Revitalization of integrated disease surveillance and response in Sierra Leone post Ebola virus disease outbreak

摘要

BackgroundPublic health surveillance generates information needed to assess health status of populations, track events of public health importance such as outbreaks, identify priorities and evaluate the effectiveness of programs [1]. Integration of disease surveillance systems is recommended to increase cost effectiveness, efficiency and effectiveness of surveillance system [2, 3]. In 1998, the WHO-Africa region countries adopted the IDSR for the timely detection and response to epidemic prone diseases [4]. The strategy proposed efficient use of resources to develop an integrated surveillance and response system for major communicable diseases as prioritized by individual countries. The IDSR strategy focused on surveillance at the district level but also defined core and support functions for other levels of the public health system. Technical guidelines for the implementation of IDSR strategy were developed in 2001 and adopted by various African countries including Sierra Leone in 2008 [5].Prompted by the severe acute respiratory syndrome pandemic at the beginning of the twenty-first century, the re-emergence of infectious diseases and threat of the misuse of infectious agents such as smallpox virus as biological weapons, WHO member states adopted the revised International Health Regulations in 2005 which came into force in June 2007 [6]. These new regulations widened the scope of reportable events by defining public health events of international concern, core surveillance and response capacities, that countries would need to focus on in order to increase their ability to detect, respond and contain public health emergencies. Full implementation of international health regulations 2005 would ensure containment of public health threats with minimal interference [7] with international trade and travel.In order to comply with the new regulations, WHO African member states with technical support from United States Centers for Disease Control and Prevention (CDC) revised guidelines for implementation of IDSR in 2010 [7]. Systematic reviews of the implementation of IDSR strategy shows that most African countries adopted the IDSR strategy albeit partially. However, most countries have poor performance in IDSR core functions which is closely linked to suboptimal supervision, training, resources and coordination [8].The Ministry of Health and Sanitation (MOHS) in Sierra Leone partially rolled out the implementation of IDSR in 2003. Before the Ebola virus disease outbreak that occurred in 2014, the country had not yet adopted or implemented the revised IDSR guidelines (2010). Thus, public health surveillance was weak in Sierra Leone and may have contributed to the delayed case detection of the first Ebola cases [9]. The situation was aggravated by the infection of 328 health care workers with Ebola virus disease and the death of at least 152 [10]. Many volunteer health care workers, who constitute a considerable proportion of health workforce in Sierra Leone, resigned during the outbreak further worsening the shortage of health care workers. This led to the closure of health facilities thus interfering with collection and transmission of surveillance data. A rapid assessment conducted in 2015 showed that less than half of the health facilities were submitting weekly reports of priority diseases and often, the reports were submitted late. Thus, the surveillance system was in need of revitalization to ensure rapid detection of outbreaks and tracking of the progress of health events such as the Ebola virus disease outbreak. This paper describes the processes, successes and challenges of revitalizing public health surveillance in a country recovering from a protracted Ebola virus disease outbreak. It aims to provide insight on strategies and requirements for successful implementation of IDSR. By demonstrating the usefulness of IDSR as an early warning system for epidemic prone diseases such as Ebola Virus disease, this work hopes to trigger more investment in public health surveillance. It can provide a reference for countries/regions seeking to strengthen weak disease surveillance and response systems.