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Using digital tools data science to strengthen COVID-19 management – case study Rwanda

Rwanda has raised the bar in using digital tools to scale up community-based testing in its COVID-19 response. 

A national Joint COVID Task Force, established in February 2020 before the first case was confirmed, led the pandemic response of this African country. The team gave both high-level strategic guidance and day-to-day operational support. 

This had, however, been preceded by years of investment in the broader digital health infrastructure, where digital technologies were expanded to support service delivery – a longstanding government priority.

Institutions in Rwanda were therefore able to combine resources and capacities to respond to emerging problems.  Adopting a multi-sectoral approach from the start has allowed rapid deployment of interventions and more efficient troubleshooting.

It also helped the country to build COVID-specific digital systems to strengthen the areas of testing, contact tracing, patient support and surveillance. 

Rwanda’s numbers

First registered COVID-19 case: 14 March 2020
14 March 2021: more than 20 000 cases diagnosed, with mortality rate of 1.4%

Sharpest peak in cases: late 2020 and early 2021. This prompted stringent restrictions on movement that led to a rapid decline in new cases.

Testing the toolbox

Rwanda has used District Health Information Software (DHIS-2) to survey and monitor disease since 2011 and, in early 2020, this system was adapted to capture data on COVID-19 diagnosis and case management. 

DHIS-2 is integrated with the laboratory information system which allows for automated transmission of data. 

COVID-19 Command Posts, the sub-national operational centres of the Joint COVID Task Force, receive and analyse surveillance data from these different systems to inform policy and programme decisions. 

Rwanda also devised a stringent port of entry system to avoid importing COVID-19 cases. 

Other technologies were deployed in selected settings, including the internal Visitor Tracking Record and the e-ASCOV pilot, a locally developed application to help give access to rapid antigen testing.

Patient-facing tools

  • WhatsApp help line 
  • Unstructured supplementary service data (USSD) platform, which provides basic information on COVID-19 on any phone with no data or airtime requirements
  • WelTel app, where patients can report symptoms
  • Standard electronic medical record (EMR) system 
  • Online results portal
  • Open Data Kit (ODK) application which captures data for targeted surveillance activities outside of health facilities, particularly in hotspots. 

Impact of digital tools 

The use of digital tools in Rwanda has had a significant impact.  For example, through integrating laboratory and health management information systems, the testing process is now paperless. All facilities capture data in the same central system. 

Patient unique health codes (UHCs) also allow data transfer between different digital solutions. This cuts down the time taken by health care workers to record and report data, as it is captured in real-time at the point of care. 

Application programming interfaces have also been developed for a number of tools to enable interoperability. 

Mobile-data collection tools for community-based surveillance have generated valuable insights to inform timely responses to outbreaks. 

Monitoring cases and contacts remotely using digital tools has reduced the burden on the health system. This has allowed the country to focus limited capacity on delivering services to the most at-risk individuals, while consistently monitoring other patients.

Key success factors in Rwanda

  • Pre-existing digital infrastructure  
  • Political will, with digital infrastructure bolstered by political commitment at the highest levels of government
  • National ownership of systems, minimising the challenge of isolated pilots, duplicate interventions and “data fog”
  • Building on existing tools
  • Multisectoral collaboration
  • Providing patients with direct access to results. 


The lack of readiness of health care workers to adopt new digital tools can be a barrier to successful implementation. 

This is worsened in a crisis such as COVID-19, where systems are already overwhelmed with new protocols and interventions. 

Resource requirements are also unpredictable due to the rapidly evolving nature of the pandemic. 

It is important to coordinate decisions on selection of digital tools from among numerous vendors.


  • Ensuring integration of national COVID-19 data (public and private sector) into one platform enhances understanding of the pandemic and simplifies data management. 
  • Leveraging databases in other areas can minimise the time and effort required for individual data capture. 
  • Digital tools, particularly on mobile devices, are key in providing decentralised testing services. 

While Rwanda is still in the early stages of rolling out its approach, it shows potential to expand and standardise testing outside of health facilities. 

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Using digital tools data science to strengthen COVID-19 management – India Case Study

India’s digital ecosystem for COVID-19 management has centred around Aarogya Setu – Sanskrit for “Bridge to Health” – a public-facing mobile application designed in response to the pandemic. 

Software engineers, epidemiologists, statisticians, social scientists and legal experts from across India started to work with the Indian government to develop a digital response to the pandemic in March 2020.

The resulting systems, new digital tools as well as adapted existing tools, aimed to help test-trace-isolate (TTI) programme activities, predict emerging hotspots and identify high-risk individuals in need of targeted testing. 

This case study examines how India leveraged these digital solutions in their COVID-19 response.

India’s numbers

First confirmed COVID-19 case: 28 January 2020.

1 March 2021:  11-million cumulative cases detected from 227-million tests. 

15 March 2021: 2,19,262 active cases, a cumulative recovery rate of 96.7% and death rate of 1.4%.

The digital backbone of Aarogya Setu 

Aarogya Setu, the backbone of India’s COVID-19 management strategy, is a mobile application launched on 2 April 2020. By November 2020, it had 170 million registered users, or 13% of the country’s population.

Users download the app free and register using their mobile number, following which a de-identified identification (DID) is generated to enable anonymised transfer of their data in the system. It captures two key sets of data:

  • Self-reported symptoms – for case management and hotspot mapping 
  • Location (via Bluetooth) for contact alerts

Aarogya Setu then scores user risk based on exposure to confirmed cases to determine who is at high risk of infection and should be prioritised for testing. Based on this, follow-up actions are recommended: Caution, Quarantine or Test.

Information on high-risk individuals is also transmitted to the Ayushman Bharat call centre, which follows up with them by phone to support linkage to testing and care.

Within the first eight weeks of the app’s introduction, more than 900 000 users identified through the algorithm had been contacted. 

India’s response also leveraged the pre-existing electronic infrastructure of Ayushman Bharat, the National Health Authority (NHA) scheme to provide free healthcare to 500-million citizens. 

The IT-enabled Integrated Hotspot Analysis System (ITIHAS) uses syndromic data submitted by Aarogya Setu users to map future hotspots. This in turn informs targeted testing strategies.

ITIHAS also generates hotspot predictions using the historic location data, based on cell phone tower signals, of confirmed positives diagnosed in the Indian Council of Medical Research (ICMR)’s network of approved labs. 

Digital tools: the benefits 

Digital health solutions can help address high-priority gaps, particularly in India, which has high overall digital maturity and a rapidly evolving digital health landscape. 

Digital solutions tailored to support the integration and/or bundling of tests provide an opportunity to identify at-risk patients earlier and intervene faster. 

Practical ways to scale

India’s government has established a positive and enabling environment for ICT intervention in health. 

In August 2020 the country launched the National Digital Health Mission, in which every Indian was due to receive an electronic health account in the form of a mobile application.


Despite its digital maturity, India’s health system is underfunded, with government healthcare spending only 0.96% of its GDP. 

This is lower than spend in other low- and middle-income countries (1.3%), and BRIC countries (3.0%). It contributes to a lack of adequate public health services, especially in rural areas. 

India’s population relies heavily on private health providers, in the face of an under-resourced and unregulated health system, skilled staff shortages and disparate management systems.  


India has an increasingly low-cost and fast digital infrastructure, with high mobile phone penetration and growing smartphone penetration. This has enabled extensive use of the Aarogya Setu mobile app.

As mobile penetration and ICT literacy in India is growing rapidly, scale-up of digital health tools will be necessary to optimise the nation’s limited resources, bridge inequity in healthcare access and strengthen the availability of quality diagnostics. 

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Global Partnership to Make Available 120 Million Affordable, Quality COVID-19 Rapid Tests for Low- and Middle-Income Countries

Rapid tests are a fast and accurate way to diagnose patients in a primary healthcare setting

Global partnership feeds healthy supply of rapid COVID-19 tests to low- and middle-income countries 

A set of global agreements reached in September 2020 paved the way for 120 million rapid COVID-19 tests to be distributed to low and middle-income countries.

The Access to COVID-19 Tools (ACT) Accelerator, working with other organizations, concluded these agreements to enable the manufacture, distribution and rollout of these vital diagnostic tools.

At the time, there was a huge unmet need for fast diagnostic testing globally, especially in the low and middle-income bracket.

The Africa Centres for Disease Control and Prevention (Africa CDC), the Bill & Melinda Gates Foundation, the Clinton Health Access Initiative (CHAI), the Foundation for Innovative New Diagnostics (FIND), the Global Fund, Unitaid, and World Health Organization (WHO) all worked on this project.

There was a particular focus on making tests available to countries without extensive laboratory facilities or trained health workers to implement molecular (polymerase chain reaction or PCR) tests.

Why is testing crucial in the fight against COVID-19?

Rapid tests are a fast and accurate way to diagnose patients in a primary healthcare setting, as this is where most people access services. 

Rapid tests are also cheaper than laboratory tests. With a fast initial diagnosis, track and trace teams in more remote and rural areas can start work sooner without waiting for laboratory test results. 

Quick results can prevent the virus from spreading in communities. Rural and remote healthcare settings especially need access to rapid testing, as accessing centralized laboratory services can take a long time.


The Global Fund made $50-million available to purchase 10 million tests per country.


FIND and WHO supported countries in distributing these tests.

Unitaid and the Africa CDC combined resources rollout tests to countries in Africa from October 2020. 

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R&D blueprint expands for COVID-19 epidemic and beyond

The R&D Blueprint is a global strategy and preparedness plan that allows the rapid activation of research and development activities during epidemics. 

It aims to fast-track the availability of effective tests, vaccines and medicines that can be used to save lives and avert large scale crises. 

With WHO as convener, WHO Member States welcomed the development of the Blueprint at the World Health Assembly in May 2016.

As part of WHO’s response to the coronavirus pandemic in 2020, the R&D Blueprint was activated during COVID-19 to accelerate diagnostics, vaccines and therapeutics for the novel virus. 

This aims to improve coordination between scientists and global health professionals, accelerate the research and development process, and develop new norms and standards to inform the global response.

Building on the response to recent outbreaks of Ebola virus disease, SARS-CoV and MERS-CoV, the R&D Blueprint has facilitated a coordinated and accelerated response to COVID-19.

In 202, WHO published the final version of Target Product Profiles (TPP) for priority COVID-19 diagnostics. These TPPs describe the desirable and minimally acceptable profiles for four tests.

  • Read more on the R&D Blueprint here
  • Read more on COVID-19 Blueprint  here
  • Read more on TPP here
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Collaborations lead to apps, toolkits to collect COVID-19 RDT data

Collaboration between organizations is essential to quickly design and develop human-centred health tools to tackle the COVID-19 pandemic. The list below is a collection of various applications and toolkits developed in this way to capture COVID-19 related data.

  1. The COVID-19 Template App, designed by FIND and Dimagi, supports health workers as they administer and record the results of COVID-19 antigen rapid diagnostic tests (RDTs). The application features workflows for patient registration, test initiation, and result capture. 
  1. The RDToolkit: Currently Supported RDTs is a listing of the RDTs that the Rapid Diagnostics Tookit hosts.
  1. FIND and HISP India collaborated to develop a DHIS2-based package for capturing data for RDTs. The resultant COVID-19 RDT Data Capture programme metadata package is available for download.
  1. As part of the ACT-Accelerator, Argusoft added a novel digital health solution to enable RDT capture with FIND. This COVID-19 RDT Data Capture is a MEDplat extension.
  1. ODK partnered with FIND to create a ready-to-use form to help community health workers in collecting data when performing RDTs. Read more on the COVID-19 Antigen RDT form for standards-compliant data.
  1. Medic’s CHT App with COVID-19 RDT Workflows is a community health toolkit to enhance RDT workflows. It also was developed in partnership with FIND. The app is powered by the Community Health Toolkit (CHT).
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Model to improve COVID-19 diagnostic data collection

FIND and PATH have been working together to support the development and implementation of digital tools for the global COVID-19 response.

With more than 400 COVID-19-based digital health tools available, countries need to determine the most appropriate ones for their needs, and how to use them. 

The Digital Square initiative within PATH’s Centre of Digital Excellence has convened a network of global collaborators to streamline a more effective approach to using these tools.

Its goal is to improve COVID-19 diagnostic data and use, which will increase the ability to share and view rapid diagnostic testing data.

To this end, FIND and PATH created a template of data fields relevant to the COVID-19 rapid diagnostic test workflow, called the ACT-A COVID-19 Antigen RDT Data Model.

Aimed at supporting low- and middle-income countries, the common data model is freely available to download.

Read more here

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Assessing COVID-19 digital tools in Kenya

This case study of Machakos and Mombasa counties in Kenya was conducted by the Ministry of Health, Jomo Kenyatta University of Agriculture and Technology, and FIND in 2021.

It mapped the use of digital tools to strengthen COVID-19 screening, testing, contact tracing and case management.

It makes findings on:

  • Management of COVID-19 in Machakos and Mombasa
  • COVID-19 management cascade
  • Use of digital tools
  • Primary and secondary outcomes
  • Epidemiological outcomes.

Key challenges are presented, and recommendations made on:

  • Screening process
  • Testing
  • Contact tracing
  • Management.

It also provides general recommendations to improve the use of digital tools for COVID-19 management in Kenya.

Read full report here

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Call for solution to capture COVID-19 testing data

FIND issues proposals request from digital health solution providers for COVID rapid diagnostic test data capture 

FIND, as co-convener of the ACT-Accelerator (ACT-A) diagnostics pillar, is working towards supporting countries in implementing an effective test-trace-isolate response using digital tools. 

This includes partnering with digital solution providers to speed up development and deployment of a set of minimum functionalities for COVID rapid diagnostic test (RDT) data. 

The idea is to incorporate these functionalities into existing digital tools to be used in low- and middle-income country (LMIC) settings.

FIND therefore issued a Request for Proposals (RFP) to identify and work with developers of existing digital health solutions already in use in LMICs at community level. 

Any organization, institution or entity specializing in developing and implementing digital health solutions for healthcare data collection in LMICs was invited to apply, with potential for further collaboration.

Partners were to be selected through a process which focused on:

  • Current capability to deliver the RFP requirements 
  • Organizational assessment
  • Cost of the project.

This RFP contained three appendixes which provided data points to be captured, target characteristics to be considered, and a response template.

The RFP opened on 7 April 2021, and closed on 28 April 2021. Data collection functionalities and workflows were due to be ready for rollout by the end of June 2021.

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Framework to safeguard personal data in a public health emergency

The Access to COVID-19 Tools Accelerator (ACT-A) was established to respond to the COVID-19 pandemic by scaling up development and equitable distribution of tests, treatments and vaccines, and strengthening underlying health systems infrastructure.

Key takeaway: Protecting individual right to privacy is vital both during and after a pandemic response.

Early on, the Research and Development and Digital Working Group of the ACT-A Diagnostics Pillar recognised that it was essential to collect, link and share timely access to data.

However, during this public health emergency (PHE), government states of emergency were declared, and fundamental human rights, including the right to privacy, were limited as part of national COVID-19 responses. 

As the world’s first pandemic where digital technologies and personal data have been used on such a large scale, this has highlighted the issue of how personal data is used. 

It also raised the related issue of how to ensure that use remains in the public interest.

Proactive response The Framework for the Governance of Personal Data for the Access to COVID-19 Tools Accelerator  was developed as a guide to promoting best practice and responsible use of personal data by all initiatives funded under the ACT-A. 

Published in January 2021, it outlines how using personal data in responding to COVID-19 must safeguard privacy and the rights of vulnerable groups. 

The framework aims to:

  • Promote best practice
  • Support the safeguarding of the rights of vulnerable groups 
  • Complement national laws and policies
  • Guide the development of national regulations on the governance of data for COVID-19 related activities
  • Guide the development of mechanisms for appropriate levels of community reviews and oversight
  • Be a dynamic framework. 

Six substantive principles guide decisions on data and data use:

  • Solidarity
  • Respect for persons and communities
  • Equity
  • Non-exploitation
  • Privacy
  • Data stewardship.

There are also three procedural principles:

  • Transparency
  • Accountability
  • Engagement.

The nine principles provide overarching guidance on both managing personal data and balancing collective interests with individual rights during a COVID-19 response. 

The framework provides detailed guidance on data management, including data collection and storage, retention, access, and the responsibilities of those processing personal data during COVID-19. 

Read more here

Guidelines on equitable access to data and public engagement are included in the framework.

Governance of this personal data must extend to its use in a post-pandemic world; hence it also calls for the establishment of national independent Data Stewardship Oversight Committees for COVID-19. 

During a pandemic, these should monitor the collection and use of personal information in line with public expectations, human rights and clear and accountable processes. 

In a post-COVID-19 world, these national committees should be tasked with determining access to COVID-19 data and conditions for access. 

Importantly, they also should ensure decisions on access continue to be driven by public and not private or commercial interests. link page text ends 

The framework will be updated and refined based on recommendations and experiences, and reviewed every six months. Feedback is encouraged and may be sent to the ACT-Accelerator Diagnostics Pillar at email

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In-house test development for molecular detection of SARS-CoV-2

Roadmap to create diagnostic tests available in English, French and Portuguese.

This document provides guidance on the development of a new, in-house, real-time RT-PCR test for SARS-CoV-2 aimed at laboratories which have established molecular biology capabilities. 

The information – available in English, French and Portuguese – will also provide a roadmap for the creation of new molecular diagnostic tests for other emerging pathogens. 

It acknowledges the constraints  of resource-limited laboratories, and outlines  requirements for good molecular biology practices, including quality control and quality assurance.

Steps to success
When a new virus such as SARS-CoV-2 emerges, laboratories rely on time-tested methods of developing diagnostic tests when commercial assays are unavailable. 

These LDTs are rarely perfect on the first attempt. 

Ideally, these tests continue to develop and gain validation until formally certified for in vitro diagnostic use by a regulatory body.

Most LDTs do not progress to the point of formal certification for use. However, they should still be held to the highest standard of quality possible to mitigate the health and economic impacts of the emerging disease and help protect vulnerable populations.

Read the report here