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Surveillance and Information Systems Strategy
Global Health Risk Framework: A Workshop on Resilient and Sustainable Health Systems to Response to Global
Infectious Disease Outbreaks 5 – 7 August 2015
David Fitter Division of Global Health Protection
Center for Global Health Centers for Disease Control and Prevention
Division of Global Health Protection Center for Global Health
IDSR in West Africa
IDSR framework adopted in all three countries
Not fully implemented Timeliness and completeness
of reporting inadequate Weak feedback mechanisms Lack of capacity at local levels
for detection and reporting Almost no subnational analysis
observed Lack of adequate supervision at
all levels
The West Africa Ebola Outbreak State of the Health Systems
Evolving government stability due to recent
emergence from conflict in region Telecommunications providers lagging well behind
many countries in Eastern and Southern Africa which had seen years of GFATM and PEPFAR investment
Power grids and road networks damaged Dilapidated laboratory and clinical infrastructures Not a comprehensive sub-national to national
disease surveillance system Ebola never before seen in region so no clinical or
lab preparedness or capacity
The West Africa Ebola Outbreak The Response
VHF deployed to MOH headquarters for organizing VHF case, lab and contact data in a single database System designed based on Gulu Uganda (2001) and similar
EVD outbreaks (limited geo scope, cases and response) Single data manager consolidating case investigation, lab and
contact data Extensive EVD outbreak subject matter expertise built into data
linkages and analytic tools
As the outbreak engulfed the national health systems and hundreds of health organizations responded the people and tools which comprised “the system” could not keep up and became increasingly disorganized
The West Africa Ebola Outbreak The Response
Lack of capacity (persons and infrastructure) in MOH to centrally integrate/warehouse data
Insufficient human capacity to collect, manage or use data from community to national level
Lack of sufficient capacity to train or supervise subnational or national health system personnel
Thousands of often lay community health workers and volunteers engaged in the response
Unimaginable political and civil demand for information, assistance, and change in priorities
The West Africa Ebola Outbreak The Response
Cases in remote hard-to-reach areas – information lag
Many responders working across multiple domains Many new labs often each under different technical oversight Multiple Ebola Treatment Units with providers from different
groups
VHF attempted to be used as case report/surveillance tool Form too long Untrained staff Lag / Incomplete data
The West Africa Ebola Outbreak The Response
Alternate data sources and systems (paper/Excel) Sit Reps Decedent registries Call centers Lab logbooks and spreadsheets Ebola Treatment Units Surveys Sporadic innovation
Lack of robust unique ID systems across services
The West Africa Ebola Outbreak The Response
Alternate data sources and systems (paper/Excel) Sit Reps Dead body registries Call centers Lab logbooks and spreadsheets Ebola Treatment Units Surveys Sporadic innovation
Lack of robust unique ID systems across services
Innovations Mobile Data Collection
• Surveys • Contact tracing • Team supervision • Technical assistance/SOPs • Geocoding
Cloud Hosting • Central Data Storage • Data Integration • Case and Lab registries • Analysis/Dashboards
Global Health Security Agenda
Antimicrobial Resistance
Zoonotic Diseases
Biosafety/Biosecurity
Immunization
National Laboratory System
Syndromic Surveillance Linked Data Systems
GHSA Reporting
Emergency Operations Centers
Link Public Health and Law Enforcement
Medical Countermeasures
Workforce Development
GHSA Principles – National Surveillance Strategy (IDSR-based/IHR compliant)
• Combines Indicator-based and Event-based Surveillance across human and animal health systems for early detection and rapid response
• Step-wise implementation / Routine progress monitoring
– One Health trained workforce • Human and Animal health systems • Civil (Public/Private) / Military
– Infrastructure [ICT, Secure data centers (terrestrial/cloud)]
– Data Integration
– Data exchange
– Standards (Process/Data/Systems interoperability)
GHSA Priority Investments Surveillance
• National surveillance strategy with disease-specific protocols
• Information Communication Technology (ICT) Infrastructure
• Workforce trained in surveillance data capture and use
• Routine indicator-based and event-based surveillance
• Laboratory information systems and specimen tracking
• Integrated surveillance and laboratory national health data warehouse (linking human and animal health)
• Data Exchange supporting use across local, national, EOC and international platforms
GHSA Priority Investments eSurveillance
• Data process flow analysis – data source and data flow to support surveillance of priority diseases
• National Health Information System Architecture (hardware/connectivity)
• Establish national HIS technical working group chaired by responsible government ministries and constituting stakeholders across animal and human health systems (Governance)
• Develop platform for data integration and exchange • Establish and promote data and information systems
standards • Workforce development
Partners
– Host Country Government Ministries (Health, Agriculture, Livestock, Defense)
– WHO and Regional Offices (especially AFRO, EMRO, WPRO, PAHO)
– AU / African CDCs – Technical partners (Indigenous and international NGOs) – World Bank (ECOWAS/WAHO) – CDC Country Office
• Across Agency (Disease surveillance and response SMEs)
– USG (Inter-Agency) – Other donor nations and private philanthropy
For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: [email protected] Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Thank You
Division of Global Health Protection Center for Global Health