Surveillance and Information Systems Strategy/media/Files/Activity Files... · Surveillance and Information Systems Strategy ... disease surveillance system ... • Routine indicator-based

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

Routine Reporting

Routine Surveillance System

Laboratory Surveillance

Data Integration and Use

Expanding Health Data Network

Elevated Suspect Cases Increased Capacity

Early Outbreak – IM Activation

Outbreak: International Response

Response without Health Information System Architecture

National Health Information System Architecture

Outbreak: International Response

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