A WORKFLOW TO DEVELOP AND IMPLEMENT AN E-HEALTH INFORMATION SYSTEM IN WAR-TORN COUNTRIES: A CASE STUDY IN IRAQI KURDISTAN

Abstract

Conflicts and terrorism, especially when protracted, can deeply debilitate countries’ security and safety, with multidimensional impact even on the public healthcare systems. The long-term effects can last for years after the cessation of emergencies, with health data not available and / or not fully reliable, causing targeted health interventions to be almost non-existent. Despite health information systems (HIS) being paramount in contributing to national security by guiding public health decision-makers, policy formulation, resource allocation and quality control, many Middle East countries, especially when they are faced with security instability, at present still do not collect electronic records. As a case study from the field, we describe the workflow - development, implementation, challenges and lessons learned - to create, maintain and advance a HIS in the Iraqi Kurdistan, a war-torn region in the Middle East. After a pilot phase, in 2018, a HIS based on the open-source software District Health Information System 2 (DHIS2) was set up in the region. It collects diseases registered in public health facilities and health data coded using the international WHO nomenclature ICD-10. The HIS was adapted to the local scenario, with user interfaces provided in Arabic and Kurdish-Sorani languages. The Pentaho Data Integration tool was used to effectively automate the process of data integration and bulk import from local systems already in use. The aim of this study is to provide lesson learned from the field to support evidence-based public health decisions even in other war-torn countries.
Keywords: Public health; epidemiological surveillance; e-health; electronic records; District Health Information System 2 (DHIS2)

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