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Review
. 2023 Sep 7:11:1204165.
doi: 10.3389/fpubh.2023.1204165. eCollection 2023.

Progress and experiences of implementing an integrated disease surveillance and response system in Somalia; 2016-2023

Steven Ssendagire  1 , Mary Joan Karanja  1 , Abdulkhadir Abdi  1 , Mutaawe Lubogo  1 , Abdullah Azad Al  1 , Khadija Mzava  2 , Abdinasir Yusuf Osman  3   4 , Ahmed Mohamed Abdikarim  1 , Mohamed Abdirahman Abdi  3 , Abdirahman Mohamed Abdullahi  3 , Abdirizak Mohamed  3 , Hussein Sheik Ahmed  3 , Nuralein Yusuf Hassan  3 , Aden Hussein  3 , Aisha Daud Ibrahim  3 , Abdullahi Yusuf Mohamed  3 , Ibrahim Mohamed Nur  3 , Mukhtar Bulale Muhamed  5 , Mohamed Abdelrahman Mohamed  5 , Fawziya Abikar Nur  3 , Hassan Sheik Ahmed Mohamed  3 , Mohamed Mohamud Derow  3 , Abdifatah Ahmed Diriye  5 , Sk Md Mamunur Rahman Malik  1
Affiliations
Review

Progress and experiences of implementing an integrated disease surveillance and response system in Somalia; 2016-2023

Steven Ssendagire et al. Front Public Health. .

Abstract

Introduction: In 2021, a regional strategy for integrated disease surveillance was adopted by member states of the World Health Organization Eastern Mediterranean Region. But before then, member states including Somalia had made progress in integration of their disease surveillance systems. We report on the progress and experiences of implementing an integrated disease surveillance and response system in Somalia between 2016 and 2023.

Methods: We reviewed 20 operational documents and identified key integrated disease surveillance and response system (IDSRS) actions/processes implemented between 2016 and 2023. We verified these through an anonymized online survey. The survey respondents also assessed Somalia's IDSRS implementation progress using a standard IDS monitoring framework Finally, we interviewed 8 key informants to explore factors to which the current IDSRS implementation progress is attributed.

Results: Between 2016 and 2023, 7 key IDSRS actions/processes were implemented including: establishment of high-level commitment; development of a 3-year operational plan; development of a coordination mechanism; configuring the District Health Information Software to support implementation among others. IDSRS implementation progress ranged from 15% for financing to 78% for tools. Reasons for the progress were summarized under 6 thematic areas; understanding frustrations with the current surveillance system; the opportunity occasioned by COVID-19; mainstreaming IDSRS in strategic documents; establishment of an oversight mechanism; staggering implementation of key activities over a reasonable length of time and being flexible about pre-determined timelines.

Discussion: From 2016 to 2023, Somalia registered significant progress towards implementation of IDSRS. The 15 years of EWARN implementation in Somalia (since 2008) provided a strong foundation for IDSRS implementation. If implemented comprehensively, IDSRS will accelerate country progress toward establishment of IHR core capacities. Sustainable funding is the major challenge towards IDSRS implementation in Somalia. Government and its partners need to exploit feasible options for sustainable investment in integrated disease surveillance and response.

Keywords: Somalia; implementation progress; integrated disease surveillance and response; lessons; next steps.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Key IDSRS actions/processes implemented, 2016–2023, Somalia. IHR, International Health Regulations; NAPHS, National Plan of Action for Health Security, EWARN, Early Warning Alert and Response, Network; IDSR, Integrated Disease Surveillance and Response; CO VID-19, Coronavirus Disease 2019, IMS, Incident Management System; EOC, Emergency Operations Centre; CHW, Community Health Worker; PCR, Polymerase Chain Reaction; FETP, Field Epidemiology Training Program; DHIS2, District Health Information Software 2; PHEOC, Public Health Emergency Operation Centre.
Figure 2
Figure 2
Revised flow of surveillance data and information in Somalia’s surveillance system.
Figure 3
Figure 3
Estimated cost of implementation of integrated disease surveillance, 2021-2023.
Figure 4
Figure 4
Participant evaluation of the training-of-trainers course on implementation of integrated disease surveillance, Somalia, 2023.
Figure 5
Figure 5
IDSR strategy implementation progress, 2016-2023, Somalia.
See this image and copyright information in PMC

References

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