pleas contact me (firstname.lastname@example.org) or the website www.bluecloudhealth.com if you need some free advice and help to set this up.
In the meantime, good luck!!!
sir I want to know about feasibility issues regarding establishing of a HDSS in rural area where not much is known.
THANK YOU..WHAT IS THE STEPWISE APPROACH TO ESTABLISH A HDSS.
Dear Dr Suresh
thank you for your comment. The information and links above give quite a lot of information on both these issues - do you have specific questions that you feel are not available from the information above? If so please feel free to post them here.
The Editorial Team