Demonstrating DHIS2 tracker success in large scale longitudinal client level service data and referrals for AGYW in DREAMS service delivery

BACKGROUND: One of the underpinning components of a successful PEPFAR DREAMS program is ensuring adolescent girls and young women (AGYW) receive all services in the primary prevention package and clinical services that meet each AGYW's individual HIV risk. This relies on 'active referrals' by DREAMS implementing partners to ensure that not only are they identifying which services the AGYW needs from another partner but to actively support and follow that referral to linkage. Paper vouchers passively provided have never managed to accomplish this task.
DESCRIPTION: PSI leveraged the DREAMS DHIS2 database in Malawi and Zimbabwe to manage referral workflows using a tracker program shared across partners. Partners issue referrals, indicating the service needed and receiving partner. To close referrals, the referring or receiving partner is able to confirm the outcome (whether linked or lost to follow up). Partners can view referrals received and linkage status of outgoing referrals in real-time. While the referral program is shared, the service outcome data captured in DREAMS relies on separate DHIS2 programs for each partner to maintain confidentiality.
LESSONS LEARNED: The scale of this implementation using DHIS2 tracker has demonstrated the ability of DHIS2 to stand up to this volume of longitudinal client tracking, providing an important use case for the new feature development in analytics and referrals workflow in DHIS2. The ability to seamlessly track data across partners allows for a deeper analysis into barriers to linkages: which services are slow to link, which geographic regions have the biggest challenge, and how community and facility partners are working together to support bringing the right care to the right clients.
CONCLUSIONS: Despite a robust referral system the biggest lesson is that on the ground efforts by partners are still key to manage linkages. This system exposed where referrals needed strengthening and will continue to allow programs to increase layering and linkage rates across IPs in support of DREAMS programming. Now that it's demonstrated that it is possible to leverage DHIS2 at scale for referrals and linkages, the PSI's development team shared the configuration as use cases with UiO to support the next round of DHIS2 innovations.

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