Beyond infectious diseases: a scoping review of DHIS2 use for NCD monitoring in Southeast Europe

Introduction

Non-communicable diseases (NCDs) cause 90% of deaths in the WHO European Region and 95% in Serbia, yet systematic NCD monitoring remains underdeveloped. DHIS2, the world’s largest health management information system (HMIS) platform, has proven effective for infectious disease surveillance, but its role in NCD monitoring is poorly understood. We conducted a scoping review to map barriers and facilitators of DHIS2-based NCD monitoring and assess its applicability for Southeast Europe.

Methods

We followed the Arksey and O’Malley framework and PRISMA-ScR guidelines, with the protocol registered on OSF. We searched PubMed, Embase, Web of Science, and Scopus, supplemented by grey literature. From 3,235 records identified up to 2025, we included 19 studies (Fleiss’ κ = 0.83). We extracted barriers and facilitators and mapped them across five health information system (HIS) domains using the Stages of Continuous Improvement (SOCI) model.

Results

Most included studies (17/19) originated from Africa. Hypertension and diabetes were the most frequently monitored NCDs (13/19; 68.4% each), followed by chronic respiratory diseases (4/19; 21.1%) and neoplasms (2/19; 10.5%). Data quality and use showed the highest barrier prevalence (18/19; 94.7%), Management and Human Resource Capacity ranked second (15/19; 78.9%), and Leadership and Governance represented the strongest facilitators (17/19; 89.5%). Notably, strong governance did not translate into operational data capacity - the domain with the most persistent challenges.

Conclusions

This first scoping review of DHIS2-based NCD monitoring identifies data quality and human resource capacity as priority domains for implementation readiness. Comparison with SOCI assessment provides a transferable framework for countries in Southeast Europe seeking to strengthen their HMIS for NCD monitoring, with relevance across the WHO European Region.

Key messages

• Data quality (94.7% barrier prevalence) and human resource capacity (78.9%) are the priority domains for DHIS2-based NCD monitoring implementation.

• Domain-level barrier mapping using the SOCI framework offers a transferable pre-implementation assessment for NCD monitoring across Southeast Europe.