Establishment of an electronic integrated disease surveillance and response system in Sierra Leone

Abstract

Purpose: The 2014–16 Ebola epidemic exposed weaknesses within Sierra Leone's disease surveillance system and served as a catalyst to improve detection systems. In 2015, the national Integrated Disease Surveillance and Response (IDSR) system consisted of health facilities (HF) calling/texting or hand-delivering reports to their District Health Management Team (DHMT), DHMT staff entering IDSR data from all HF into a spreadsheet, and each DHMT emailing the file weekly to the national level. When districts lacked adequate bandwidth to upload attachments, DHMT staff emailed a curtailed IDSR data summary to the national level, which jeopardized data timeliness and accuracy. In 2016, Sierra Leone introduced an electronic IDSR (eIDSR) system to gauge feasibility and efficacy in a resource-constrained setting. Methods & Materials: The U.S. Centers for Disease Control and Prevention and eHealth Africa supported the Ministry of Health and Sanitation to establish eIDSR, which transmits data into the web-based District Health Information System (DHIS2). In 2016, district-level eIDSR was piloted then rolled out to all fourteen districts. District-level eIDSR entails HF staff calling the DHMT, then DHMT staff entering data directly into the national DHIS2 database. From 2016–17, facility-level eIDSR was piloted in one district to enable data entry using tablets at all 112 HF in the district, and in 2018, a national scale-up of facility-level eIDSR is underway to reach all 1285 HF in Sierra Leone. Results: After implementing district-level eIDSR, IDSR reporting increased from <40% of HF in 2016 to >97% in 2017, an increase maintained in 2018. The district-level pilot revealed that data-entry time decreased by 63% and errors decreased by 45%. Analyses from the facility-level eIDSR pilot found that data accuracy was 12% higher than data reported through district-level eIDSR. The Joint External Evaluation (JEE) score for real-time surveillance went from “limited” to “developed” capacity between 2016 and 2017. Conclusion: District-level eIDSR improved the timeliness and accuracy of surveillance data. Additional benefits are anticipated with completion of the national scale-up of facility-level eIDSR, and JEE scores are projected to reach the next level of “demonstrated” capacity. Lessons learned in Sierra Leone can inform other low-resource settings considering implementation of electronic disease surveillance systems.