Integrated Disease Surveillance and Response (IDSR) strategy: current status, challenges and perspectives for the future in Africa

Abstract

In 1998, the WHO African region adopted a strategy called Integrated Disease Surveillance and Response (IDSR). Here, we present the current status of IDSR implementation; and provide some future perspectives for enhancing the IDSR strategy in Africa. In 2017, we used two data sources to compile information on the status of IDSR implementation: a pretested rapid assessment questionnaire sent out biannually to all countries and quarterly compilation of data for two IDSR key performance indicators (KPI). The first KPI measures country IDSR performance and the second KPI tracks the number of countries that the WHO secretariat supports to scale up IDSR. The KPI data for 2017 were compared with a retrospective baseline for 2014. By December 2017, 44 of 47 African countries (94%) were implementing IDSR. Of the 44 countries implementing IDSR, 40 (85%) had initiated IDSR training at subnational level; 32 (68%) had commenced community-based surveillance; 35 (74%) had event-based surveillance; 33 (70%) had electronic IDSR; and 32 (68%) had a weekly/monthly bulletin for sharing IDSR data. Thirty-two countries (68%) had achieved the timeliness and completeness threshold of at least 80% of the reporting units. However, only 12 countries (26%) had the desired target of at least 90% IDSR implementation coverage at the peripheral level. After 20 years of implementing IDSR, there are major achievements in the indicator-based surveillance systems. However, major gaps were identified in event-based surveillance. All African countries should enhance IDSR everywhere.

Keywords: African region; Integrated Disease Surveillance and Response; International Health Regulations; World Health Organisation; key performance indicators.

Figure 1

Integrated Disease Surveillance and Response (IDSR) steps and milestones. IDS, integrated disease surveillance; IHR, International Health Regulations.

Figure 2

Status of IDSR key performance indicator (KPI) for country performance (health driver development, HDD) in 2014 and 2017. IDSR, Integrated Disease Surveillance and Response.

Figure 3

Status of IDSR key performance indicators (KPI) for WHO attributable contribution (WAC) performance in 2014 and 2017. IDSR, Integrated Disease Surveillance and Response; TG, technical guidelines.

Figure 4

(A) Countries implementing event-based surveillance, as of December 2017. (B) Countries implementing community-based surveillance, as of December 2017. (C) Countries implementing electronic Integrated Disease Surveillance and Response (IDSR), as of December 2017.