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Sustaining the Impact: MEASURE Evaluation Conversation on Strengthening Real-Time Surveillance


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Presented as part of the End of Project webinar series.

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Sustaining the Impact: MEASURE Evaluation Conversation on Strengthening Real-Time Surveillance

  1. 1. Sustaining the Impact MEASURE Evaluation Conversation on Strengthening Real-Time Surveillance Stephanie Watson-Grant, DrPH Derek Kunaka, MSc MEASURE Evaluation End of Project Webinar September 11, 2019
  2. 2. Focus countries
  3. 3. Key contributions Embedding technical assistance to respond to Ebola and help health systems to recover (2015 – 2016) • GUINEA, LIBERIA, and SIERRA LEONE Piloting/deploying information systems for surveillance beyond Ebola (2016 – 2018) • CÔTE D’IVOIRE, GUINEA, MALI, and SENEGAL Strengthening One Health (2017 – present) • BURKINA FASO, MALI, and SENEGAL 1 2 3
  4. 4. Embedding two technical advisors in Guinea, Liberia,and Sierra Leone for three months 1 Building resilient systems
  5. 5. Embedding technical assistance • Rapid start-up and access to PRISM results indicated this need: o Strengthen MOH health informatics and the health management information system (HMIS) with organizational development Our response: • Prioritized advocacy for DHIS2 • Developed HIS strategy and capacitated TWG to plan for upgrading required infrastructure Guinea: The situation
  6. 6. Embedding technical assistance DHIS2 not functioning optimally Our response: • Mapped health information system (HIS) stakeholders • Re-established technical working group (TWG) • Assessed HIS and information and communications technology (ICT) infrastructure • Developed HIS strategy for 2016–2021 and supported capacity to implement it • Set requirements for DHIS2 interoperability, better access Liberia: The situation
  7. 7. Embedding technical assistance Nascent DHIS2; data quality issues Our response: • Hybrid of PRISM/HMN/Management and Organizational Sustainability Tool (MOST) to assess HIS capacity of Ministry of Health (MOH) • Mentorship of MOH on data use o First health bulletin in five years! • Stronger HIS TWG produced national master facility list (MFL) to improve data quality Sierra Leone: The situation
  8. 8. Piloting or deploying information systems to facilitate disease surveillance and detection, beyond Ebola, in Côte d’Ivoire, Guinea, Mali, and Senegal 2
  9. 9. Pilot or deploy systems Results of our robust presence: • Addition of integrated disease surveillance and response (IDSR) module to DHIS2 for Ebola early warning system • SMS notification in DHIS2 for surveillance data • Interoperability of DHIS2 and Magpi mobile platform Côte d’Ivoire
  10. 10. Pilot or deploy systems • Roadmap for national rollout of DHIS2 • Fostered culture of data-driven decision making through training • Led technical team to configure and customize HMIS • Developed health facility registry (HFR) to manage MFL • Hosted DHIS2, built capacity to use it, and transitioned it to MOH Guinea Results of DHIS2 advocacy:
  11. 11. Pilot or deploy systems • Developed IDSR beyond Ebola—deployed to 52 districts (more than the 36 requested) • Boosted surveillance data quality and reporting rate in target districts with 200 digital tablets Mali Results of HIS strengthening efforts:
  12. 12. Pilot or deploy systems Results of strong community focus: • Piloted Rapid-pro based mobile app (mInfosante) for community surveillance • Workaround for poor Internet: provided DHIS2- compatible tablets • Harmonized data analysis tools and trained MOH to examine alert data Senegal
  13. 13. Strengthening the One Health approach in Burkina Faso, Mali, and Senegal for the Global Health Security Agenda 3
  14. 14. GHSA countries supported
  15. 15. GHSA action packages
  16. 16. Country capacity to prevent, detect, and rapidly respond to public health threats Source: WHO Joint External Evaluation (JEE) mission reports, 2017 Indicators—Capacity Level Burkina Faso Mali Senegal P.2.1. A functional mechanism is established for the coordination and integration of relevant sectors I the implementation of IHR N/A 1 1 P.4.1. Surveillance systems in place for priority zoonotic diseases/pathogens 3 2 2 P.4.2. Veterinary or Animal Health Workforce 1 2 3 P.4.3. Mechanisms for responding to zoonosis and potential zoonosis are established and functional 1 2 1 D.2.1 Indicator and event-based surveillance systems 3 3 3 D.2.2. Interoperable, interconnected, electronic real-time reporting system 2 2 3 D.2.3. Analysis of surveillance data 3 4 3 D.2.4. Syndromic surveillance systems 3 N/A 4 1 – no capacity 2 – limited capacity 3 – developed capacity 4 – demonstrated capacity 5 – sustainable capacity   a cell with a dotted pattern is not an area contributed by MEASURE Evaluation
  17. 17. Support One Health • PRISM assessment to identify areas for surveillance system strengthening • Multisectoral TWG to coordinate One Health efforts and fill surveillance gaps Burkina Faso • Interoperability layer in DHIS2 enabled real-time reporting of event-based surveillance data from three ministries • Trained 400 community agents from the three sectors, based on our curricula from Senegal, to improve reporting rate and provide real-time status MEASURE Evaluation Technical Advisor with training participants from health, animal and fisheries resources, and environment sectors
  18. 18. Support One Health Strategy to streamline and focus on what matters • Established functioning multisectoral TWG to guide effort • Prioritized surveillance from 33 diseases in WHO guidance to 12 priorities in Mali (52 variables vs. 1,190) • Expanded IDSR beyond border communities to detect public health threats at facility level Mali • Customized DHIS2 reports for priority diseases, with data exchange among three sectors
  19. 19. Support One Health • Expanded real-time surveillance to two regions beyond mInfosante pilot • Trained 3,000+ community volunteers for community- based surveillance • Convened One Health TWG and developed national surveillance guidelines Senegal
  20. 20. Trends 1. Fundamental information technology (IT) infrastructure to enable electronic real-time surveillance 2. Assistance to establish multisectoral platforms to coordinate stakeholders and facilitate collaboration 3. Focus on strengthening community detection of health threats 4. Emphasis on cross-border data sharing; demand for appropriate interoperability tools and standards Country demand
  21. 21. Recommendations 1. Monitor collaboration mechanism functioning to increase stakeholder accountability 2. Build capacity of animal health workforce in established zoonotic surveillance systems 3. Advocate stakeholder involvement to improve infrastructure for electronic real-time reporting systems, especially in communities 4. Assure skills are available to analyze surveillance data used for reporting and risk assessment Future investment
  22. 22. Resources HIS Strengthening Resource Center
  23. 23. This presentation was produced with the support of the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID-OAA-L-14-00004. MEASURE Evaluation is implemented by the Carolina Population Center, University of North Carolina at Chapel Hill in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. Views expressed are not necessarily those of USAID or the United States government.