Questions/Answers

Dengue is a significant public health concern that persistently affected the Thai economy and society. From 2003–2017, there were around 1 million dengue cases, which consumed a total budget of 133 Billion Thai Baht for treatment. In 2017, the cost of treatment was 290 Million Baht (the second-highest among Southeast Asian countries after Indonesia). In Thailand, the traditional dengue surveillance system had relied on a paper-based and a singular-based approach, limiting the efficiency of epidemiological surveillance and prevention & control operations of dengue diseases. A digital and comprehensive system is thus needed to efficiently drive public health officers in conducting these operations. The Department of Disease Control (DDC) and National Science and Technology Development Agency (NSTDA) have then collaborated to apply the digital technology transformation for fully and efficiently driving epidemiological activities. In this collaboration, DDC via Division of Vector Borne Diseases (DVBD) and NSTDA via National Electronics and Computer Technology Center (NECTEC) has delivered the software suite “TanRabad”. Dengue has initially been piloted. TanRabad has been launched since May 2016 and recognized as a surveillance tool in DDC’s Aedes borne disease strategy 2018-2021. TanRabad has strengthened public health officers to perform epidemiological surveillance and prevention & control operations of dengue diseases. Essentially, TanRabad has reduced the workload of public health officers to accomplish the data analytics and decision-making in 3 seconds (from 3 days) and hence to promptly drive an effective response.

TanRabad is aligned with the “Promoting Digital Transformation in the Public Sector”. Essentially, TanRabad is a software suite that digitally and comprehensively supports epidemiological surveillance and prevention & control operations of dengue diseases. TanRabad has transformed paper-based to digital-based processes and singular to comprehensive processes. Initially, dengue has been piloted as it is a significant public health concern in Thailand. Other infectious diseases such as Flu, Chikungunya and Rabies would be next accompanied in TanRabad.

TanRabad is aligned with the SDG Goal 3 “Good Health and Well Being -- ensure healthy lives and promote well-being for all at all ages” and Target 3.3 “By 2030, end other communicable diseases”. In Thailand, TanRabad has been used nationwide as a crucial surveillance tool since May 2014. Particularly, TanRabad has strengthened public health officers to perform epidemiological surveillance and prevention & control operations of dengue disease. These operations are conducted for all citizens no matter what their genders, ages, nationalities and races are. TanRabad has thus efficiently driven the accomplishment of healthy lives along with good social well-being for all at all ages. Furthermore, an attempt in reducing the number of dengue cases can be historically and spatially monitored via TanRabad. More or less, this could raise awareness to the relevant parties (i.e. public sectors, private sectors and communities) to collaboratively create proactive prevention & control interventions to minimize the dengue cases. Essentially, Thailand has put an effort to reduce the number of dengue cases and fatality rate (not more than 0.10 %) for a better quality of life of the people.

TanRabad has been recognized as a surveillance tool in DDC’s Aedes borne disease strategy 2018-2021. According to the contribution of TanRabad, the number of dengue cases and death cases can be reduced. The healthy lives along with good social well-being for all at all ages have clearly been promoted. This results in the reduction of both direct costs (i.e. medical costs) and indirect costs (i.e. income lost and traveling expenses) are decreased. Moreover, businesses in the country can smoothly and sustainably run.

In Thailand, Dengue surveillance operations have been implemented for over 30 years. However, the traditional operations were very limitation. The “TanRabad: Software Suite for Dengue Epidemic Surveillance and Control” was developed as a new mechanism aimed for increasing efficiency on Dengue control, surveillance, and management. This smart software can help reduce the burden of tasks on data preparation and analysis for all surveillance officers and also help increase efficiency for disease surveillance operations in outbreak situations at the border provinces and urban areas with dense populations. With rapid and prompt information from the “TanRabad” software, the disease control staff can conduct their operations in time and can use risk factor monitoring data (Aedes larva density in the community, high-risk containers of larvae) for conducting risk communication operations among the public health volunteers and the public. The information can also be utilized to promote Public-Private Participation (PPP) for Dengue control operations such as planning a campaign for destroying the breeding sites of Aedes larva in all households and public places. This could help enhance the efficiency of Dengue control in a community since there is a strong collaboration among the public and private sectors and the people.

TanRabad can be reachable by public health officers regardless of their gender. Currently, there are more than 4,500 public health officers throughout the country registered to TanRabad. The proportion of male and female officers are 48% and 52%, respectively. Based on the empirical collaboration, both male and female officers have worked together and typically used TanRabad as a surveillance tool to strengthen their epidemiological surveillance and prevention & control operations of dengue disease. Furthermore, the operations are also conducted for all citizens no matter what their genders are.

Public health officers (i.e. entomologists, epidemiologists, officers, researchers and executives) are direct target groups of TanRabad. TanRabad has facilitated them to efficiently and effectively perform their epidemiological operations via real-time and interactive dengue surveillance and data analytics. Essentially, all high-risk larval habitats can be timely identified and eliminated to prevent dengue outbreak in any risk areas. The recurrence and spread of dengue outbreaks can be effectively prevented and controlled. TanRabad has been realistically deployed since May 2014 with an increasing number of registered public health officers throughout the country. The result has shown that in 2018 the number of dengue cases was reduced to 85,849 cases compared to the 130,000 predicted cases. Beside this, the death cases were minimized more than 50 cases. These saved the medical costs and income lost costs for 330,324,077 Thai Baht. According to the contribution of TanRabad, the number of dengue cases and death cases can be reduced. Citizens are thus significantly considered as the indirect target group of TanRabad.

DDC and NSTDA have an agreement for the collaboration under the MOU “technology research and development for strengthening epidemiological surveillance and prevention & control operations of dengue diseases” since 2014. Under this collaboration, DDC via DVDB and NSTDA via NECTEC have jointly developed TanRabad. NECTEC is responsible for technology development, while DVBD is for technology requirements, evaluation and transfer. TanRabad has been iteratively developed as following steps: The requirement elicitation. This step was to interview potential users (i.e. entomologists, epidemiologists, public health officers and public health executives). Here, they needed to describe and demonstrate their current operational processes and pain points. The requirement analysis. This step was to evaluate and analyze the requirement. This resulted in a precise and complete system specification to address the requirement. The system designs. This step was to architect the system, design data models, design workflows between system components and finally design screen mockup. The system implementation. This step was to create databases, implement the back-end components and the front-end user interfaces of underlying applications. The system testing. This step was to perform the unit testing and system integration testing. The system maintenance. This step is to monitor the working status of system components deployed on servers. This is to ensure that they are in good conditions. If not, they must be promptly recovered to provide services. TanRabad beta version was launched in March 2015 and version 1.0 in May 2016. It was trained to public health officers at all levels via more than 50 workshops. Currently, there are over 4,500 users throughout the country. TanRabad has been continuously developed and extended to meet the user needs. TanRabad 2.0 is now available. Last not least, TanRabad has been recognized as a surveillance tool in DDC’s Aedes borne disease strategy 2018-2021.

Technology adaptation is a critical concern. The learning curve is required, making most public health officers were afraid of adapting their traditional ways from paper-based to digital-based. To address this, “Train the Trainers” model was conducted. This resulted in trainers at different levels, ranging from national to regional and provincial levels. Essentially, trainers demonstrate and coach their users the utilization and benefits of TanRabad together with question-answering. Furthermore, the online manuals and the 24/7 help desk via telephone and social media (i.e. Facebook and Line) are available to promptly provide any technical supports.

TanRabad has been architected and developed as a one-stop service for enhancing the dengue surveillance and improving the prevention and control strategy. TanRabad is novel and innovative in that (i) it facilitates the real-time, continuous and systematic process from data entry, data collection, data integration, data management, data analytics and data visualization; (ii) it holistically supports the utilization of data ranging from larval breeding habitats to dengue epidemics; (iii) it personally provides the interactive data visualizations via different measures and dimensions in various formats; and last but not least (iv) its consists of 5 applications for different epidemiological operations.

TanRabad was inspired by the previous error-prone and time-consuming operational processes. Several applications (i.e. HealtMap and FluNearYou) had thus been studied. These applications enable people to report incident cases and to visualize incident cases via map. While these applications take steps into the right direction, they insufficiently support the overall previous operational processes. Particularly, cases reported by hospitals are needed along with other measures (i.e. morbidity rate, cluster and generation). Besides this, the larval breeding habitats must be accompanied to enhance dengue surveillance. The historical data is also significant for an effective prevention and control strategy.

TanRabad has been used nationwide. Its usage has initially been started at Bangkok conducted by the Institute for Urban Disease Control and Prevention since April 2016. Its usage has next expanded to several regional public health offices since May 2016. Gradually, its usage has expanded to other regional public health offices, provincial public health offices, public health service centers, hospitals, schools and universities. TanRabad was disseminated through various channels: (i) poster presentations at both national and international conferences; (ii) academic journals; (iii) exhibitions; and (iii) more than 50 training workshops. TanRabad had a chance to be incorporated with Impetus, a dengue prediction system, conducted by the University of Massachusetts, University of Florida and John Hopkins University, USA. Furthermore, TanRabad was selected to partially drive the Lower Mekong Initiative (LMI) Young Scientist Program organized by the US Embassy, Arizona State University, at Vientiane, Laos PDR. The participants, expertise in health domain, were from the Lower Mekong Sub-region member countries: Laos PDR, Vietnam, Burma, Cambodia and Thailand. TanRabad has gained an attraction to these participants as dengue is also a public health concern to their countries. DDC, Thailand has thus planned to extend the application of TanRabad to these member countries.

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The crucial resources for driving TanRabad development and implementation are (i) budget -- to support any expenses (i.e. traveling); (ii) development team -- to technically build applications under TanRabad; (iii) training team -- to transfer TanRabad to regional, provincial and local public health officers; (iv) implementation team -- to utilize TanRabad for strengthening epidemiological operations and the prevention and control strategy; (v) help desk team -- to answer questions in 24/7; (vi) monitoring team - to ensure that TanRabad components are in good condition at all times; and (vii) IT infrastructure -- to deploy TanRabad components.

Since 2014, TanRabad has been driven by budget allocated by DDC and NSTDA and strong collaboration of DDC, NSTDA and DGA. Essentially, DDC requires innovative technology to strengthen epidemiological operations and enhance prevention and control strategy. NSTDA technically creates such innovative technology “TanRabad”. DGA provides the IT infrastructure for deploying “TanRabad” as on-line services. Currently, over 4,500 users throughout the country are now registered with an approximation of 500-800 users indeed utilizing TanRabad a day. A long-term plan is to apply Artificial Intelligence and Machine Learning Technologies to enhance the overall system and to predict the disease epidemics.

Oui

TanRabad was evaluated internally by DVBD, DDC. It was evaluated by the number of patients that was reduced from the predicted number, reduction in costs of medical fees, the cost of lost revenues of dengue fever patients and satisfaction of TanRabad software users. There was also external evaluation by NECTEC which was evaluated in accordance with the efficiency of budgeting management and other relevant dimensions.

Indicators consisted of the satisfaction level of the TanRabad users on a scale of 1 to 5. For external evaluation from NECTEC, there were two indicators; 1) economic impact 2) social impact, environmental impact, education impact, security impact, quality of life and others.

From the impact assessment report in 2019, NECTEC found that the TanRabad can achieve an improved economic impact saving and expense reduction. It can save of 132,200 sheets of paper per year or 255,108 Thai Baht and also help increase efficiency on data display and analysis that supports the disease control agency in protecting people from dengue epidemics as well as adding accuracy for disease forecast. As a result, there were fewer dengue patients than the estimated number and calculated an increased budget development efficiency of 526,309,875 Thai Baht. From the satisfactory assessment of this software gathering data from the ODPC and PHO staff, the DVBD found that 95% users will utilize the TanRabad for dengue surveillance, prevention and control in their responsible areas, 92.5% are satisfied with this tool on the issue of supporting on policy planning, 91.35% preferred usage on larva bleeding site control and 88.88% used it to control a dengue outbreak. Data also showed that TanRabad helped save 44,151 people from dengue in many high-risk areas.

The DDC, Ministry of Public Health plays an important role to support academic information on surveillance and disease control for the “TanRabad” development. The DDC conveys and propagates how to use the software to other organizations. The DDC also takes responsibility for Dengue surveillance and control, supporting the technical and teams and working 24 hours to support problem-solving for users immediately, as well as the evaluation. NECTEC via NSTDA, Ministry of High Education, Science, Research and Innovation takes responsibility to develop and apply appropriate technology, and maintenance on “TanRabad” software suite. NECTEC also work closely to convey and solve the problems of users. The agencies that responsible for Dengue surveillance and control such as Provincial Health Offices, District Health Offices, Sub-District Health Promoting Hospitals, and local area agencies take an important role to communicate the information from TanRabad and used it to support disease surveillance and control. Health volunteers and people in Dengue outbreak risk areas bring all information from TanRabad to build up the participation and cooperation to eliminate the risk factors and inform risk areas in their community.

TanRabad was designed and developed to analyze and emphasis the demand of users. Its procedures involved collecting the demand from involved agencies both in the central and regional levels. It also prioritizes what is important and what is needed in the areas of concern. There are many processes involved when the public health officers receive Dengue outbreak information from the TanRabad. The officers will reach out to the area for investigation and cluster outbreak surveillance in the community. They also coordinate with the local government organization for disease control in the area immediately. TanRabad is not used only for important outbreak information such as the generation of outbreaks, outbreak areas, the density of patients, outbreak situation but it also can identify the risk factor level in the community or the common area such as schools, temples, hotels, and hospitals. It is beneficial to public health officers for Dengue prevention and sustainable disease control management in their own areas.

Change management is a critical success factor in the implementation of digital solutions that produce transformations in epidemiological surveillance and prevention & control operations of dengue diseases. The digital transformation should involve as many professions and approaches as possible, accompanied by a solid communication strategy. In addition, all sectors and communities must be in charge of dengue. To empower communities to timely aware of and cope with the dengue outbreak, the people-centric application is needed. Essentially, this application is in the development pipeline under TanRabad and will be launched in the near future.