EpiCentre

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Epi-Centre

• Experience in the
• Indian TB Programme

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The dimensions..

• Country population 1.14 billion
• 27 States and 8 Union Territories
• 632 district with average population of 2 million
• 1.3 million TB patients registered annually
• 0.5 million New Sve treated annually
• Programme surveillance through Epi-Centre
  software since 1999
• 96 electronic reporting
• Nearly 1000 users

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Population in India covered under DOTS and total
tuberculosis patients put on treatment each
quarter
Nationwide DOTS coverage achieved in Mar 2006
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Case detection rate and treatment success rate in
DOTS areas, 1999-2006

• Estimated no. of NSP cases - 75/100,000
  population per year (based on recent ARTI report)

• Estimated no. of NSP cases - 75/100,000
  population per year (based on recent ARTI report)

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Programme Surveillance System
Peripheral Health Facility
Monthly Report (referral of suspects, microscopy
activities, drugs logistics)
TB Register
Sub-district level Tuberculosis Unit In every
500,000 population
Quarterly Report (CF, SC, TO PM)
District TB Centre
Data entered at District level
Quarterly Feedback
Quarterly Report send by email
Central TB Division
State TB Cell
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Inputs to the system..
Epi-Centre installed
Tuberculosis Unit
District TB Centre
120 WHO field Consultant Network
Epi-Centre installed
State TB Cell

• ?Network Administrator
• ? Email server
• ? Software Team
• System Analyst
• Data Analyst
• Programmer
• Data Entry Operators

Central TB Division
Epi-Centre installed
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Result .
Annual report published on the following World TB
day (within 90 days)
Quarterly reports consistently published within
50 days
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Epi-CentreAn Epi-Info based software to Create
and Evaluate National Tuberculosis REports
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Who uses it ?

• Data entry operators (DEO) at District / State /
  Central level
• District TB Officer / State TB Officer
• WHO field Consultants
• Monitoring Unit at Central TB Division

Nearly 1000 user at various level
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Advantages

• Epi-Info (DOS) based. So License free freely
  distributable.
• Validation of data at source.
• Small sized REC file easily transmittable over
  email, works even in places with weak
  connectivity.
• Remote maintenance over phone or email.
• Menu driven
• Raw data remains at source enabling further
  analysis for immediate corrective actions
• Automated merging of data in the Central database

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Data entry
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Data entry of Case finding report
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Data entry of Case finding report contd.
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Data entry of Case finding report contd.
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Data entry of Case finding report contd.
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Data entry of Smear Conversion report
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Data entry of Smear Conversion report contd.
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Data entry for Result of treatment
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Data entry for Result of treatment contd.
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Data entry for Result of treatment contd.
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Data entry for Result of treatment contd.
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Data entry for Result of treatment contd.
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Data entry screen for Programme management
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Resources required

• Hardware
• One computer with internet connectivity per
  district and per state.
• Central level email server and file server.
• Software
• Epi-Centre in-house development by WHO based on
  free Epi-Info software.
• Maintenance (enhancements thru software update
  patches).
• Human resource
• In-country Central level support team.
• Data Entry operators at district, State Central
  level.
• Training of DEOs.

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Flexibility..

• Exports data to MS-Excel
• Annual Report and Quarterly Performance
  Evaluation report prepared in MS-Excel.
• Exports data for GIS application
• ArcView GIS uses exported data from Epi-Centre.
• Exports maps for Powerpoint

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Adaptability..

• Adapted for other countries like
• Nepal currently using it.
• Bangladesh, Indonesia started every
  enthusiastically but discontinued due to lack of
  continued support.
• An estimated 15-20 developer days are required
  for adapting to country specific requirements and
  forms with a follow-up 3-7 days visit for
  cleaning software bugs and doubts.

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Lesson learnt ..

• Frequent changes in RR forms creates-
• Different version of the software in the field.
• Inconsistent linkages with previous data.
• Managing software becomes very difficult.
• Trained staff turn-over is a major constraint to
  100 e-reporting.
• Administrative commitment necessary
• Dedicated Central level monitoring unit most
  necessary (slowly build capacity at lower
  levels).
• Prior arrangements for sustaining the support.

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Impact of Epi-Centre.

• Substantially improved programme monitoring
  supervision.
• Timely, complete error-free compilation,
  analysis and publication of quarterly data.
• Simple and fast data transfers.
• Facilitates detailed data analysis at all levels
• Revised Indian RR successfully implemented via
  Epi-Centre.
• Improved Drug distribution and reporting leading
  to no significant drug stock-outs in the recent
  years.

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Recommendations..

• Frequent changes in forms should be avoided to
  reduce frequent updates in the software
• Detailed planning prior to introduction of
  Epi-Centre in a country-
• Development cycle
• Training implementation
• Enhancements and bug removal
• Data analysis and feedback mechanism
• Sustainability issues
• Country-level helpdesk, master trainers and data
  managers with some elementary programming skills.
• IT group comprising of system designer, developer
  at Regional / HQ level providing developmental
  support.

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EPI-CENTRE Users Manual
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Future ..

• Window based Epi-Centre almost ready for
  field-testing using
• VB
• MS-Access at district and state level.
• SQL-Sever at central level.
• Crystal reports for power reporting.
• Map-Objects for GIS.
• To be linked with a web based application

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Modules of the new software

• Functional
• Quarterly data entry analysis
• Automatic transmission of data thru email
• Thematic representation of data on maps.
• Export data to Excel
• Planned
• Drug logistics management
• Budgeting Finance
• Demographical information
• Automated feedback alarming system

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How the new system works..

• Aggregated quarterly sub-district level data
  entered at district computer.
• Automatic emailing of data and automatic
  uploading of data into the central database from
  emails directly.
• Analyze data using pre-programmed standard
  reports on charts, tables and maps
• Export data to MS-Excel
• Export maps/charts to MS-Powerpoint

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Sample of a data entry screen
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Email send and receive screens
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Sample GIS output
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Export data to MS-Excel
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Conclusion.

• Epi-Centre has been successfully implemented in
  India and Nepal as a electronic programme
  surveillance system based on aggregated data
• Epi-Centre has been one of the factors behind the
  success of the India TB programme
• Many lessons learnt which would be useful for
  other countries
• New Epi-Centre software being developed to
  improve upon the previous DOS version

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Thank you