Integrated Disease Surveillance and Response

Integrated Disease Surveillance and Response
Name	Integrated Disease Surveillance and Response
Acronym	IDSR
Launched	1998
Region	Africa
Implementing agency	World Health Organization African Region
Partners	Centers for Disease Control and Prevention, UNICEF, World Bank

Integrated Disease Surveillance and Response is a public health strategy designed to strengthen World Health Organization African Region member states' capacity for detecting, reporting, and responding to priority diseases and conditions. It synthesizes techniques from Epidemiology, Public health surveillance, and field-based outbreak response models used by agencies such as the Centers for Disease Control and Prevention, Médecins Sans Frontières, and United Nations Children's Fund. IDSR emphasizes timely case detection, laboratory confirmation, and coordinated action involving ministries such as the Ministry of Health (Nigeria), regional bodies like the African Union, and financing institutions including the World Bank.

History and development

IDSR emerged from collaborative initiatives between the World Health Organization African Region, the Centers for Disease Control and Prevention, and partners following regional evaluations after events such as the 1994 Rwandan genocide and the 1995 Ebola virus epidemic in Zaire. Early pilot projects drew on surveillance examples from Uganda and Mozambique and frameworks established by the International Health Regulations (2005), the Global Outbreak Alert and Response Network, and experience with vaccination campaigns like the Expanded Programme on Immunization. The formal technical guidance was issued in the late 1990s and refined through successive regional workshops involving delegations from countries including Kenya, Tanzania, Ghana, and South Africa.

Objectives and core functions

IDSR’s principal objectives align with obligations under the International Health Regulations (2005), the Alma-Ata Declaration, and regional health strategies promoted by the African Union and the Economic Community of West African States. Core functions include event-based surveillance modeled on protocols used during SARS outbreak, indicator-based surveillance similar to systems in Japan, case-based reporting protocols inspired by Polio Eradication Initiative practice, and rapid response mechanisms comparable to those used during HIV/AIDS emergency scaling. The strategy prioritizes diseases listed by ministries such as Ministry of Health (Ghana) and partners like the Global Fund.

Structure and implementation

National adaptations of IDSR typically establish focal points within ministries such as Ministry of Health (Ethiopia), decentralize functions to provincial or district offices as seen in Zambia and Malawi, and link to laboratory networks including regional reference laboratories like the Noguchi Memorial Institute for Medical Research and the Pasteur Institute (Dakar). Implementation relies on coordination with organizations such as the Africa Centres for Disease Control and Prevention, the United Nations Office for the Coordination of Humanitarian Affairs, and donor agencies like the Bill & Melinda Gates Foundation. Training programs often reference curricula from the Field Epidemiology Training Program and incorporate tools developed by the World Health Organization and the Centers for Disease Control and Prevention.

Surveillance components and data flow

IDSR integrates indicator-based surveillance components drawn from systems in China and Thailand with event-based surveillance techniques used during the 2014 West Africa Ebola epidemic. Data flow begins with frontline reporting from facilities akin to examples in Rwanda and Burundi, passes through district aggregation as practiced in Senegal and Cameroon, and is consolidated at national centers similar to the Nigeria Centre for Disease Control. Information sharing leverages channels used by the Global Outbreak Alert and Response Network and reporting standards influenced by the World Health Organization and the Centers for Disease Control and Prevention. Electronic reporting pilots have been modeled on platforms used in Ghana and Zambia.

Laboratory and response capacities

Laboratory strengthening under IDSR mirrors network-building efforts at institutions like the KEMRI-Wellcome Trust Research Programme and the Institut Pasteur de Tunis, supporting diagnostic capacity for pathogens such as cholera, Lassa fever, and measles. Rapid response teams are organized using templates from the Global Polio Eradication Initiative and in coordination with agencies including Médecins Sans Frontières and the International Federation of Red Cross and Red Crescent Societies. Supply chain and logistics draw on systems developed by UNICEF and the World Food Programme for emergency deployment.

Challenges and limitations

Implementation faces challenges similar to those documented for health initiatives in Liberia and Sierra Leone, including workforce shortages that echo issues in Burundi and Central African Republic, intermittent financing linked to donors such as the Global Fund and the Bill & Melinda Gates Foundation, and information system fragmentation seen in comparisons with India and Nigeria. Political instability exemplified by crises in Mali and South Sudan, and competing health priorities influenced by HIV/AIDS and malaria programs, also limit sustainability. Cross-border coordination obstacles mirror those encountered in Great Lakes region responses.

Impact and evaluation

Evaluations of IDSR draw on impact assessments used for programs like the Polio Eradication Initiative and the Measles & Rubella Initiative, showing improvements in timeliness and completeness of reporting in countries such as Uganda, Zambia, and Kenya. Post-implementation reviews after events like the 2014 West Africa Ebola epidemic and the 2018-2020 Kivu Ebola epidemic highlighted both successes in early detection and gaps in surge capacity, informing revisions by the World Health Organization African Region and partners including the Centers for Disease Control and Prevention and the Africa Centres for Disease Control and Prevention.

Category:Public health surveillance