Enhancing community death notification in Uganda using a hackathon based approach to integrate mortality surveillance into the electronic Community Health Information System (eCHIS)

Abstract

Uganda faces persistent weaknesses in mortality surveillance, particularly in the notification of community deaths, which are frequently under-ascertained. Mortality reporting is fragmented across paper-based Ministry of Health (MoH) systems and the civil registration authority (National Identification and Registration Authority [NIRA]), with limited interoperability between platforms. These parallel workflows contribute to duplication, delayed reporting, and incomplete mortality datasets. This study aimed to develop and integrate a harmonised community death notification workflow within the electronic Community Health Information System (eCHIS) using a structured, multi-stakeholder co-design process. We conducted a participatory qualitative descriptive study embedded within a multi-day, multi-stakeholder hackathon designed as a systems co-creation exercise. Data were collected through focus group discussions with Village Health Teams (VHTs) and in-depth interviews with representatives from the Ministry of Health, NIRA, police departments, health facilities, and eCHIS developers. Stakeholders collaboratively mapped existing mortality reporting pathways, identified system-level gaps, and iteratively developed a harmonised community death notification workflow. Qualitative data were analysed using reflexive thematic analysis, and draft workflow components were refined through structured plenary validation sessions. Participants described substantial fragmentation in mortality reporting, including parallel data systems, inconsistent use of Health Management Information System (HMIS) tools, limited feedback to community reporters, and duplication between facility-based reporting and civil registration processes. Based on these findings, a harmonised workflow for community death notification was developed, prioritising feasible variables for community-level capture and structured interoperability with the District Health Information System (DHIS2). The workflow was configured within eCHIS and piloted in 17 districts. Early implementation feedback indicated improved reporting consistency and reduced duplication of community death notifications; however, formal quantitative evaluation was beyond the scope of this study. A structured, participatory hackathon approach enabled the development of an interoperable community death notification workflow aligned with Uganda's national digital health architecture. Integrating mortality surveillance functions within eCHIS offers a feasible systems-strengthening pathway for improving the completeness and coordination of community death reporting in low-resource settings. Further evaluation is warranted to assess effects on data completeness, timeliness, and national mortality surveillance performance.