Abstract
BackgroundThe 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.ObjectivesThis 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.MethodsA 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.ResultsThe 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 findingsThese 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.
Highlights
The countries in the World Health Organization (WHO) African region frequently experience outbreaks and infectious disease epidemics, resulting in large-scale morbidity, disability, and deaths
While challenges related to Integrated Disease Surveillance and Response (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
The 1998 IDSR technical guideline (TG) targeted nineteen priority communicable diseases, divided into four categories: epidemic-prone diseases, diseases targeted for eradication, diseases targeted for elimination, and diseases that were endemic [1]
Summary
The countries in the WHO African region frequently experience outbreaks and infectious disease epidemics, resulting in large-scale morbidity, disability, and deaths. The scale of impact is exacerbated by a lack of robust health systems and health infrastructure, including weak surveillance, preparedness and response systems leading to late detection and ineffective response to these outbreaks To address this situation, the World Health Organization (WHO) Regional Office for Africa (AFRO) developed the first technical guideline (TG) and began to implement the Integrated Disease Surveillance and Response (IDSR) strategy in 1998 [1]. The adoption of the revised International Health Regulations (IHR) in 2005 further demanded a revision of the 1998 IDSR TG in 2010 [2] This revision proposed an alteration to the four categories to: epidemic prone diseases, diseases targeted for eradication or elimination, other major diseases, events, or conditions of public health importance, and diseases or events of international concern [2, 7] (S1 Appendix).
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