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

Enhancing community death notification in Uganda using a hackathon based approach to integrate mortality surveillance into the electronic Community Health Information System (eCHIS) - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Search Log in Primary site navigation Search Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Sci Rep . 2026 Apr 13;16:17227. doi: 10.1038/s41598-026-47970-0 Enhancing community death notification in Uganda using a hackathon based approach to integrate mortality surveillance into the electronic Community Health Information System (eCHIS) Jimmy Patrick Alunyo 1, 2, 3, ✉ , Martin Bulamu 1 , Sarah Racheal Akello 1, 2 , Mariam Nambuya 1 , Paul Edward Okello 1, 3 , Enock Tuhereze 1 , Joseph Kitumba 4 , Robert Kato 1 , Nicholas Isabirye 1 , Bwire Godfrey 1 , Allan Muruta 1 , Caroline Kyozira 1 Author information Article notes Copyright and License information 1 Ministry of Health Department of Surveillance, Kampala, Uganda 2 Department of Community and Public Health, Buistema University, Mbale, Uganda 3 Uganda National Institute of Public Health, Kampala, Uganda 4 National Identification and Registration Authority, Masaka, Uganda ✉ Corresponding author. Received 2024 Nov 22; Accepted 2026 Apr 6; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13234412  PMID: 41974894 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. Keywords: Community death notification, Civil registration and vital statistics (CRVS), Interoperability, DHIS2, Digital health systems, Uganda Subject terms: Health care, Medical research Background Mortality surveillance underpins public health decision-making by enabling monitoring of population health trends, disease burden, and the impact of interventions. Reliable death data, disaggregated by age, sex, place of occurrence, and cause, are essential for epidemiological analysis, resource allocation, and health systems planning 1 . In high-income countries, comprehensive civil registration and vital statistics (CRVS) systems routinely capture deaths at the population level. However, in many low- and middle-income countries (LMICs), particularly in sub-Saharan Africa, death registration remains incomplete and fragmented 2 , 3 Recent global assessments indicate that, as of the early 2020s, fewer than ten countries in sub-Saharan Africa have achieved near-complete (> 90%) death registration coverage within CRVS systems 4 . Across much of the region, mortality reporting relies on facility-based registers, sample surveillance systems, or project-driven community notification initiatives, resulting in systematic under-ascertainment of deaths occurring outside health facilities 5 . These structural limitations constrain outbreak detection, burden-of-disease estimation, and timely public health response 6 . Some countries have demonstrated progress through the integration of community reporting with digital national surveillance platforms. For example, Zambia has implemented structured digital workflows linking community-level death notifications with national mortality databases, strengthening surveillance coordination 7 . Such examples illustrate the potential value of interoperable reporting architectures; however, scalable integration models remain limited across the region 8 . Uganda reflects many of these structural constraints. Mortality reporting functions are distributed across multiple institutions, primarily the Ministry of Health (MoH) and the National Identification and Registration Authority (NIRA), established under the Registration of Persons Act 9 . Although both institutions hold mandates related to death reporting and certification, their systems operate largely in parallel, with limited interoperability between health information platforms and civil registration databases. Facility and community reporting rely substantially on paper-based Health Management Information System (HMIS) tools, creating duplication, reporting delays, and inconsistencies across datasets 10 . Community death notification is particularly affected. National surveillance reports indicate that approximately 60% of deaths in Uganda occur outside health facilities 10 . However, between January and August 2021, only 39% of reported deaths originated from community sources, suggesting substantial under-notification of household deaths. At facility level, mortality data are captured through multiple HMIS instruments; however, inconsistent classification, multi-tier aggregation, and weak interoperability with civil registration systems limit traceability and completeness. These challenges primarily affect coordination and notification of deaths rather than full medical certification of cause of death. Digital health platforms provide opportunities to strengthen reporting workflows. The electronic Community Health Information System (eCHIS), implemented to digitise community health reporting by Village Health Teams (VHTs) and Community Health Extension Workers (CHEWs), offers an infrastructure capable of supporting structured community death notification 11 . However, prior to this study, no harmonised and validated workflow existed for capturing community deaths within eCHIS in alignment with national surveillance architecture or interoperable with the District Health Information System (DHIS2). Participatory systems co-design approaches have been shown to facilitate alignment across fragmented health information systems, particularly in complex multi-stakeholder environments 8 , 12 . To address identified gaps in community death notification, we conducted a structured multi-stakeholder hackathon aimed at mapping existing reporting pathways, identifying fragmentation points, and co-creating a harmonised community death notification workflow configured for integration within eCHIS and aligned with Uganda’s digital health architecture. This study, therefore, focuses specifically on strengthening community-level death notification workflows. It does not address comprehensive CRVS reform, verbal autopsy implementation, or medical certification of cause of death. Instead, it examines how participatory systems design can support harmonised digital integration of community death reporting within existing national health information systems. Methods Study design We conducted a participatory qualitative descriptive study embedded within a structured multi-stakeholder hackathon designed as a systems co-creation and implementation research exercise. The study aimed to identify structural and operational gaps in Uganda’s community death notification system and to co-develop a harmonised workflow suitable for digital integration within the electronic Community Health Information System (eCHIS). This design was selected because mortality reporting in Uganda involves multiple institutions operating in parallel, requiring collaborative systems analysis rather than a single cross-sectional inquiry. The approach therefore combined qualitative data collection with iterative workflow prototyping and validation to generate both analytic findings and implementable systems output. Study setting and period The study was conducted in Uganda between May and August 2024 through three structured workshop sessions. Two sessions were held in Kampala, including participants from Makindye Division representing an urban setting, and one session was conducted in Masaka District representing a rural context. These locations were selected to capture operational variation in community death notification practices across diverse service environments where Village Health Teams (VHTs) function. Two workshops lasted three days each, and one workshop lasted five days. These sessions provided structured time for qualitative inquiry, systems mapping, and iterative workflow co-design. Participants and recruitment Participants were purposively selected based on their direct involvement in mortality reporting, community health data collection, civil registration, surveillance oversight, or digital system development. Invitations were formally issued through the Ministry of Health Department of Integrated Epidemiology, Surveillance and Public Health Emergencies. Institutional representatives were nominated based on operational roles in mortality reporting systems. A total of 26 participants contributed to the qualitative component of the study. These included 12 Village Health Team members who participated in two focus group discussions, four Ministry of Health surveillance officials, three representatives from NIRA, three health facility records officers, two police officers involved in death investigation and reporting, and two eCHIS system developers. Among the participants, 14 were male, and 12 were female. Professional experience ranged from 3 to over 20 years in surveillance, civil registration, community health, and health information systems. Village Health Team participants were selected in collaboration with district health authorities to represent active reporters from both rural and urban communities. No invited participants declined participation. No financial incentives were provided. Participants were purposively selected for their direct involvement in mortality reporting, community health data collection, civil registration, surveillance oversight, health facility records management, or the development of the electronic Community Health Information System (eCHIS). Village Health Team members were included if they were actively engaged in community health reporting in the study districts. Individuals without operational roles in mortality reporting or related health information systems were not included. Hackathon structure and co-design process The hackathon was structured as a sequenced systems design process intended to address fragmentation in mortality reporting. The first phase focused on systems mapping, during which participants documented existing mortality reporting pathways at community, facility, police, and civil registration levels. Participants described how deaths were currently reported, what reporting tools were used, and how data moved between institutions. The second phase involved identification of duplication points, reporting delays, inconsistent definitions, and stages at which data were lost or aggregated in ways that reduced traceability. Participants discussed operational bottlenecks and institutional overlaps. The third phase prioritised essential community-level death notification variables. Variables were selected based on feasibility for Village Health Teams, public health relevance, and compatibility with national reporting structures. Emphasis was placed on capturing manner of death and key screening variables rather than detailed medical certification, which remains the responsibility of facility and civil registration systems. The fourth phase involved workflow prototyping. Draft diagrams were developed to link community death notification within eCHIS to facility review processes and onward synchronisation with the District Health Information System (DHIS2). These drafts were presented in plenary sessions and revised iteratively. The final phase consisted of structured validation and consensus building. Consensus was defined as the absence of substantive objection following moderated deliberation. Agreed workflow components were documented and prepared for digital configuration. Data collection Qualitative data were collected through focus group discussions (FGDs), in-depth interviews (IDIs), and structured plenary validation sessions conducted during the hackathon workshops. Two focus group discussions were conducted with Village Health Team (VHT) members (six participants per group). Discussions explored experiences with existing Health Management Information System (HMIS) death reporting tools, barriers to community death notification, feedback mechanisms, and perceptions of duplication or data loss within current reporting systems. The discussions were guided by a semi-structured discussion guide developed by the research team and translated into Luganda. Each session lasted between 60 and 120 min. With participants’ consent, discussions were audio-recorded; where recording was not permitted, detailed field notes were taken by trained rapporteurs fluent in Luganda and English. Audio recordings were transcribed verbatim and translated into English where necessary. Fourteen in-depth interviews were conducted with institutional stakeholders from the Ministry of Health, the National Identification and Registration Authority (NIRA), police departments, health facility records offices, and the eCHIS development team. Interviews explored institutional roles in mortality reporting, existing reporting procedures, data elements collected, reporting pathways, interoperability challenges, and perceived system inefficiencies. Interviews were documented through audio recordings and written notes. Findings from FGDs and IDIs informed structured discussions during the hackathon sessions, where participants collectively reviewed identified system gaps and contributed to the co-design of a harmonised community death notification workflow. The semi-structured discussion and interview guides were developed by the research team based on the study objectives and a review of relevant literature on mortality surveillance and community death reporting. Because data collection tools were developed specifically for this study, no external copyright permissions were required. Integration Within eCHIS Following validation of the harmonised workflow, a structured community death notification fields were configured within the existing eCHIS platform. See Fig. 1 . Fig. 1. Open in a new tab Manner of death workflow for community mortality surveillance. At the time of the study, eCHIS supported approximately 11,099 Village Health Teams and 160 Community Health Extension Workers across 17 districts. Configuration enabled structured entry of community death notifications and synchronisation with DHIS2 dashboards through existing interoperability architecture. This study documents workflow co-creation and system configuration readiness. It does not report quantitative evaluation of changes in mortality data completeness, accuracy, or timeliness. Data analysis Qualitative data were analysed using reflexive thematic analysis. Two members of the research team independently reviewed transcripts and field notes to familiarise themselves with the data and develop an initial coding framework. The framework combined inductive themes emerging from participant narratives with deductive domains aligned with study objectives, including reporting pathways, system fragmentation, interoperability, and workflow feasibility. Coding was conducted manually using structured analytic matrices in Microsoft Excel. Discrepancies in coding interpretation were resolved through discussion and consensus. Themes were refined iteratively and synthesised into system-level findings. Emergent themes were mapped directly to workflow design decisions during hackathon prototyping sessions. This ensured that the final workflow reflected empirically identified system gaps rather than theoretical assumptions. Reflexivity Members of the research team were affiliated with the Ministry of Health surveillance division and the eCHIS implementation team. To minimise institutional bias, coding and thematic interpretation were conducted independently by two analysts, and findings were reviewed collectively with stakeholders during validation sessions. Reflexive discussions were held to ensure that interpretations were grounded in participant narratives rather than institutional perspectives. Study outputs The primary outputs of the study were a harmonised community death notification workflow, a defined set of core community-level death notification variables suitable for digital capture, and a structured interoperability pathway linking eCHIS with DHIS2. The study did not assess quantitative surveillance performance indicators but documented the analytic and participatory process through which the workflow was developed and configured for pilot implementation. Results Participant characteristics A total of 26 participants contributed to the qualitative component of the study. These included 12 Village Health Team (VHT) members who participated in two focus group discussions, six from Masaka District representing a rural setting and six from Makindye Division in Kampala representing an urban setting. Fourteen in-depth interviews were conducted with representatives from the Ministry of Health (n = 4), the National Identification and Registration Authority (NIRA) (n = 3), health facility records personnel (n = 3), police officers involved in death investigations (n = 2), and eCHIS developers (n = 2). Participants included both men and women with varying levels of seniority and professional experience in community health, surveillance, civil registration, and health information systems. Findings are organised into five themes: (1) fragmented community death notification practices, (2) parallel civil registration processes, (3) inconsistencies in facility-based death reporting, (4) additional unintegrated mortality data sources, and (5) development and validation of a harmonised community death notification workflow. Fragmented community death notification practices Participants described multiple parallel mechanisms for community death reporting. VHTs reported using paper-based Health Management Information System (HMIS) forms, specifically HMIS 007 (maternal death reporting), HMIS 008 (child death reporting), and HMIS 097b (community health summary forms), to report deaths quarterly. These forms are submitted to health facilities for aggregation and entry into the District Health Information System (DHIS2). A VHT from Masaka explained: “…for us here in Masaka, death data capturing started before the COVID-19 pandemic, where deaths were reported quarterly using HMIS tools. After completion, we submit the forms to the health facility for entry into DHIS2. However, we get no feedback and don’t know what they do with this data.” (VHT participant, Masaka) This reflects limited feedback mechanisms and a lack of visibility into how community-reported deaths are used within higher-level systems. Participants also described temporary reporting tools used during the COVID-19 pandemic, including an SMS-based platform (short code 6767) managed during the emergency response period. The platform enabled rapid reporting of suspected COVID-19 deaths but was not integrated into DHIS2 and was discontinued after project funding ended. One VHT from Makindye stated: “…we had this form we were using, where we reported any death in our community, but they stopped after funding ended. I think it was research, and we reported on death but never got any feedback.” (VHT participant, Makindye) Participants described these systems as operating independently, with no sustained integration into routine national mortality surveillance structures. Parallel civil registration processes Representatives from NIRA described the legally mandated process for death registration under the Registration of Persons Act. Death registration requires completion of Form 12 and entry into the Mobile Vital Registration System (MVRS). Documentation requirements include identification of a declarant and supporting documentation. A NIRA officer explained: “…family meeting minutes indicating the person chosen to process the certificate must be attached, together with photocopies of IDs and signatures.” (NIRA officer) For historical deaths, additional documentation is required: “…for deaths before 1st January 1990, a recommendation letter endorsed by the LC1 chairperson and DISO is required before certification.” (NIRA officer) For community deaths, the declarant must physically present at the parish or subcounty offices to initiate the process. Participants also described several operational challenges, including staffing constraints, reliance on police documentation for certain external causes of death, and limited coordination between MVRS and MoH reporting systems. Respondents noted that deaths captured within health facility HMIS systems and those registered through MVRS were not routinely reconciled, resulting in potential duplication or incomplete cross-system visibility. Inconsistencies in facility-based death reporting Health facility respondents described multiple reporting instruments used to document deaths, including HMIS 002 (outpatient register), HMIS 009 (inpatient register), HMIS 004 (maternity register), HMIS 006 (child register), HMIS 108 (inpatient summary), HMIS 033b (monthly report), and the Medical Certificate of Cause of Death (MCCOD). Participants highlighted inconsistencies in death classification, particularly for deaths occurring in emergency units and outpatient departments. As regards regional referral hospital records assistant reported: “…there is a lack of clarity regarding death classification in emergency units and OPDs, particularly on how to define deaths in OPD and deaths of referred patients not yet registered.” (Records assistant, regional referral hospital) This inconsistency contributed to duplication and uncertainty in determining whether certain deaths were counted within inpatient or outpatient datasets. Participants described these reporting variations as contributing to reduced traceability of individual death records across reporting tiers. Additional unintegrated mortality data sources Police officers described capturing information on deaths related to accidents, violence, and other external causes. Mortuary registers and cemetery records were also noted as additional sources of mortality information. However, participants reported that these data sources were maintained independently and were not routinely synchronised with DHIS2 or MVRS. A police officer noted: “…we record road traffic accidents and suspected homicide cases in our station records, but that information is not automatically shared with health systems unless specifically requested.” (Police participant) These accounts suggest that multiple institutions generate mortality data, but integration across systems is limited and dependent on ad hoc coordination. Development of a harmonised community death notification workflow Drawing on themes identified through FGDs and interviews, participants collaboratively developed a harmonised community death notification workflow for integration into eCHIS. The workflow focused on capturing feasible community-level variables rather than full medical certification of the cause of death. The agreed core community-level variables included: age, sex, date of death, place of death (home, facility, other), manner of death (disease-related, accident, suicide, homicide, other external cause), and selected screening questions for epidemic-prone conditions and acute fatal events, including road traffic injuries. Participants prioritised capturing “manner of death” rather than detailed medical causes, recognising that VHTs are not clinically trained to assign specific diagnoses. Draft workflow diagrams were presented in plenary sessions and refined iteratively. Consensus was defined as the absence of substantive objection following structured discussion. Final outputs included a harmonised workflow diagram, a defined variable set, and an interoperability pathway linking eCHIS community reporting to DHIS2 dashboards. See Fig. 2 . Fig. 2. Open in a new tab Showing Uganda eHealth interoperability architecture. Configuration within eCHIS and preparation for pilot implementation Following validation, the harmonised workflow was configured within the existing eCHIS platform. Community death notifications entered by VHTs through the mobile application were structured for synchronisation with DHIS2. Within DHIS2, analytic dashboards were configured to visualise reported deaths by age, sex, district, and manner of death, supporting monitoring of reporting trends and completeness. At the time of configuration, eCHIS was operational in 17 districts. Early implementation feedback from participating districts suggested improved consistency in community death notification reporting and reduced duplication between reporting channels; however, formal quantitative evaluation of surveillance performance was beyond the scope of this qualitative study. Discussion This study examined fragmentation in Uganda’s community death notification system and documented the co-creation of a harmonised workflow configured for integration within the electronic Community Health Information System (eCHIS). Approximately 60% of deaths in Uganda are estimated to occur outside health facilities 10 , underscoring the importance of strengthening community-level death notification. Our findings suggest existing reporting pathways, spanning community HMIS tools, police records, facility registers, and the National Identification and Registration Authority, Mobile Vital Registration System, largely in parallel, with limited structured reconciliation across platforms. Rather than demonstrating system-wide performance change, this study documents how a structured multi-stakeholder hackathon facilitated joint systems mapping, identification of duplication points, and development of agreed workflow components. The primary deliverables included a harmonised community death notification workflow, a defined set of feasible community-level variables, and an interoperability pathway linking eCHIS data capture with DHIS2 dashboards. These outputs provide a structured foundation for improved alignment between community reporting and national health information systems. Evidence from participatory systems design literature suggests that collaborative co-design processes can improve technical feasibility and stakeholder ownership of digital health reforms 13 . Our findings are consistent with this body of work in demonstrating that stakeholders were able to reach consensus on a simplified and operationally feasible reporting pathway. Interoperability emerged as a central system concern. Participants described fragmentation between Ministry of Health reporting platforms and NIRA’s Mobile Vital Registration System. The workflow developed through this study was configured within eCHIS and structured to synchronise with DHIS2; however, comprehensive cross-institutional data reconciliation between MoH and NIRA systems was not formally implemented or evaluated as part of this study. Thus, while the architecture for improved integration has been established, the extent to which interoperability reduces duplication or improves completeness requires future quantitative assessment. International experience indicates that interoperable digital health architectures can strengthen surveillance coherence when supported by governance mechanisms and sustained implementation 13 . Our study contributes a locally developed model aligned with that principle but does not claim demonstrated impact on mortality data completeness or timeliness. Capacity strengthening was identified as a necessary complement to digital configuration. VHTs described limited feedback mechanisms and uncertainty regarding how submitted data were used. These findings suggest that improving community mortality surveillance requires not only digital tools but also structured feedback loops, supervision, and district-level data use practices. Evidence from digital health implementations in comparable settings shows that training must extend beyond data entry to include interpretation, local analysis, and decision-making capacity 14 . Without strengthening data use culture and supervisory systems, digital tools alone are unlikely to achieve sustained improvements. Experiences from other LMICs provide contextual comparison but should be interpreted cautiously. For example, Zambia’s integration of community reporting with national surveillance platforms demonstrates the feasibility of structured digital linkage 15 . Similarly, Ethiopia’s phased expansion of its community health information system highlights the importance of governance, staged rollout, and monitoring frameworks during scale-up 16 . While these cases illustrate elements relevant to Uganda, such as phased implementation and digital integration, they differ in institutional context and cannot be assumed to be directly comparable. Uganda’s model remains at the stage of workflow configuration and early implementation. Strengths and limitations This study has several limitations. First, the qualitative design involved a relatively small number of participants drawn from Masaka District and Makindye Division and may not capture operational variations in other districts of Uganda. Participants were purposively selected to represent key stakeholder groups involved in community death notification, civil registration, surveillance oversight, and digital health system development. While this approach enabled in-depth exploration of system workflows and facilitated collaborative design, the sample was not intended to support statistical generalisation. Findings should therefore be interpreted as context-specific insights that informed workflow development rather than as representative estimates of national practices. Second, participants may have been more engaged with surveillance processes than the broader range of actors involved in mortality reporting, which could introduce selection bias. Third, focus group discussions conducted in Luganda were translated into English, which may have introduced minor interpretive shifts despite careful transcription and verification. Fourth, some members of the research team were affiliated with the Ministry of Health surveillance division and the eCHIS implementation programme, which may have influenced framing of discussions; reflexive analytic procedures were used to minimise this risk. Finally, the study did not include a quantitative evaluation of mortality data completeness, accuracy, or timeliness following workflow configuration within eCHIS. As a result, conclusions regarding improvements in surveillance performance remain preliminary and descriptive, and further quantitative evaluation will be required to assess the impact of the proposed workflow on national mortality reporting systems. Overall, this study documents a structured participatory systems-design process for addressing fragmentation in community death notification and demonstrates how multi-sectoral collaboration can support the development of technically feasible and operationally aligned digital health workflows within existing national health information infrastructure. Conclusion Fragmentation in community death notification remains a significant barrier to comprehensive mortality surveillance in Uganda, particularly given that the majority of deaths occur outside health facilities. Through a structured multi-stakeholder hackathon, this study produced a harmonised community death notification workflow, a defined core variable set, and a configured interoperability pathway within eCHIS aligned with DHIS2 architecture. These outputs establish a systems foundation for strengthening community-level mortality reporting. However, a formal evaluation of the impact on mortality data completeness and integration is required. Recommendations First, national implementation of the harmonised community death notification workflow should be accompanied by structured monitoring and evaluation to assess completeness, timeliness, and duplication across eCHIS, DHIS2, and NIRA systems. Second, formal mechanisms for cross-platform data reconciliation between Ministry of Health reporting systems and the Mobile Vital Registration System should be developed to reduce parallel reporting and enhance coherence between civil registration and health surveillance data. Third, capacity-building initiatives should extend beyond digital data entry training to include district-level data analysis, feedback provision to community health workers, and strengthening of local surveillance response mechanisms. Finally, phased scale-up strategies with governance oversight and continuous evaluation should guide expansion to additional districts to ensure sustainability and system integration. 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. 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 Author contributions 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. Funding The study received no funding and was part of the Uganda Ministry of Health programming. 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. Competing interests The authors declare no competing interests. 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. Consent to publication The Ministry of Health Department of Integrated Epidemiology, Surveillance and Public Health Emergencies. Footnotes Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. WHO. Civil registration and vital statistics. https://www.who.int/news-room/fact-sheets/detail/civil-registration-and-vital-statistics#:~:text=WHO is working with partners,deaths in low-income countries (2023). 2. AbouZahr, C. et al. Towards universal civil registration and vital statistics systems: the time is now. Lancet 386 (10001), 1407–1418 (2015). [ DOI ] [ PubMed ] [ Google Scholar ] 3. Nichols, E. K., Ragunanthan, N. W., Ragunanthan, B., Gebrehiwet, H. & Kamara, K. A systematic review of vital events tracking by community health agents. Glob. Health Action 10.1080/16549716.2019.1597452 (2019). [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 4. World Health Organisation. Civil registration and vital statistics. https://www.who.int/news-room/fact-sheets/detail/civil-registration-and-vital-statistics (2024). 5. Ye, Y., Wamukoya, M., Ezeh, A., Emina, J. B. O. & Sankoh, O. Health and demographic surveillance systems: A step towards full civil registration and vital statistics system in sub-Sahara Africa?. BMC Public Health 12 (1), 1. 10.1186/1471-2458-12-741 (2012). [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 6. African Union and Africa CDC. Continental framework for strengthening mortality surveillance systems in Africa, [Online]. Available at: https://africacdc.org/download/continental-framework-on-strengthening-mortality-surveillance-systems-in-africa/ (2023). 7. Chisumpa, V. H. & Dorrington, R. Estimating adult mortality in Zambia using information on survival of parents from surveys (2013). 8. Basajja, M., Nambobi, M. & Wolstencroft, K. Possibility of enhancing digital health interoperability in Uganda through FAIR data. Data Intell. 4 (4), 899–916 (2022). [ Google Scholar ] 9. GoU. Act 4 registration of persons act registration of persons act. vol. CVIII, no 3, pp. 1–54 (2015). 10. Byaruhanga, A. A., Ahirirwe, S. R. & Bulage, L. Counting deaths in Uganda: history, challenges, and what is currently being done amidst COVID-19 Pandemic. Uganda Natl. Inst. Public Heal. Q. Epidemiol. Bull. 6 (4), 1–10 (2021). [ Google Scholar ] 11. MoH. Electronic Community Health Information 2 eCHIS Implementation Achievements. bll 1–6 (2023). 12. Peters, D. H., Adam, T., Alonge, O., Agyepong, I. A. & Tran, N. Implementation research: what it is and how to do it. BMJ 347 , 6753 (2013). [ DOI ] [ PubMed ] [ Google Scholar ] 13. Basajja, M., Nambobi, M. & Wolstencroft, K. Interoperability in Uganda through FAIR Data, Vol. 4. 10.1162/dint. (2022). 14. Transform Heath, “Investing in Digital Health”, 2025. https://transformhealthcoalition.org/investing-in-digital-health/ (toegang verkry 18 November 2024). 15. Chisumpa, V. H. & Dorrington, R. Estimating adult mortality in Zambia usinginformation on survival of parents from surveys. Afr. Popul. Stud. 25 (1), 113–126. 10.11564/25-1-259 (2011). [ Google Scholar ] 16. Ministry of Health. Policy brief optimizing eCHIS implementation in Ethiopia: Major determinants and recommended strategies (2025). Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Data Availability Statement The study data is available by request to the corresponding author. 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. Articles from Scientific Reports are provided here courtesy of Nature Publishing Group ACTIONS View on publisher site PDF (1.3 MB) Cite Collections Permalink RESOURCES Similar articles Cited by other articles Links to NCBI Databases Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top

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