SysRef - Digital System for a Better Health Care Management of Refugees

Common health problems of refugees and displaced population groups in the Sahel region are infectious diseases, particularly respiratory infections, acute diarrheal diseases, malaria and malnutrition, as well as general mental illnesses such as post-traumatic stress disorder, depression, and psychosis. The project "Digital System for a Better Health Care Management of Refugees" (SysRef) aims to improve the quality of health care for refugees and displaced people in Chad living in refugee camps. 

Measures to improve health care management include the development, validation and implementation of digital tools. The project thus pursues the following objectives: (i) improving the diagnosis and treatment of infections and other health problems, such as mental illness among refugees and displaced people; (ii) a follow-up of specific target groups, such as pregnant women; (iii) registration of vaccinations and monitoring of vaccination status; and (iv) automatic collection and assessment of epidemiological data. Their transferability to regions with comparable humanitarian crises is assessed.

The digital solution consists of four components. The largest one is a clinical decision support system (CDSS) tool building on the choice of symptoms to provide clinical and therapeutic guidance to health professionals (nurses and midwives) covering a whole lifespan. The other tools include an electronic register for pre- and postnatal consultations integrating a CDSS covering frequent complications during and after pregnancy, an electronic vaccination register and an epidemiologic database (DHIS2 dashboard) including epidemic prone and notifiable diseases and key project indicators.  

The project timeframe is 4 years from 2019 to 2022 and includes the phases of a situation analysis, development and validation of digital tools, implementation and use of tools, and dissemination of results and analysis of the replicability. The project is coordinated by the Swiss Tropical and Public Health Institute (Swiss TPH) in close collaboration with the ‘Centre de Support en Santé Internationale’ (CSSI), the Ministry of Health and the UNHCR in Chad. The digital system is piloted in three primary health care centers in the district of Goré in South Chad bordering the Central African Republic.  

Update from July 2022:  

The project team developed, validated and implemented all four digital tools, the CDSS covering for the time being the integrated management of childhood illnesses of children aged 2 months to 5 years. More than 12’800 consultations were made using the CDSS.  The CDSS covering the management of health issues in adults is currently being validated. A first user satisfaction survey indicates that local health workers are very motivated to work with the tool and its use is also well accepted by the patients.

The local project team based in Goré bears much responsibility across all phases, and therefore a substantial technical capacity transfer of the clinicians and ICT specialists was strived since the beginning. Local ownership was strengthened by closely involving national clinicians and health professionals, including from the pilot health centres in the process. The replicability of the digital tools includes the adaption and piloting the children’s CDSS in the national health system from 2023 to 2026 in two health districts enrolled in the regional health support programme (programme d’appui au district sanitaire, PADS) funded by the Swiss Developpment Cooperation (SDC). A collaboration with International Rescue Committee working in refugee camps in eastern Chad is under negotiation for the implementation of the management and follow-up of adult persons suffering from mental health issues, which is included in the adult CDSS.

The SysRef digital solution offers clinical guidance to the health care providers to improve the clinical management (detection, treatment and prevention) of priority health conditions among the refugee population, follow-up of vaccination status and pre-and post-natal consultation, and provides early detection of potential local epidemics. With a broad range of clinical diagnoses covered by the CDSS, including potentially emerging infectious diseases such as Dengue and Chikungunya and potentially endemic diseases of poverty such as Buruli ulcer, the digital solution contributes to health-facility based passive surveillance and response. The Chadian Ministry of Health will have access to improved routine reporting and quality data allowing for burden of disease estimates.

Please find here the study report (in French) and a sythesis of the report (in English) for further information.

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