Disease surveillance remains the cornerstone to overcome health threats affecting humans and their environments globally. It is the core attention of global health security. A functioning surveillance system is required to promptly detect and report outbreaks of diseases and conditions with the potential of public health impact [1, 2]. An efficient surveillance system is also required to monitor and measure the impact of public health interventions. This in turn depends on a robust information system with reliable and timely data collection, collation, analysis, interpretation, and transmission of the information for action.
The Integrated Disease Surveillance and Response (IDSR) is the adopted strategy for public health surveillance in Nigeria as with other members’ states in the African sub-region of the World Health Organization (WHO) [3]. IDSR provides a rational basis for decision-making and implementation of public health interventions that are efficacious in responding to priority diseases and events. The strategy was adopted in Nigeria since 2001 to improve the ability of local government areas (LGAs) to detect and respond to outbreaks of diseases, conditions, and events that cause high levels of death, illness, and disabilities [4]. It operates at the three levels of governance in the country (National, state, and LGA levels). The health facility (primary, secondary, or tertiary) is the basic operational unit for IDSR. It is the primary point for the generation of surveillance data with the health facility register being the source document. The data from each health facility is collated by the LGA Disease Surveillance and Notification Officer (LGA DSNO) for submission to the State Epidemiologist. The reports from each state are transmitted to the Nigeria Centre for Disease Control (NCDC). The process relies on manually extracting the data from a paper-based source at the health facility and transmission to the LGA DSNO. Although the IDSR strategy had been implemented in Nigeria for about two decades [5], the delays in detection of diseases such as Lassa fever, measles, cerebrospinal meningitis and Yellow fever leading to outbreaks in the country [6–10] indicate problems with the traditional way of implementing the strategy [11, 12].
The information technology (IT) has contributed significantly to shaping the 21st -century world. IT is increasingly becoming available in the health care industry including public health surveillance system where communication plays the central role. The speed of transmission of the information is one of the important qualities of the surveillance system to limits the mortality, morbidity, and disabilities caused by the outbreak of any disease [13–15]. The IT can facilitate early detection of infectious disease outbreaks and tracking of public health intervention [16, 17]. The routine public health surveillance systems can leverage on the system in the form of electronic IDSR reporting (eIDSR) to collect, report, and respond to public health threats in the country [18]. The electronic reporting by-passes the manual collation of the data improves the quality and reliability of the surveillance data and increases the speed of transmission of the information. Some innovative methods using information technology to improve reporting of diseases and outbreaks in the country include the mobile Strengthening Emergency and Response System (mSERS) and the Surveillance Outbreak Response Management and Analysis System (SORMAS). mSERS supports electronic transmission of the weekly data from the LGA DSNO to the state, SORMAS facilitates automatic notification of outbreaks in real-time by the LGA DSNOs to the higher levels [15, 19]. These innovative approaches still depend on manual transmission of the IDSR data from the health facilities to the LGA DSNOs. Consequently, there is a need for a system that will boost the performance of disease surveillance and response particularly with early reporting from the health facilities level. The eIDSR captures data from the point of generation at the health facility level. The idea was conceived as part of the revitalization of disease surveillance and response system in the country. Its main goal was to strengthen the disease surveillance system for early detection and real-time reporting enabling prompt responses to the outbreak of diseases including rumor verification and reporting.
The objectives were to:
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build capacity of health facility personnel, the LGA, and State on detection, reporting, and responses to outbreaks of diseases and public health events in the country
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build the capacity of the LGA and state DSNOs, the state Epidemiologists and national staff on the coordination roles for disease surveillance and management of the surveillance data including the provision of supportive supervision to the lower levels
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improve on the quality of the surveillance data for evidence-based decision making.
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ensure real-time data reporting from the health facility for prompt action
The project was implemented in 10 LGAs from two states in North-East Nigeria. The implementation had a two-phased approach; the first phase was to strengthen the IDSR reporting system at all levels in the selected states. These included the provision of standard case definitions of the priority diseases under surveillance in the country, IDSR reporting tools, and training of the State, LGA and health facility surveillance focal persons on the reporting system. This is based on the premise that introducing a new concept or innovation in a weak system would be worthless. An eIDSR can only function in a system where the traditional IDSR system is already working.
The second phase was the introduction of the eIDSR in the selected health facilities. A total of 54 health facilities from ten LGAs drawn from two states were selected for the initial implementation. The selection criteria were; location of the health facilities, participation in IDSR reporting, availability of mobile network, accessibility, and security challenges. An application was developed for the eIDSR by a team of specialists on an electronic application for the Auto-visual AFP detection and response (AVADAR) system in the polio eradication initiative. The immediate notification, weekly, monthly reporting form, and supervision checklist were converted into electronic format. A task team was formed to develop a blueprint and coordinate the implementation of the eIDSR. The members of the task team were also trained on the application which was subsequently field-tested by the task team. Surveillance focal persons and the officers in charge of the selected health facilities were trained on the use of mobile phones to collect and report IDSR data. A total of 108 staff from the piloting health facilities were recruited and trained for the study. A supervision plan was developed for eIDSR. The supervisors from State and LGA visited the health facilities at least once a week, while the supervisor from the federal level visited at least once a quarter using the supervision checklists. The supervision process included a written summary of findings, deliberations, and solutions from the health facilities. The states produced weekly situation reports and conducted monthly meetings at the state level. There was a quarterly meeting at the national level with all key stakeholders to review the progress of implementation, address challenges, and proffer solutions.
We evaluated the initial implementation of the eIDSR to determine whether the project met its predetermined objectives for improving timeliness and completeness of IDSR reporting, prompt identification of public health events, timely information sharing, and use of the system by the key players in disease surveillance in the piloting facilities and LGAs for actions.