Between 2014 and 2016, an outbreak of Ebola Virus Disease (EVD) swept across West Africa causing the death of about 11,325 people. The outbreak was first reported in a Guinean village in December 2013 and spread to Conakry, the country’s capital within three months. Following the confirmation of 49 cases and 29 deaths, an official outbreak was declared by the WHO in March 2014. The outbreak went on to become the worst EVD outbreak on record, spreading to seven countries including the United States and the United Kingdom. With concerted efforts by the government of Guinea and partners including the CDC, WHO, International Medical Corps and International Office of Migration, among others, the outbreak was brought under control in March 2016.
In their research paper, “Lessons learned for surveillance system strengthening through capacity building and partnership engagement in post-Ebola Guinea, 2015 – 2019,” published in Frontiers in Public Health, Jennifer J. Hemingway-Foday, Boubacar Ibrahima Diallo, Salomon Compaore et al. examine the actions taken by the government of Guinea’s to learn from the Ebola outbreak and strengthen their disease surveillance systems, including through the implementation of DHIS2.
Reviewing its response to the outbreak, the government of Guinea, the outbreak’s epicenter, recognized gaps in its surveillance systems that resulted in unreported cases, delayed detection and significant cross-border transmission. Furthermore, data quality limitations compounded the challenges faced by disease outbreak investigators and health managers within and outside the country. Consequently, the Guinean Ministry of Health (MoH) included surveillance strengthening as a priority activity in its post-Ebola transition plan and requested the support of partners to achieve its goals.
With the support of the CDC and its implementing partners, some methods were adopted to strengthen the surveillance and response systems in Guinea, thereby emplacing better-prepared systems for possible future outbreaks. These methods include:
Strategic planning and coordination to harness essential resources toward improved accuracy of disease surveillance programs. This includes establishing channels for effective inter-agency communication, use of information technology systems in disease surveillance, capacity building and standardization of surveillance practices.
Surveillance strategic activities including community-based surveillance strengthening were also noted to be a crucial component of an effective outbreak response system. It was observed that a lack of community engagement contributed to delayed case identification and reporting during the EVD outbreak, resulting in the further spread of the virus. Another useful strategy was to reinforce surveillance at points of entry. Ineffectual cross-border disease surveillance systems were identified as a major contributing factor to the quick spread of the outbreak to neighboring Côte d’Ivoire, Liberia and Sierra Leone. As a result, the IOM and the African Field Epidemiological Network worked with countries in the region to strengthen cross-border surveillance systems. Additionally, IDSR capacity-building programs were employed to boost the skilled manpower capable of responding to outbreaks by helping health workers identify, classify and report priority diseases in accordance with established guidelines. Finally, the implementation of electronic reporting using DHIS2 completes the strategic surveillance plan by the government of Guinea and its partners. This was in sync with the broader ambition of the Ministry of Health to strengthen the national HMIS for routine reporting.
After a comprehensive needs assessment, the DHIS2 platform was adopted due to its proven effectiveness in numerous health program management. The use of DHIS2 for national HMIS in neighboring Sierra Leone and Liberia also facilitated data sharing and better cooperation in fostering effective cross-border surveillance collaboration.
Authors: Jennifer J. Hemingway-Foday, Boubacar Ibrahima Diallo, Salomon Compaore et al.
Publishers: Frontiers in Public Health
Date of Publication: 11 August 2022.