Digitalizing disease surveillance: experience from Sierra Leone

Abstract

The Integrated Disease Surveillance and Response (IDSR) system was adopted by the Sierra Leone Ministry of Health (MOH) in 2008, which was based on paper-based tools for health data recording and reporting from health facilities to the national level. The Sierra Leone MoH introduced the implementation of electronic case-based disease surveillance reporting of immediately notifiable diseases. This study aims to document and describe the experience of Sierra Leone in transforming her paper-based disease surveillance system into an electronic disease surveillance system. Retrospective mixed methods of qualitative and quantitative data were reviewed. Qualitative data were collected by reviewing surveillance technical reports, epidemiological bulletins, COVID-19, IDSR technical guidelines, Digital Health strategy and DHIS2 documentation. Content and thematic data analyses were performed for the qualitative data, while Microsoft Excel and DHIS2 platform were used for the quantitative data analysis to document the experience of Sierra Leone in digitalizing its disease surveillance system. In the early 2017, a web-based electronic Case-Based Disease Surveillance (eCBDS) for real-time reporting of immediately notifiable diseases and health threats was piloted using the District Health Information System 2 (DHIS2) software. The eCBDS integrates case profile, laboratory, and final outcome data. All captured data and information are immediately accessible to users with the required credentials. The system can be accessed via a browser or an Android DHIS2 application. By 2021, there was a significant increase in the proportion of immediately notifiable cases reported through the facility-level electronic platform, and more than 80% of the cases reported through the weekly surveillance platform had case-based data in eCBDS. Case-based data from the platform are analysed and disseminated to stakeholders for public health decision-making. Several outbreaks of Lassa fever, Measles, vaccine-derived Polio and Anthrax have been tracked in real-time through the eCBDS.

Keywords: DHIS2; Sierra Leone; Surveillance; eCBDS; eIDSR.

Figure 1.

IDSR weekly reporting form, version 2021

Figure 2.

Case-based paper notification form, version 2021

Figure 3.

Electronic surveillance systems implementation timelines in Sierra Leone

Figure 4.

The relationship between HMIS, eIDSR and eCBDS data systems in Sierra Leone

Figure 5.

Electronic case-based notification form on an android tablet

Figure 6.

Electronic case-based disease surveillance system architectural design

Figure 7.

Electronic case-based disease surveillance system data flow diagram

Figure 8.

A line graph showing the progress of eCBDS use over 6 years in Sierra Leone