Implementation toolkit

Introduction

The purpose of this implementation manual is to provide a comprehensive guide for introducing and implementing SORMAS in a new country. It aims to support project teams and stakeholders in navigating the various stages of the implementation process, from initial needs assessment to full-scale deployment. The manual outlines the key components, activities, and considerations necessary for a successful implementation, ensuring that SORMAS is effectively customized, integrated into the country's disease surveillance and outbreak response systems, and aligned with national health priorities.  

Introducing SORMAS in a new country holds significant importance in strengthening disease surveillance and outbreak response capabilities. By leveraging digital technology, SORMAS enables timely and accurate data collection, analysis, and reporting, enhancing the country's ability to detect, monitor, and respond to disease outbreaks effectively. SORMAS facilitates real-time collaboration and information sharing among key stakeholders, such as healthcare workers, epidemiologists, and public health officials, enabling coordinated response efforts. This integrated system enhances early warning systems, supports evidence-based decision-making, and enables targeted interventions to prevent the spread of diseases. By implementing SORMAS, you can strengthen national public health infrastructure, improve disease surveillance, and ultimately protect the health and well-being of your population.

Engage with the SORMAS Community of Practice

Engaging with the Community of Practice (CoP) of SORMAS is a vital aspect of introducing and implementing SORMAS in a new country. This can be an essential first step and a strong reliable sustainability platform for the continuous improvement of SORMAS for the country.

The Community of Practice comprises a network of experts, implementers, and stakeholders who have hands-on experience with SORMAS. Engaging with this community offers numerous benefits, including knowledge sharing, best practice exchange, and access to valuable resources and support.

The benefits of engaging with the Community of Practice can immediately be appreciated by new countries as the space provides a platform for knowledge sharing and learning, where exchange of ideas, experiences, and best practices are shared by experts. In addition to this, problem-solving and troubleshooting can be leveraged at the start of the implementation of SORMAS. New implementers of SORMAS can receive solutions to project-specific issues, by seeking advice and guidance from a diverse community of experts who in turn can provide suggestions and potential solutions based on experience from solving similar challenges.  

Continuous improvement and innovation which is a key aspect of sustainability can also be benefited by engaging the SORMAS community. Up-to-date information and methodologies employed in the continuous development of the software can inspire new users to adopt innovative practices and techniques, while implementing SORMAS.  

By actively participating in the Community of Practice, project teams can tap into the collective wisdom and lessons learned from previous implementations, gaining insights into implementation strategies, customization approaches, and overcoming challenges. This collaboration facilitates peer-to-peer learning, fosters innovation, and helps ensure the successful deployment and utilization of SORMAS. Additionally, the Community of Practice provides a platform for ongoing support, where project teams can seek guidance, troubleshoot issues, and receive updates on system enhancements.  

Engaging with the Community of Practice not only strengthens the implementation process but also contributes to the growth and sustainability of SORMAS in the new country.  

To join the SORMAS Community Online Platform, simply follow these steps:

1. Visit our Community Online Exchange Platform https://community.sorm.as and join the SORMAS Community

2. Fill out the registration form with your name, email address, and other required information.

3. Confirm your email address by clicking on the verification link that we will send to your email.

4. Log in to the platform and start exploring the content, joining discussions, and interacting with other members.

The first steps

Needs Assessment and Scoping

The goal of the needs assessment and scoping phase is to gather a comprehensive understanding of the country's healthcare system, existing disease surveillance and outbreak response capabilities, and the specific requirements and challenges that need to be addressed through the implementation of SORMAS. This phase involves analyzing the country's health system structure, policies, and regulations, evaluating existing health information systems and technologies, understanding the epidemiological landscape and disease patterns, and assessing the capacity and readiness of the healthcare workforce. By conducting a thorough assessment of the country's landscape, the needs assessment and scoping phase aims to identify gaps, barriers, and opportunities for improvement. It may be helpful to have a look at recent epidemic events and understand how and by whom they were handled.

This information serves as the foundation for developing a tailored implementation plan, setting realistic goals, and ensuring that SORMAS is effectively customized to meet the country's unique needs. It also enables the project team to align the implementation with national health priorities, establish partnerships, secure stakeholder buy-in, and ultimately enhance the country's disease surveillance and outbreak response capabilities through the successful implementation of SORMAS.

During this phase, it is crucial to engage with stakeholders involved in disease surveillance and outbreak response, including government agencies including those involved in data protection, specialized health institutes, technical and financial partners, and NGOs. The goal is to foster collaboration, build partnerships, and ensure that the implementation of SORMAS aligns with the priorities and needs of all stakeholders. Engaging stakeholders allows for the gathering of valuable insights, expertise, and contributions to the customization and adaptation of SORMAS to the country's context. Effective stakeholder engagement facilitates the sharing of responsibilities, resources, and knowledge, creating a supportive environment for sustainable implementation. Regular communication channels, consultations, and workshops provide opportunities for stakeholders to provide feedback, address concerns, and foster a sense of ownership and commitment to the successful implementation of SORMAS. By actively involving stakeholders, the implementation process can benefit from their diverse perspectives, leading to the successful integration of SORMAS into the country's disease surveillance and outbreak response systems.

We have developed generic Terms of reference for the needs assessment that can be downloaded [here].  

Costing

Estimating the financial resources required for various aspects of introducing and running SORMAS is a crucial step in the implementation process. This includes assessing costs associated with software procurement, customization, hardware, training, maintenance, and ongoing support. A comprehensive cost estimate allows for an accurate assessment of the financial implications associated with implementing SORMAS, taking into consideration not only the initial implementation costs but also the long-term sustainability and maintenance expenses.

At this point it is useful to be aware of the current funding situation regarding the surveillance system, in particular with regards to human resources: Are they paid for by the government or by an external source, (in that case for how long and are there plans for the continuity). Similarly, one should know if budget provision for responding to an outbreak exists, this relates to the logistical and human resource costs of investigation and response. During this phase, it is also important to explore potential funding sources to secure the necessary financial resources for successful implementation. This can involve seeking support from government budgets, grants, partnerships, and donor organizations. By identifying and securing appropriate funding, the project can ensure sufficient resources to sustain the implementation and address any unforeseen challenges that may arise.  

To achieve long-term success and sustainability of digital health interventions like SORMAS in low-resource settings, it is crucial to accurately plan for expenditures throughout the intervention's lifecycle. This entails understanding and documenting all costs associated with owning and operating the technology, commonly referred to as the total cost of ownership (TCO). To assist with budgeting and benchmarking resources, we recommend using the Digital Square's Total Cost of Ownership (TCO) Tool, which provides valuable insights to develop more realistic budgets. You can access and download the tool at https://digitalsquare.org/tco-tool.  

By utilizing the TCO tool and incorporating accurate cost estimation and budgeting practices, the implementation of SORMAS can be effectively planned and managed, ensuring the availability of necessary resources and maximizing the long-term impact of the intervention.

Planning the introduction of SORMAS

Planning and Management  

This section focuses on developing a comprehensive plan and establishing effective project management practices to ensure a successful and smooth implementation process.

Project Scope and Objectives

Clearly define the project's scope, including the specific goals to be achieved through the introduction and implementation of SORMAS. This helps to align the project with the country's disease surveillance, outbreak response priorities and data protection regulations. This will ensure a mutual understanding among all stakeholders. You can download [here] a generic logical framework to be adapted or tailored to fit your specific project requirements.

Timelines and Milestones

Develop a detailed implementation plan that outlines the key activities, milestones, and deadlines associated with the implementation of SORMAS. This allows for effective project tracking, ensuring that tasks are completed in a timely manner and dependencies are effectively managed. You can download [here] a generic chronogram with the main activities to carry out to adapt to your requirements.  

Project Team and Roles

Identify the project team members, their roles, and responsibilities. This includes assigning project leads, technical experts, trainers, and support staff who will be involved in various aspects of the implementation. Clearly defining roles and responsibilities helps in streamlining communication and decision-making processes This is all the more important as the different skills required may not exist within the same department or ministry (for example, IT experts may come from a different ministry or even from the private sector).Some hierarchical lines could be disrupted and require a functional approach.

Table 1: Project Team and Implementation Roles

Establishing Project Management Processes and Communication Protocols:

1. Regular Project Meetings: Schedule regular project meetings with the project team and relevant stakeholders to discuss progress, address challenges, and make decisions. These meetings can be conducted weekly, bi-weekly, or monthly, depending on the project's timeline and needs. Meetings can be held in person or through video conferencing tools. Establish an agenda for each meeting to ensure that discussions are focused and productive.

2. Communication Channels: Determine the communication channels that will be used throughout the project. This can include email, instant messaging platforms (such as Slack or Microsoft Teams), project management software (such as Trello or Asana), and shared document repositories (such as Google Drive or Microsoft SharePoint). Establish guidelines for how and when project team members should communicate through these channels, ensuring timely responses and efficient collaboration. The SORMAS Foundation Community Online platform offers a robust group section for this purpose.

3. Documentation and Reporting: Develop a system for documenting project activities, decisions, and outcomes. This includes maintaining project documentation, progress reports, and lessons learned. Effective documentation ensures transparency, accountability, and knowledge sharing throughout the project lifecycle. The frequency and format of these reports should be determined, ensuring that key information is included and distributed to the appropriate stakeholders in a timely manner. The SORMAS Foundation encourages countries to publish/post documents on progress reports and lessons learned on the Community Online Platform, as a way of contributing to the overall enhancement and sustainability of SORMAS globally.

4. Risk Management: Develop processes for identifying, tracking, and resolving project issues and risks. Establish a mechanism for reporting and documenting issues as they arise, including a clear escalation path for critical issues. Determine how risks will be assessed, monitored, and mitigated throughout the project's lifecycle. Implement proactive measures to address potential risks and minimize their impact on the project's success.

5. Monitoring and Evaluation Framework: To track progress and outcomes, it is essential to implement a monitoring and evaluation (M&E) framework. This involves defining key performance indicators (KPIs) that measure the success of the SORMAS implementation. Establish data collection methods, data quality assurance processes, and analysis procedures to assess the project's performance. Regular monitoring allows for timely identification of challenges, enabling prompt adjustments and improvements. Evaluation helps measure the impact of SORMAS on disease surveillance and outbreak response capabilities, providing insights for future enhancements and ensuring that the project's objectives are met

6. Stakeholder Engagement: Develop strategies to engage and communicate with stakeholders throughout the implementation process. This includes regular updates, consultation meetings, and workshops to gather feedback, address concerns, and foster collaboration. Effective stakeholder engagement ensures that the project remains aligned with their needs and priorities.

Training and capacity building

1. Training of trainers: Delivered by the Sormas Foundation with the objective of training a core group of individuals who will become trainers themselves and will cascade the training to a wider audience. The audience should be selected from the actual MoH/NPHI staff and already involved in the surveillance system. Preference should be given to people with a high likelihood of remaining in position or evolving within the system. Consider them for key positions in the Sormas range of users (as administrator, national and regional users, and supervisors). Administrators should be identified Within this core group, , as they will benefit from a specific component which will be added to the training. Administrators are meant to manage both the database (data configuration of health facilities and population data, advanced data processing functions), and the users (usernames, profiles and passwords, enabling/disabling users). Therefore, careful consideration should be given when identifying staff for the administrator roles at national and regional level. In addition, it must be considered that all staff in key positions (for example system administrators) must be doubled to compensate for possible vacancies (maternity leave, illness or vacation). The training of trainers should not only covers all SORMAScomponents relevant to your country, but also drafts interactively the procedures to be set up for a smooth and efficient use of the system, as well as it allows to design the training of your users. We recommend this to be minimum a five-day, face-to-face, training. For effective support during the exercises, there should ideally be one trainer for 6 to 8 participants. An additional 2-3 hour session is required for the administrator profile module (which can be done on-line).

2. Training Program Development: develop a training program that covers all relevant aspects of SORMAS implementation. This can include technical training on system functionalities, data management and analysis, outbreak response protocols, and reporting mechanisms. Additionally, consider training on change management, stakeholder engagement, and effective communication to support the successful adoption of SORMAS.

3. Training Delivery: Choose appropriate training delivery methods, considering the needs and preferences of the target audience. This can include in-person workshops, virtual training sessions, webinars, or a combination of various approaches. Engage experienced trainers or subject matter experts to facilitate the training sessions, ensuring that they have a deep understanding of SORMAS and its implementation requirements.

4. Training Sessions: Specify the number of training sessions that will be conducted. Identify the different groups or individuals who will attend each session based on their roles and responsibilities in using SORMAS. This could include healthcare workers, data managers, epidemiologists, and other relevant stakeholders.

5. Training Schedule: Develop a detailed training schedule that outlines the dates, duration, and location of each training session. Consider the availability of participants, their work schedules, and any other logistical factors that may impact the training schedule. Aim to provide adequate time for participants to grasp the concepts and practice using SORMAS effectively.

6. Training Budget: Allocate resources for training activities in the overall project budget. Consider the costs associated with venue rental, training materials, facilitators' fees, logistics support, infrastructure requirements, and other related expenses. Ensure that the training budget is aligned with the project's financial resources.

7. Staffing Plan: Identify the facilitators who will deliver the training sessions. Ensure that they possess the necessary expertise in SORMAS functionality and implementation. If required, consider assigning support or supervisors to assist the facilitators during training. Additionally, include logistics support and administrative who will manage the training logistics and ensure smooth operations.

8. Logistics/Infrastructure Requirements: Assess and address the logistical and infrastructure requirements for training sessions. Determine the number of computers or devices needed to accommodate participants. Ensure access to consistent and reliable power supply and internet connectivity, or identify backup methods to overcome any infrastructure challenges that may arise.

9. Training Materials: Prepare comprehensive training materials that cover all aspects of SORMAS implementation and usage. This may include user manuals, job aids, video tutorials, and reference guides. Ensure that the training materials are accessible, user-friendly, and tailored to the specific needs of the target audience.

10. Ongoing Support and Refresher Training: Provide ongoing support and refresher training to reinforce knowledge and address any emerging challenges. This can include regular follow-up sessions, helpdesk support, online resources, and user forums. Ongoing training and support help users stay updated on system enhancements, address any questions or issues, and optimize their utilization of SORMAS.

11. Evaluation and Feedback: Incorporate evaluation mechanisms to assess the effectiveness of the training programs. Collect feedback from participants to understand their training experience, identify areas for improvement, and make necessary adjustments to future training sessions. Monitoring the impact of training helps ensure that the desired knowledge and skills are acquired and applied in practice.

Detailed budget  

Now that you are set on the scope and objectives of your implementation, including your team and customization as well as training needs required for implementation, a detailed budget should be created.  

Implementation of SORMAS

The implementation phase of SORMAS includes planning and conducting the technical setup and configuration of your system, and define the features used, desired, customized, and extended in the implementation.

Technical set up and requirements, configuration and customization, deployment  

SORMAS is designed, among other things, for technical interoperability and for data transfer from or to other tools. The application consists of server-based components that are operated in a data centre. It is operated via a web interface or via an app for mobile devices (Android). SORMAS is based on the Java Enterprise Platform. The web interface is based on the Vaadin 8 framework. The data is persisted in a relational database (PostgreSQL).

The SORMAS platform consists of the following main components:

• Vaadin Web Application [essential]

• Payara server [essential]

• Mobile app (Android) [optional]

The mobile app interacts with the Payara server via a REST API and runs on Android mobile devices and tablets (Andriod 8.0 Oreo). The Vaadin-based web app runs directly on the Payara server, can be used with all common browsers, and is optimized for use with PCs.

The individual source code repositories, backlogs and specifications are managed and documented on GitHub (https://github.com/sormas-foundation).

In the SORMAS-Docker sub-project (https://github.com/hzi-braunschweig/SORMAS-Docker and https://hub.docker.com/orgs/hzibraunschweig), prefabricated container images are provided. These container images serve as the basis for all current SORMAS installations, both nationally and internationally.

Server setup instructions are also provided on GitHub (https://github.com/hzibraunschweig/SORMAS-Project/blob/development/docs/SERVER_SETUP.md), as well as server update instructions (https://github.com/hzi-braunschweig/SORMASProject/blob/development/docs/SERVER_UPDATE.md).

It is an important tool for public health institutions, and it requires a robust and reliable server to function effectively. This document provides guidance on the server requirements for SORMAS and best practices for setting up the server and IT infrastructure. 

Cloud vs On-Premise  

The decision to use cloud-based or on-premise servers for SORMAS should be based on the specific needs of the country, which is usually determined by availability of IT infrastructure and human resources. Cloud-based servers offer the advantage of scalability, reliability, and ease of maintenance. On the other hand, on-premise servers provide greater control over data and security.

Operational Analysis of Having a Cloud (Virtualized) Server 

Cloud operations are best known for on-demand capabilities when it comes to quick provision of services. With the presence of experts on cloud operations, it takes a shorter timeline to solve issues such as server downtime compared to a situation where critical errors occur in an on-site dedicated server or group of servers. Dedicated servers, therefore, require their databases to be backed up regularly in preparation for an unplanned disaster.                                                                                

The following factors provide an insight into the benefits and disadvantages of using a cloud server for the operation of the SORMAS platform: 

1. Compliance with requirements: In terms of compliance with standard requirements such as data security and data governance, having a dedicated server or group of servers provides a better guarantee, but this comes with a higher cost as having a dedicated server has a higher cost of operation and maintenance. However, non-compliance with these requirements can be equally costly in terms of data loss or a breach of data confidentiality. 

2. Configuration, Management, and Support: Performance optimization operations (involving fine-tuning for continuous scaling, provisioning, and regular management of resources) which should be done regularly on the SORMAS platform are easier and more reliable using a cloud server. With a dedicated server, The Public Health Institute may require the support of a vendor to physically perform updates on management and provisioning.   

3. Size of the System database: With the continuous daily increase in the amount of data coming from end users and regular development of features, modules, and sub-systems on the SORMAS platform, future expansion of the SORMAS cloud servers will be required to cater to the frequent increase of needs. It is therefore cheaper to use a dedicated server(s) that has higher capacity in terms of storage, processor speed, and memory. 

4. System Upgrades and Backup: With a cloud server, deployments, upgrades, and backup of features are faster compared to a dedicated server which uses more time and resources. 

Standard requirements to consider before setting up SORMAS server on an on-premise tenancy 

Setting up a SORMAS server on-premise requires careful planning to ensure it is reliable and can withstand disasters. Here are some standard requirements to consider: 

1. Hardware Requirements: Determine the required hardware specifications for the SORMAS server, such as processor speed, RAM, storage capacity, and network connectivity. Ensure that the server hardware is reliable and resilient, such as using redundant power supplies, Internet connectivity and RAID storage. 

2. Operating System: Install a secure operating system (OS) that is compatible with SORMAS. Choose a stable version of the OS and regularly apply security updates to protect against vulnerabilities. 

3. Database: Set up a reliable database server that can store and manage the SORMAS data. Use a database system that supports backup and recovery mechanisms. 

4. Disaster Recovery: Develop a disaster recovery plan to ensure business continuity in case of disasters such as hardware failure, cyber-attacks, and natural disasters. Implement backup and restore procedures to ensure data availability in case of a disaster. 

5. Network Security: Secure the network infrastructure by implementing firewalls, intrusion detection systems, and security patches. Implement security protocols such as SSL/TLS encryption for data transmission and enforce access controls to prevent unauthorized access to the SORMAS server. 

6. Monitoring: Implement monitoring tools to ensure the SORMAS server is running smoothly and detect any anomalies or performance issues. Regularly monitor server logs and analyze system metrics to identify potential problems and take corrective actions. 

7. Training and Support: Provide training to staff responsible for maintaining and operating the SORMAS server. Establish a support system to address technical issues and aid users. 

These are the major standard requirements to consider when setting up a SORMAS server on-premise with disaster recovery measures. It is essential to regularly review and update these measures to ensure that the SORMAS server remains secure and reliable. 

 Server requirements  

The following are the minimum server requirements for running SORMAS: 

• Operating System: Linux Ubuntu Server 16.04 or later 

• Processor: Eight-core 2.0 GHz or higher 

• RAM: 16 GB or more

• Storage: 100 GB or more 

• Database: PostgreSQL version 15 or later 

 Android device requirements

The following are the minimum requirements for running SORMAS android app on your devices:

• 32GB of storage or more

• Android 8.0 Oreo OS or higher  

• 3GB of RAM or more

• GPS Sensor

• Internet connectivity through Wi-Fi or Mobile data

General recommendations

IT infrastructure is a critical component of the SORMAS system. To ensure the system's success, it is important to follow best practices for setting up and maintaining the server. Concerned parties should carefully consider their IT infrastructure requirements and choose the deployment option that best fits their needs. To host and successfully run a SORMAS instance, several services should be secured (in-house, by an external service provider, or a combination of both). The recommended provision of server services include:

• IT-operation, Software, Platform, and Infrastructure as a Service (SaaS, PaaS, IaaS) capabilities

• Single Point of Contact (SPoC)

• Technical support (i.e., 1st, 2nd, 3rd, 4th level services)

• Open Solutions (Dev Ops, automatization/containers)

• Managed security (data privacy and IT-security)

• Incident management, problem management, change management and "full" managed service „on demand “

• Maintenance of operating system levels (patch management)

• IT operation of the SORMAS application instance

• IT operation of the backup solution (backup solution can be provided by the data centre)

• Ongoing monitoring and analysis of the SORMAS application instance

• Regular review of configurations and data backup

• Recording, categorization, and prioritization of service requests via phone, email, and web service portal

• Processing of service requests according to Service Level Agreement (SLA)

• Recording, tracking and escalation of all technical service requests

• Processing of service requests for change requests (configuration adjustments, etc.)

• Processing of service requests for incidents (malfunctions)

• Managed security and data privacy, aspects of data protection, revision, and IT-security (i.e., firewall cluster solutions, awareness, website security check)

• ISO 9001:2015 and 27001 certified