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Review
. 2020 Oct;5(10):e003901.
doi: 10.1136/bmjgh-2020-003901.

Systems thinking for health emergencies: use of process mapping during outbreak response

Kara N Durski  1   2 , Dhamari Naidoo  3 , Shalini Singaravelu  3 , Anita A Shah  3 , Mamadou Harouna Djingarey  4 , Pierre Formenty  3 , Chikwe Ihekweazu  5 , James Banjura  6 , Benoit Kebela  7 , Adesola Yinka-Ogunleye  5 , Ibrahima-Soce Fall  4 , Womi Eteng  5 , Mohamed Vandi  6 , Charles Keimbe  6 , Anwar Abubakar  5 , Abulazeez Mohammed  8 , Desmond E Williams  9 , Margaret Lamunu  10 , Sylvie Briand  3 , Jean Claude Changa Changa  11 , Etienne Minkoulou  4 , Dan Jernigan  9 , Demba Lubambo  4 , Asheena Khalakdina  3 , Ibrahim Mamadu  12 , Ambrose Talisuna  4 , Albert Mbule Kadiobo  13 , Amara Jambai  6 , Bruce Aylward  3 , Michael Osterholm  2
Affiliations
Review

Systems thinking for health emergencies: use of process mapping during outbreak response

Kara N Durski et al. BMJ Glob Health. 2020 Oct.

Abstract

Process mapping is a systems thinking approach used to understand, analyse and optimise processes within complex systems. We aim to demonstrate how this methodology can be applied during disease outbreaks to strengthen response and health systems. Process mapping exercises were conducted during three unique emerging disease outbreak contexts with different: mode of transmission, size, and health system infrastructure. System functioning improved considerably in each country. In Sierra Leone, laboratory testing was accelerated from 6 days to within 24 hours. In the Democratic Republic of Congo, time to suspected case notification reduced from 7 to 3 days. In Nigeria, key data reached the national level in 48 hours instead of 5 days. Our research shows that despite the chaos and complexities associated with emerging pathogen outbreaks, the implementation of a process mapping exercise can address immediate response priorities while simultaneously strengthening components of a health system.

Keywords: diseases; disorders; epidemiology; health systems; infections; injuries; public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Mapping process.
Figure 2
Figure 2
Process mapping exercise: Ebola in Sierra Leone. DERC, District emergency response center; DSO, district surveillance officer; ETU, Ebola treatment units; EVD, Ebola virus disease; HC, holding centres, Mgmt, management.
Figure 3
Figure 3
Process mapping exercise: yellow fever im the Democratic Republic of Congo. AFRO, Africa regional office, CIF, case investigation form; DRC, Democratic Republic of Congo; HQ, headquarters; INRB, Institut National de Recherche Biomédical; IP, Institute Pasteur; MGMT, management; YF, yellow fever.
Figure 4
Figure 4
Process mapping exercise:monkeypox in Nigeria. CIF, case investigation forms; CPHL, Central public health laboratories; NCDC, Nigeria Centers for Disease Control.
See this image and copyright information in PMC

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