8.3 EPI-info

The health authorities in Tigray was not without computerised support in their information handling. They used a system called Epi-info, both at the bureau and in the districts. This system is developed and maintained by Centers for Disease Control and Prevention (CDC). CDC is a operating component under Department of Health and Human Services in the government of United States. EPI-info is in the public domain, so you can basically do what you want with it. They currently develop and maintain a Windows version of the software, but a DOS version is also available.

In Tigray they still used the DOS version, but Windows versions were also in use. To get an better understanding of what DHIS had to ‘compete’ against I am going to do a comparison between Epi-info and DHIS in this section.

This is the description of the Windows version from epi-info’s web site. The older DOS version together with the Geographical Information System (GIS)-tool EPIMAP have the same functionality, but is more difficult to use.

Epi Infois a public domain software package designed for the global community of public health practitioners and researchers. It provides for easy form and database construction, data entry, and analysis with epidemiologic statistics, maps, and graphs. The primary applications within EpiInfo are (CDCP 2005):

A program for creating forms and questionnaires which automatically creates a database.
A program for using the forms and questionnaires created in MakeView to enter data into the database.
A program for producing statistical analyses of data, report output and graphs.
A program for creating GIS maps and overlaying survey data on to them.
A tool that allows the user to combine Analysis output, Enter data and any data contained in Access or SQL Server and present it in a professional format. The generated reports can be saved as HTML files for easy distribution or web publishing.

Here you can see that Epi-info is not very different from DHIS when it comes to data gathering and analysis. The DHIS equivalent to MakeView and Enter are the data elements you configure DHIS to use. DHIS offer the possibilities of printing out questionnaires too. By using pivot tables, GIS and the report module of DHIS you get a similar functionality to Analysis, EpiMap and EpiReport programs of DHIS.

The differences are, however, significant. The most important difference are based in the different problems they try to solve. Epi-info are made with decease surveillance in mind. The data that need to be gathered are different for each possible outbreak that need to be monitored. Therefore Epi-info is designed to make it easy to make forms, input data, design report and do data analysis. Epi-info is a excellent tool for gathering a lot of data and do data analysis on them, and then to move on to another project.

DHIS on the other hand are designed with the primary health system of, specifically, South Africa in mind. One leading thought behind DHIS have been that the primary health units like clinics and hospitals gathers data and report it to the district, the district reports to the regions and so on. From DHIS version 1.4 any unit at any level in the organisational hierarchy can be the reporting unit. Data in DHIS are also connected to a specific time period, a month or a quarter.

The notion that data exist within an organisational hierarchy and belong to a time period leads to a big difference between DHIS and Epi-info. In DHIS data are connected with an organisational unit, the organisational unit exist within an organisational hierarchy. Epi-info have no specific notion of an organisational hierarchy or reporting period. You can have an input field in a form that specify the organisational unit it belongs to and which time period it belongs to, but the data are not easily aggregated across to health units, districts, region or time period.

It is interesting to note that both systems is in a sense FLOSS. EPI-info is public-domain software, you can get the source code if you request it. DHIS is licensed with a FLOSS license. Both relies on non-FLOSS software components, however.