From Paper to Digital: Performance and Challenges of the Electronic Hepatitis B Surveillance System in Ninh Binh, Northern Vietnam (2017-2022).

Hepatitis B remains a major public health issue in Vietnam. Mandatory reporting to the national electronic communicable disease surveillance system (eCDS) has been required since July 2016. We conducted an evaluation of the hepatitis B surveillance system in Ninh Binh, the province with the highest reported burden of hepatitis B in Northern Vietnam, between 2017 and 2022. Using the CDC's guidelines for evaluating public health surveillance systems, we assessed four key attributes: simplicity, timeliness, data quality, and acceptability. This retrospective evaluation included document reviews, analysis of hepatitis B data, and in-depth interviews with provincial-level healthcare staff involved in the reporting of hepatitis B cases. The results showed that the eCDS improved reporting frequency, provided more detailed case information, and enhanced data accessibility compared to the previous paper-based system. However, the system faced several challenges, including unclear objectives, difficulties in distinguishing acute from chronic cases, insufficient training for staff, lack of supervision for data quality, and technical software issues. Despite these challenges, stakeholders found the system acceptable but emphasized the need for improvements, including revising the system's objectives, automating case classification, enhancing training, securing funding for maintenance, and implementing regular data review processes.