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MacDonald Pia

The 2014-2016 Ebola outbreak in Guinea revealed systematic weaknesses in the existing disease surveillance system. The lack of public health workers adequately trained in Integrated Disease Surveillance and Response (IDSR) contributed to underreporting of cases and problems with data completeness, accuracy, and reliability. These data quality issues resulted in difficulty assessing the epidemic's scale and distribution and hindered the control effort (McNamara, 2016; Bell, 2016). In 2015, the Guinean Ministry of Health (MoH) recognized the importance of the IDSR framework as a tool for improving disease surveillance and emphasized IDSR strengthening as a priority activity in the post-Ebola transition (MoH, 2015). To support this strategic objective, we engaged with the MoH, CDC, and key surveillance partners to strengthen surveillance capacity through a national initiative to improve IDSR tools, including assistance with developing Guinea-specific IDSR technical guidelines, simplified and standardized case notification forms, and supportive job aids to facilitate appropriate IDSR implementation by health workers at all levels of the system.

Objective: The objective is to discuss capacity building for Integrated Disease Surveillance and Response in Guinea and synthesize lessons learned for implementing the Global Health Security Agenda in similar settings.

Submitted by elamb on

The West Africa Ebola outbreak of 2014-2016 demonstrated the importance of strong disease surveillance systems and the severe consequences of weak capacity to detect and respond to cases quickly. Challenges in the transmission and management of surveillance data were one factor that contributed to the delay in detecting and confirming the Ebola outbreak. To help address this challenge, we have collaborated with the U.S. Centers for Disease Control and Prevention (CDC), the Ministry of Health (MOH) in Guinea, the World Health Organization and various partners to strengthen the disease surveillance system through the implementation of an electronic reporting system using an open source software tool, the District Health Information Software Version 2 (DHIS 2). These efforts are part of the Global Health Security Agenda objective to strengthen real-time surveillance. This online system enables prefecture health offices to enter aggregate weekly disease reports from health facilities and for that information to be immediately accessible to designated staff at prefecture, regional and national levels. Incorporating DHIS 2 includes several advantages for the surveillance system. For one, the data is available in real time and can be analyzed quickly using built-in data analysis tools within DHIS 2 or exported to other analysis tools. In contrast, the existing system of reporting using Excel spreadsheets requires the MOH to manually compile spreadsheets from all the 38 prefectures to have case counts for the national level. For the individual case notification system, DHIS 2 enables a similar accessibility of information that does not exist with the current paper-based reporting system. Once a case notification form is completed in DHIS 2, the case-patient information is immediately accessible to the laboratories receiving specimens and conducting testing for case confirmation. The system is designed so that laboratories enter the date and time that a specimen is received, and any test results. The results are then immediately accessible to the reporting district and to the stakeholders involved including the National Health Security Agency and the Expanded Program on Vaccination. In addition, DHIS 2 can generate email and short message service (SMS) messages to notify concerned parties at critical junctures in the process, for example, when a laboratory result is available for a given case.

Objective: The objective is to share the progress and challenges in the implementation of the District Health Information Software Version 2 (DHIS 2) as an electronic disease surveillance system platform in Guinea, West Africa, to inform Global Health Security Agenda efforts to strengthen real-time surveillance in low-resource settings.

Submitted by elamb on

Syndromic surveillance data have been widely shown to be useful to large health departments. Use at smaller local health departments (LHDs) has rarely been described, and the effectiveness of various methods of delivering syndromic surveillance data and information to smaller health departments is unknown. Syndromic surveillance data and information in North Carolina are available to all local public health staff by several routes. This report characterizes LHD access to syndromic surveillance data and information and their use for key public health purposes.

 

Objective

To characterize use of syndromic surveillance information for key public health functions at the local health department level, and to make recommendations to facilitate use of syndromic surveillance data for these functions.

Referenced File
Submitted by hparton on

Improving surveillance and response is a critical component of the Global Health Security Agenda. While it is impossible to predict where the next Ebola outbreak will occur, it is very likely that another outbreak will occur in the DRC. Of the 20 known outbreaks, 7 have occurred in the DRC, one as recently as 2014. To rapidly detect and respond to an Ebola outbreak, we sought to develop a real-time surveillance and response system for use in DRC and similar settings. RTI International developed Coconut Surveillance mobile software, which is currently used for real-time malaria surveillance and response in Zanzibar, Africa, where malaria elimination efforts are underway. We took this system and adapted it for Ebola as a possible tool for surveillance and response to Ebola and other (re)emerging diseases. Plans include pilot testing functionality at clinical sites in DRC, where surveillance infrastructure is limited at the local level. Coconut Surveillance is a mobile disease surveillance and rapid response system currently used for malaria elimination activities. It receives suspected positive case alerts from the field via mobile phones and uses mobile software to guide surveillance officers through a follow-up process. Coconut Surveillance runs on Android mobile devices that are used to coordinate work in the field as well as provide decision support during data collection and case management. In addition to standard case information, the GPS coordinates of the case’s household are captured as well as malaria status of all household members. Data are collected and accessed off-line, and are synchronized with a shared database when Internet connectivity is available. This tool has been used successfully in Zanzibar for more than three years and has been recognized as one of the most advanced applications of its kind.

Objective

We will describe a real-time mobile surveillance and case management system designed to organize data collected by multiple officers about cases and their contacts. We will discuss this surveillance system and its application for Ebola and other infectious diseases in the Democratic Republic of the Congo (DRC) and other similar settings. We will review the technology, results, challenges, lessons-learned, and applicability to other contexts.

Submitted by teresa.hamby@d… on

RTI International has worked on enhancing health information and disease surveillance systems in many countries, including The Democratic Republic of the Congo (DRC), Guinea, Indonesia, Kenya, Nepal, Philippines, Tanzania, Zambia, and Zimbabwe. Strengthening these systems is critical for all three of the Prevent, Detect and Respond domains within the Global Health Security Agenda. 

We have deep experience in this area, ranging from implementing District Health Information Software (DHIS), electronic medical records, health facility registries, eHealth national strategies, electronic Integrated Disease Surveillance and Response system (eIDSR), mobile real-time malaria surveillance and response, national weekly disease surveillance, patient referral system, and community based surveillance. These experiences and lessons learned can inform work being done to advance the GHSA.

We will discuss several examples, including activities in Zimbabwe and Tanzania. RTI has been working in Zimbabwe for over six years to strengthen the national health information system. This work has included the configuration and roll-out of DHIS 2, the national electronic health information system. In doing so, RTI examined and revitalized the weekly disease surveillance system, improving disease reporting timeliness and completeness from 40% to 90%. Additionally, RTI has integrated mobile technology to help more rapidly communicate laboratory test results, a laboratory information management systems to manage and guide test sample processing, and various other patient level systems in support of health service delivery at the local level. This work has involved capacity building within the ministry of health to allow for sustainable support of health information systems practices and technology and improvements to data dissemination and use practices. 

Objective

The objective is to discuss two decades of international experience in health information and disease surveillance systems strengthening and synthesize lessons learned as applicable to implementation of the Global Health Security Agenda (GHSA). 

Submitted by uysz on
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