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Linking operational data from the two systems can directly match observed cases from the DSS with cases seen at the health services. In both systems the granularity of the data goes down to the level of the single case and to the single day. Operational HMIS data on service activities are stored on paper in the facilities, e.g. patient/case registers. The health services don't have digitized case recordings. The first challenge on this level lies therefore in the physical transmission of the data. If this barrier has been overcome, cases and individuals have to be matched. This effort is being made for specific studies by manually searching the register books, but is surely too costly for a routine linkage.

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