Figures & Tables
Figures
- FIGURE 1
High-Level Architectural Design of the Unified Data System Software Components, 2024
- FIGURE 2
Use of the UDS as a Digital Case Management Platform and Data Management Tool in the PEPFAR-Funded Community HIV Activities in Ethiopia, 2024
Abbreviations: CHCT, community HIV care and treatment activity; CHW, community health worker; CVC, caring for orphans and vulnerable children; DATIM, data for accountability, transparency, and impact; KPI, key performance indicators; KPP, comprehensive HIV prevention, care, and treatment for key and priority populations; RDQA, routine data quality assessment; SOP, standard operating procedure; UDS, Unified Data System.
- FIGURE 3
Illustrative Geo-Referenced Map Depicting Service Coverage and Utilization Based on UDS Mobile App Data in the PEPFAR-Funded Community HIV Activities in Ethiopia, 2024
Abbreviations: CHCT, community HIV care and treatment activity; CVC, caring for orphans and vulnerable children; KPP, comprehensive HIV prevention, care, and treatment for key and priority populations; UDS, Unified Data System; DIC, Drop-in center.
- FIGURE 4
Interactive UDS Dashboard Visuals Depicting Key Performance Indicators in (a) CHCT, (b) KPP, and (c) CVC Projects, Ethiopia, 2024
- FIGURE 5
Data Completeness Composite Score Dashboard for Index Contact Testing, Ethiopia
Abbreviations: CHCT, community HIV care and treatment activity; KPP, comprehensive HIV prevention, care, and treatment for key and priority populations.
Tables
- TABLE 1.
Characteristics of UDS Community-Based Service Delivery Points, End-Users, and User Accounts as of December 31, 2024, Ethiopia
Characteristic No. (%) Type of SDPa (N=950) Community SDPs 707 (74.4) Collaborating health facilities 201 (21.2) Drop-in centers 42 (4.4) Region of SDP (N=950) Amhara 317 (33.4) Addis Ababa 309 (32.5) Oromia 177 (18.6) Tigray 56 (5.9) Gambella 31 (3.3) SNNP 29 (3.1) Sidama 19 (2.0) SWEP 12 (1.3) Program area of SDP (N=950) CHCTb 475 (50.0) CVCb 199 (21.0) KPP 276 (29.1) UDS user accounts ever created (N=2,158) Mobile accounts 1,766 (81.8) Web accounts 392 (18.2) UDS accounts in use as of December 31, 2024 (N=1,407) Mobile accounts 1,066 (75.8) Web accounts 341 (24.2) Type of UDS app end-users as of December 31, 2024 (N=1,291) SDP-level usersa 950 (73.6) Above-site users 341 (26.4) Sex of UDS app end-users as of December 31, 2024 (N=950) Female 548 (57.7) Male 402 (42.3) Program area of UDS app end-usersa (N=950) CHCT 579 (60.9) CVC 264 (27.8) KPP 107 (11.3) Highest educational level of UDS app end-users (N=950) Bachelor’s degree 551 (58) Diploma 237 (25) Master’s degree 71 (7.5) Completed high school 59 (6.2) Other 32 (3.2) Abbreviations: CHCT, community HIV care and treatment activity; CVC, caring for orphans and vulnerable children; KPP, comprehensive HIV prevention, care, and treatment for key and priority populations; SDP, service delivery point; SNNP, Southern Nations, Nationalities, and Peoples; SWEP, South-West Ethiopia People; UDS, Unified Data System.
↵a The relationship between SDPs, community health workers (CHWs), and user accounts is characterized by a many-to-many relational complexity because a single CHW may manage multiple accounts across various SDPs, while a single SDP may be supported by multiple health workers. The number of CHWs and user accounts is also changing due to activation, deactivation, and reactivation of accounts based on workload, attrition, recruitment, or shifting geographic locations.
↵b Community SDPs could provide both CHCT and CVC services.
- TABLE 2.
Characteristics of People Registered in UDS as Beneficiaries as of December 31, 2024, Ethiopia (N=2,858,427)a
Characteristics No. (%) Sex Female 1,691,292 (59.2) Male 1,167,135 (40.8) Program area CVC 1,284,220 (44.9) KPP 977,066 (34.2) CHCT 597,141 (20.9) Region of residence Amhara 1,123,700 (39.3) Addis Ababa 790,556 (27.7) Oromia 558,888 (9.6) SNNP 145,024 (5.1) Sidama 80,110 (2.8) Tigray 79,341 (2.8) Gambella 54,045 (1.9) SWEP 26,763 (0.9) Abbreviations: CHCT, community HIV care and treatment activity; CVC, caring for orphans and vulnerable children; KPP, comprehensive HIV prevention, care, and treatment for key and priority populations; SNNP, Southern Nations, Nationalities, and Peoples; SWEP, South-West Ethiopia People; UDS, Unified Data System.
a Total number of forms submitted=20,336,335.
Level Data Access Level 1 Frontline CHWs at the SDP level collect and enter client-level data into the UDS system.
Paper-based records are used as sources of data during RDQA and data verification visits.
Mobile apps/accounts are used for client-level data collection and entry to the UDS system electronically.
Level 2 Local implementing partners can access “real-time” case data, form data, and configurable reports.
Partners can access the UDS database for data cleaning and quality checking.
Data are used by monitoring and evaluation and program staff for monitoring CHW activity.
Client-level data can be downloaded in .csv file for further analyses.
Level 3 Partners can access the UDS dashboard to track progress and gain insight.
Local implementing partners, government officials, and other stakeholders can access KPIs to facilitate data use for planning (target setting), review performance, and make data-informed decisions.
Data validation and testing can be completed prior to DATIM data import (for report submission to the next level).
Abbreviations: DATIM, data for accountability, transparency, and impact; RDQA, routine data quality assessment; UDS, Unified Data System.
- TABLE 4.
Technical Challenges Commonly Faced by Frontline Community Health Workers and Local Implementing Partners During Initial Rollout of the UDS, Ethiopia, 2024
Technical Issues Measures Taken Frontline Community Health Workers Mobile data outage (internet blackout) in areas with security problems Increased offline data persistence capability of UDS mobile app Mobile app dysfunction for data entry Installed the latest mobile app version Slow loading of cases in case list (mobile app taking too long to navigate and find clients from the case list) Divided location hierarchies with >6,000 number of beneficiaries; recommended device specification based on the number of beneficiaries Duplicated and wrong data entry Introduced validation logics, conducted data cleaning and data verification visits Delayed data entry Developed real-time data entry tracking metrics to track field-level operations by CHWs Incomplete data entry to CommCare/UDS Developed data completeness composite score monitoring dashboard Device loss due to damage or theft Provided device management training and standard operating procedure to CHWs End-users had the expectation that the move from paper-based to a fully digitized system would coincide with the initial rollout Developers clearly communicated with end-users about the time it would take to transition fully from a paper to digital system to set expectations Other technical issues UDS partners’ forum was conducted to discuss issues and put solutions in place Local Implementing Partners Mobile device misspecification Developers conducted testing of mobile app performance across SDPs with different number of beneficiaries, and they recommended device specifications based on the test results Data discrepancy and mismatch between dashboard and case data/form data available in the database Conducted data cleaning and validation checks Indicator computation challenges Joint review of indicator definitions and computational procedures Lack of some functionalities New features and functionalities were added, such as automated reporting of activity performance Sub-optimal data use Conducted monthly KPI review meetings to promote data use for reviewing performance and monitoring, reporting, and data-informed decision making Manual data entry burden to DATIM by local implementing partners Developers implemented DATIM data import for performance reporting electronically UDS complex data export and usage issues Provided training, developed user manuals and short tutorial videos on data merging and analysis Misunderstanding of some MER indicator definitions among partners The unified UDS dashboard guarantees consistency and accuracy of indicators across programs Bidirectional referral implementation issues Upgraded UDS software to track actual referral from designated mobile devices Software Developers System integration (with the national e-CHIS) Developers supported the Ministry of Health in developing and pilot testing of the HIV module within e-CHIS CommCare Power BI integration performance issues Implemented custom software layer to solve this issue Technical glitches and bugs Provided regular software maintenance Challenge in tracking dashboard usage performance Developers built a custom web application that displays Power BI dashboard and tracks usage statistics Mobile workers failed to enter client-level follow-up data despite service provision Developers added visual reminders to the UDS mobile app when client follow-up is due Abbreviations: CHW, community health worker; DATIM, data for accountability, transparency, and impact; KPI, key performance indicator; MER, monitoring, evaluation, and reporting; SDP, service delivery point; UDS, Unified Data System.
- TABLE 5.
Recommended Device Capacity and Specifications Allowing for a Maximum Loading Time of 10 Seconds, Ethiopia, 2024
No. of Beneficiaries per SDPa Recommended Device Capacity (RAM)b Recommended GPUb ≤2,000 2GB Mali-T720 MP1 GPU 2,001–4,000 3GB Mali-T760 MP8 GPU 4,001–7,000 4GB ARM Mali-G71 GPU >7,000 6GB Qualcomm Adreno 630 GPU ↵a Mobile app performance testing was conducted using Tecno Camon CX Air and Samsung Galaxy S-series models.
↵b Based on testing UDS performance on different types of phones, we observed that “UDS case list loading (rendering)” performance showed an improvement with increased GPU rating and by increasing the capacity of the RAM.
Abbreviations: GPU, graphics processing unit; SDP, service delivery point.
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