Systematic review of Integrated Disease Surveillance and Response (IDSR) implementation in the African region

Abstract

Background The WHO African region frequently experiences outbreaks and epidemics of infectious diseases often exacerbated by weak health systems and infrastructure, late detection, and ineffective outbreak response. To address this, the WHO Regional Office for Africa developed and began implementing the Integrated Disease Surveillance and Response strategy in 1998. Objectives This systematic review aims to document the identified successes and challenges surrounding the implementation of IDSR in the region available in published literature to highlight areas for prioritization, further research, and to inform further strengthening of IDSR implementation. Methods A systematic review of peer-reviewed literature published in English and French from 1 July 2012 to 13 November 2019 was conducted using PubMed and Web of Science. Included articles focused on the WHO African region and discussed the use of IDSR strategies and implementation, assessment of IDSR strategies, or surveillance of diseases covered in the IDSR framework. Data were analyzed descriptively using Microsoft Excel and Tableau Desktop 2019. Results The number of peer-reviewed articles discussing IDSR remained low, with 47 included articles focused on 17 countries and regional level systems. Most commonly discussed topics were data reporting (n = 39) and challenges with IDSR implementation (n = 38). Barriers to effective implementation were identified across all IDSR core and support functions assessed in this review: priority disease detection; data reporting, management, and analysis; information dissemination; laboratory functionality; and staff training. Successful implementation was noted where existing surveillance systems and infrastructure were utilized and streamlined with efforts to increase access to healthcare. Conclusions and implications of findings These findings highlighted areas where IDSR is performing well and where implementation remains weak. While challenges related to IDSR implementation since the first edition of the technical guidelines were released are not novel, adequately addressing them requires sustained investments in stronger national public health capabilities, infrastructure, and surveillance processes.

COVID-19 surveillance systems in 13 African countries

“…69 The second edition of the IDSR framework strategy was released in 2010 and the third edition was published in 2019. 70 The overall aim of the strategy was to enhanced surveillance and response capacities at each level of the national health systems in order to facilitate early responses to public health emergencies. 70 The strategy also makes it possible to integrate a number of surveillance systems, and link laboratory and surveillance data to guide response activities.…”

“… 70 The overall aim of the strategy was to enhanced surveillance and response capacities at each level of the national health systems in order to facilitate early responses to public health emergencies. 70 The strategy also makes it possible to integrate a number of surveillance systems, and link laboratory and surveillance data to guide response activities. 71 During the first year of the emergence of COVID-19, the IDSR strategy assisted in investigating, identifying, and responding to outbreaks of circulating vaccine-derived type 2 poliovirus, measles, yellow fever, hepatitis virus, and COVID-19 in many locations.…”

“…This is a long-standing challenge facing effective surveillance in Africa. 70,73,[75][76][77] There are various tasks in diseases surveillance that requires expertise in other to ensure effective response e.g., data analysis, early case reporting, and understanding surveillance data use in response measures. 70,77 This fundamental challenge also continues to undermine COVID-19 surveillance e.g., genomic surveillance and environmental surveillance in some African countries.…”

“…70,73,[75][76][77] There are various tasks in diseases surveillance that requires expertise in other to ensure effective response e.g., data analysis, early case reporting, and understanding surveillance data use in response measures. 70,77 This fundamental challenge also continues to undermine COVID-19 surveillance e.g., genomic surveillance and environmental surveillance in some African countries. 62,63,77 The challenge of limited skilled staff is also doubly compounded by the incessant brain-drain surge in Africa.…”

Twenty years of integrated disease surveillance and response in Sub-Saharan Africa: challenges and opportunities for effective management of infectious disease epidemics

“…However, most efforts to improve IDSR in SSA focused on the support functions rather than core functions. The successes of the desire for integration of the disease surveillance strategies in SSA have been documented in several countries, including Ghana, Ethiopia, Botswana, Kenya, Liberia, Sierra Leone, Uganda [ 56 ]. These include the efficient utilisation of the vertical programme surveillance mechanisms that provided functional infrastructure and trained personnel [ 56 , 57 ].…”