Lessons learned for surveillance system strengthening through capacity building and partnership engagement in post-Ebola Guinea, 2015–2019

Abstract

The 2014–2016 Ebola outbreak in Guinea revealed systematic weaknesses in the existing disease surveillance system, which contributed to delayed detection, underreporting of cases, widespread transmission in Guinea and cross-border transmission to neighboring Sierra Leone and Liberia, leading to the largest Ebola epidemic ever recorded. Efforts to understand the epidemic's scale and distribution were hindered by problems with data completeness, accuracy, and reliability. In 2017, recognizing the importance and usefulness of surveillance data in making evidence-based decisions for the control of epidemic-prone diseases, the Guinean Ministry of Health (MoH) included surveillance strengthening as a priority activity in their post-Ebola transition plan and requested the support of partners to attain its objectives. The U.S. Centers for Disease Control and Prevention (US CDC) and four of its implementing partners—International Medical Corps, the International Organization for Migration, RTI International, and the World Health Organization—worked in collaboration with the Government of Guinea to strengthen the country's surveillance capacity, in alignment with the Global Health Security Agenda and International Health Regulations 2005 objectives for surveillance and reporting. This paper describes the main surveillance activities supported by US CDC and its partners between 2015 and 2019 and provides information on the strategies used and the impact of activities. It also discusses lessons learned for building sustainable capacity and infrastructure for disease surveillance and reporting in similar resource-limited settings.

How has Guinea learnt from the response to outbreaks? A learning health system analysis

“…They exemplified or verified the LHS-wide effects (potential benefits) hypothesised by Sheikh and Abimbola—when means of learning and learning loops happen together either at the individual, team or organisation level, they result in improved performance of the health system’s functions, increased adaptivity and innovation and greater self-reliance 20. In terms of performance of the health system’s functions, we note—some improvements in the outbreak response governance and leadership (better coordination of outbreak surveillance and response with an autonomous management authority)85—the training of health personnel85 86—improvements in service delivery (response and case management)85 86—the building and equipment of health infrastructures (epidemic centres, laboratories and health centres)85 86—the strengthening of health information system using DHIS2 for disease surveillance and reporting87 88—and improvements in finances (increase in the national budget allocated to the MoH, from 3% to 8% in 2018, though this budget remains inferior to the requirement (15%) of the West African Health Organisation), approval of orders for supplies by the laboratory committee and other national committees to reduce waste of resources and improvements in funding mobilisation mechanisms85. Regarding the increased adaptivity and innovation, we point out namely—the strengthened capacity of health personnel including the leads of health centres in integrated disease surveillance and response, and computer science—and the developed local genomic surveillance capacity.…”