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.
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Data availability
The study data is available by request to the corresponding author.
Code availability
No custom computer code or algorithms were developed or used in this study. Qualitative data were coded and analysed using ATLAS.ti software, following a thematic analysis approach. The coding framework and thematic structure that informed the study findings are available from the corresponding author upon reasonable request.
Abbreviations
- ANC:
-
Antenatal care
- ART:
-
Antiretroviral therapy
- CHEWs:
-
Community health extension workers
- CRVS:
-
Civil registration and vital statistics
- DHI:
-
Division of health information
- DHIS2:
-
District health information system 2
- DISO:
-
District internal security officer
- eCHIS:
-
Electronic community health information system
- FGDs:
-
Focus group discussions
- HMIS:
-
Health management information system
- IPD:
-
Inpatient department
- LC1:
-
Local council one
- MCCOD:
-
Medical certificate of cause of death
- MoH:
-
Ministry of health
- MVRS:
-
Mobile vital registration system
- NCDs:
-
Non-communicable diseases
- NIRA:
-
National identification and registration authority
- NIN:
-
National identification number
- OPD:
-
Outpatient department
- PNC:
-
Postnatal care
- ROPA:
-
Registration of persons act
- SOPs:
-
Standard operating procedures
- TB:
-
Tuberculosis
- VHTs:
-
Village health teams
- WHO:
-
World Health Organization
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Acknowledgements
We do acknowledge all the mortality surveillance stakeholders, from the Ministry of Health, National Identification and Registration Authority, CDC Foundations, METs, MUCHAP, Police and the community.
Funding
The study received no funding and was part of the Uganda Ministry of Health programming.
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All authors contributed significantly to the manuscript. Contributions included conceptualizing and designing the study, conducting data collection and analysis, interpreting the results, and drafting and revising the manuscript. All authors reviewed and approved the final version of the manuscript and agreed to its submission for publication.
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Ethics approval and consent to participate
This activity was conducted as part of a Ministry of Health-led programmatic systems strengthening initiative to improve mortality surveillance workflows in Uganda. The work involved stakeholder consultations and workflow co-design and did not include the collection of patient-level clinical data or identifiable personal health information. Under national public health guidelines, the activity was classified as programmatic systems improvement rather than human subjects research requiring formal institutional review board approval; therefore, no ethics approval ID was issued. Ethical oversight was provided by the Ministry of Health Department of Integrated Epidemiology, Surveillance and Public Health Emergencies. All participants were informed about the purpose of the discussions and the voluntary nature of participation. Verbal informed consent was obtained prior to participation, and no personal identifiers were retained in transcripts or analytic outputs.
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The Ministry of Health Department of Integrated Epidemiology, Surveillance and Public Health Emergencies.
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Alunyo, J.P., Bulamu, M., Akello, S.R. et al. Enhancing community death notification in Uganda using a hackathon based approach to integrate mortality surveillance into the electronic Community Health Information System (eCHIS). Sci Rep (2026). https://doi.org/10.1038/s41598-026-47970-0
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DOI: https://doi.org/10.1038/s41598-026-47970-0
