National Tuberculosis Control Program - Egypt





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Electronic Nominal Recording Reporting System (ENRS) & Quality Verification

Why do we need ENRS?
The Objectives of ENRS

The Characteristics of ENRS
ENRS Implementation in Egypt
Job Description of the Working Staff
Tools and Action Plan
Data Validation and Cleaning
Flow of Information

ENRS Evaluation Survey

Why do we need ENRS ?

The international R&R system was established successfully with standard quarterly reports covering case finding, sputum conversion and treatment outcomes.
Reports are developed manually using the District TB register and the treatment cards.
The information has to be used/analysed to monitor the progress towards the global/regional targets.

Main challenges to improve TB surveillance

Deficiencies were identified such as:

  • Delay

  • Inaccuracy

  • Discrepancy between the data of the same cohort through the time

  • Reports preparation takes long time.

  • Poor data analysis.

Usually the central level has no direct access to the district information

More indicators are requested to cover all aspects of TB control which means wider sources of data and increased workload.

Consequently less time is being spent on real analysis, and feed back. Lesser time is devoted to evidence based planning.

  • To improve accuracy, completeness and timeliness of reporting and indicators calculation in NTP (high quality)

  • To facilitate supervision and increase it’s efficiency

  • To locate patients according to their residency not only their place of diagnosis, which nis important to plan the DOT network.

  • To develop human resources

  • To Produce comprehensive NTP database to:

Connect to GIS for DOT network planning.
for operational research
Improve evidence based planning and budgeting.


The objectives of ENRS

It is the Electronic version of the main four Registers in the TB recording reporting System, where data entry is done on Nominal bases at TBMU level using Excel.
Nominal data are then processed to produce the routine reports in the NTP, and calculate indicators using Excel and Access.
Registers are linked using Access to produce patient profile.

  • Improve accuracy and timeliness of quarterly reporting at all levels.

  • Save time for analysis, feedback and evidence based planning.

  • Facilitate supervision and increase its efficiency.

  • Contribute to human resource development.

  • Strengthen the collaboration with other health providers to control TB .


The characteristics of the ENRS

  • Flexible: updating, adaptation and modification of the tool as per the country need is feasible. Training of health staff is easy.

  • Available: Excel is every where

  • Reliable: high quality data with tools of data verification and cleaning, confidentiality

  • Comprehensive: the tool is covering the four main TB registers.

  • low cost: no need for special software, programming and human resources


ENRS Implementation in Egypt

  • 2004, Two pilot governorates Cairo and Giza

  • 2005 NTP started the first stage of expansion it was planed to work on 4 governorates, Ismaelia, Qaliubia, Port Saied.

  • 2006 full expansion after computers.

  • 2 (Two) e-registers were introduced (district and lab).

  • 2007 -2008 updating to cope with the global plan of implementation or revised recording – reporting system to implement the 4 registers

  • (suspect and contacts in addition to the district and lab files

  • It is easy now for all levels to make recording and reporting of all data required for monitoring the Performance of TB activities

  • It is also easy to check, recheck data and recall it to make all needed reports in appropriate time.

ENRS training at District Level ENRS training at Provincial Level



Job Description of the Working Staff


Executive Manager of NTP
Facilitate, support and coordinate project processes on central and intermediate levels.
Promote and develop a process of audit of all processes involved in the project.
Conduct regular meetings of all focal persons for project proper management.
Plan and facilitate staff awareness of the project.

Task Force Team
- Facilitate, support and coordinate project processes on intermediate levels.
- Collect the data from the governorates.
- Supervision and data validation.
- Data cleaning through computer program in coordination with GTCs
- Prepare the national report
- Prepare the progress reports of the project.


Governorate Coordinator for Tuberculosis (GCT)
- Facilitate, support and coordinate project processes on peripheral levels.
- Collection of the data from the chest units.
- Supervision and data validation
- Data cleaning through computer program in coordination with DCs
- Feed back to the chest units.
- Prepare the governorate report


Manager of Chest Unit
- Facilitate, support and coordinate project processes on his chest unit..
- Supervision and data validation.

Data Entry (could be done by the statistical health worker)
- Transfer data to Computers from TB, lab &suspect registry.
- Ensure accuracy and completeness of data
- Update data regularly
- Prepare the district quarterly reports.


Tools and action plan

• Modified Excel Spreadsheet.
The electronic spread sheet are electronic English version of TB, lab & suspect registries, that means they contain demographic data for every TB patient, diagnosis and sub-diagnosis, lab investigations, treatment regimens, flow up and treatment outcome.
These sheets were modified to be user friendly, comments of Arabic for all titles were introduced, drop lists in English and Arabic, if conditions for translation to English for the medical expiration, division to quarts, and have been previously tested and feed back to be simply used was done.

• Establishment of Task Force Team
- WHO STB officer
- Focal point of the pilot project
- NTP central staff
- GCTs and IT persons form the provincial level

• Meetings and Training of the Selected Staff:
- Basic Training
- Mid Term Progress Report Meeting
- Data collection final meeting
- Evaluation Meeting also Data Entry , Supervision ,  Data Analysis, Evaluation



Data validating and cleaning

Dialogue boxes to Check Errors
Data filtering to examine the data entered for consistency and completeness

Quality Verification
Quality verification for completeness, accuracy, consistency and timeliness should be done at both TBMU and provincial levels.
Based on the quality verification, a feed back to the data entry level is sent for correction.
Corrected version is to be sent again to provincial level for compiling.

ENRS as a new system implements parameters of quality to ensure accuracy, completeness, consistency and timeliness. All these are done through electronic sheets which make it easy to fulfill all these parameters.




Flow of Information    

Data is collected in each chest facility and delivered to the GCT(Governorate Coordinator for Tuberculosis) of each governorate on the 5th day of each month and the GCT cleaning the data and validate it to be delivered on the 7th day to the central level. The final report of all facilities must be ready in the 10th - 15th day of each month to be send to the WHO Focal Person.



Channel of Communication

  • At BMU level: Data is send on a (floppy disk, flash stick, CD..etc) to the District Information Centre/DIC.

  • From DIC the data enter the governorate shared folder in the governorate information centre/GIC.

  • At GCT level, the data is accessible through the shared folder at GIC.

  • The Central Information Centre/CIC in the Ministry prepared an open channel directly to the Central NTP office.

  • All communication channels are secured and protected by a password.




Related Publications
International Standards for TB Care