ObjectiveThe recent 2014 Ebola Virus Disease (EVD) outbreaks rang the bell to call upon global efforts to assist resource-constrained countries to strengthen public health surveillance system for early response. Malawi adopted the Integrated Disease Surveillance and Response (IDSR) strategy to develop its national surveillance system since 2002 and revised its guideline to fulfill the International Health Regulation (IHR) requirements in 2014. This study aimed to understand the state of IDSR implementation and differences between guideline and practice for future disease surveillance system strengthening.MethodsThis was a mixed-method research study. Quantitative data were to analyze completeness and timeliness of surveillance system performance from national District Health Information System 2 (DHIS2) during October 2014 to September 2016. Qualitative data were collected through interviews with 29 frontline health service providers from the selected district and 7 key informants of the IDSR system implementation and administration at district and national levels.FindingsThe current IDSR system showed relatively good completeness (73.1%) but poor timeliness (40.2%) of total expected monthly reports nationwide and zero weekly reports during the study period. Major implementation gaps were lack of weekly report and trainings. The challenges of IDSR implementation revealed through qualitative data included case identification, compiling reports for timely submission and inadequate resources.ConclusionsThe differences between IDSR technical guideline and actual practice were huge. The developing information technology infrastructure in Malawi and emerging mobile health (mHealth) technology can be opportunities for the country to overcome these challenges and improve surveillance system to have better timeliness for the outbreaks and unusual events detection.

and, conversely, the construction of composite objects out of individual parts have long been recognized as ubiquitous and essential mechanisms involving abstraction. This applies, in particular, in areas such a s CAD, manufacturing, software development, and computer graphics. Although the part-of relationship is distinguished in object-oriented modeling techniques, it ranks far behind the concept of generalization/specialization and a rigorous de nition of its semantics is still missing. In this paper we rst show i n w h i c h w ays a shift in emphasis on the part-of relationship leads to analysis and design models that are easier to understand and to maintain. We then investigate the properties of part-of relationships in order to de ne their semantics. This is achieved by means of a categorization of part-of relationships and by associating semantic constraints with individual categories. We further suggest a precise and, compared with existing techniques, less redundant speci cation of constraints accompanying part-of categories based on the degree of exclusiveness and dependence of parts on composite objects. Although the approach appears generally applicable, the object-oriented Uni ed Modeling Language (UML) is used to present our ndings. Several examples demonstrate the applicability of the categories introduced. Index terms: Conceptual modeling, object-oriented analysis, object-oriented design, part-of relationship, part-of relationship categories, partonomy, aggregation, semantic constraints, object lifecycle. OO-terms categories of characterization, method used part-of relationship comment, example Booch has-relationship by-value aggregation part p is a part of the state of whole w, aggregation by-reference aggregation attributes are considered parts OMT part-of-relationship not distingusished attributes are not considered parts, operation aggregation propagation to be considered Jacobson consists-of relationship not distinguished an aggregate is composed of other objects, its parts composition partonomies are considered Martin/ composed-of relationship mutable composition composition is the act or result of forming Odell composition immutable composition an object from its component p a r t s Embley part-of-relationship part-of distinguished attributes are considered parts, e.g., aggregation from member-of Ordernumber part-of Order but: Student m e m ber-of StudentClub UML whole-part relationship by-value aggregation composition indicates that the lifetime of the parts version 0.9 aggregation or composition is dependent on the lifetime of the whole and 1.0 by-reference aggregation by-value aggregation is semantically equivalent t o an attribute properties: transitivity, a n tisymmetry

Objective: The emerging and recent 2014 Ebola Virus Disease (EVD) outbreaks rang the bell to call upon efforts from globe to assist resource-constrained countries to strengthen public health surveillance system for early response. Malawi adopted the Integrated Disease Surveillance and Response (IDSR) strategy to develop its national surveillance system since 2002 and revised its guideline to fulfill the International Health Regulation (IHR) requirements in 2014. This study aimed to understand the state of IDSR implementation and differences between guideline and practice for future disease surveillance system strengthening.Methods: This was a mixed-method observational study. Quantitative data were to analyze completeness and timeliness of surveillance system performance from national District Health Information System 2 (DHIS2). Qualitative data were collected through interviews with 29 frontline health service providers from the selected district and key informants of the IDSR system implementation and administration at district and national levels.Findings: The current IDSR system showed relatively good completeness (76.4%) but poor timeliness (41.5%) of total expected monthly reports nationwide and zero weekly reports. The challenges of IDSR implementation revealed through qualitative data included lack of supervision, inadequate resources for training and difficulty to implement weekly report due to overwhelming paperwork at frontline health services.Conclusions: The differences between IDSR technical guideline and actual practice were huge. The developing information technology infrastructure in Malawi and emerging mobile health (mHealth) technology can be opportunities for the country to overcome these challenges and improve surveillance system to have better timeliness for the outbreaks and unusual events detection.

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The adoption of Electronic Medical Records Systems (EMRs) is on the rise in developing countries due to the need to ensure improved quality of healthcare through client continuum and monitoring and information sharing through collecting detailed, good quality and reliable information overtime. In spite the benefits of EMRs, their success depends on use and satisfaction of users with the system. Recently National Tuberculosis and Leprosy Program of Tanzania adopted an EMRs known as the DHIS2 Tracker to help with case management, improve reporting and reduce lost to follow-up cases. This study therefore aimed to investigate factors influencing use and user satisfaction of DHIS2 Tracker by adapting both the DeLone & McLean Model with the Technology Acceptance Model. The research model consisted of six factors from which an online questionnaire using google forms was developed and shared with users of the system. In order to assess the relationship between factors, nine hypotheses were developed and multiple regression analysis was conducted.The analyzed data supported five out of nine hypotheses and indicates that system quality and attitude have positive significant influence on both system usage and user satisfaction, while use of the system has a positive significant influence on satisfaction. However, user background and information quality do not have significant influence on either use or satisfaction of DHIS2 Tracker. These findings help implementers understand areas of focus during implementation of DHIS2 Tracker.

League tables are used to compare the performance of different entities in the health systems in developing countries. The aim of this paper is to study the implementation process and its effects related to a computerized league table application in Malawi. Focusing on the health district and using a field experiment research approach, the focus is on the implementation process and how it improves information transparency for health managers. Based on routine health data recording in the health management information system DHIS2, the introduced league table was used by the district health management teams in the pilot districts to rank and compare performance among their health facilities. While the introduction of the league tables was challenging, it also showed its potential through effects including improved visibility of information and accessibility for managers, better understanding of indicators, the identification of data quality issues, skills acquisition in computing and information use and improved communication and collaboration among stakeholders.

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This study identifies the problems related with target setting for immunisation service in Ethiopia. We adopted qualitative case study and drew concepts from institutional theory to collect data and analyse our findings. The findings showed that the plan of district health offices depends on the population data projected from census. Peripheral level health workers, on the other hand, enumerate the number of population in their respective localities. Subsequently, the ambiguity occurs from mismatch between the target from census and number of eligible children counted by health workers. Health facilities are expected to follow the target given from district health offices, which is higher than the local count in most cases. Thus, we found most peripheral level health workers considered that the inflated target given from the projected census lowers their achievements, since their performance should be calculated against the given target. This in turn affects the incentive given, thus, has implication on job satisfaction and performance. The need of considering the reality at the ground, rather than following only the formal institutional rules is emphasised in order to address the identified impediments.