Electronic Integrated Disease Surveillance and Response (eIDSR)

During the 2014-2015 Ebola outbreak in Liberia, disease surveillance reports were paper-based. This created three significant problems for the MOH which greatly hindered public health emergency response: Health Facilities were unable to submit reports of potential new cases in real-time. Slow reporting limited the amount of actionable public health data available to the MOH; Without proper data validation, reports were often incomplete and/or inaccurate. This also limited the amount of data on which the MOH could base response decisions; and It was difficult for the MOH to track which health facilities were consistently reporting on new cases at all. The MOH lacked the ability to easily analyze which health facilities were reporting, and identify those requiring follow-ups. eHA’s eIDSR system is designed to ensure that new case reports can be submitted in near-real time, that data is complete and accurate, and that all health facilities are effectively reporting. With this system, the MOH will receive rapid and accurate data regarding new potential public health threats.

The objective of eIDSR is to provide electronic case-based disease reports to District Surveillance Officers (DSOs) and the central Ministry of Health (MOH) for the purpose of delivering complete data in near-real time regarding potential outbreaks. The eIDSR initiative enables health facility workers to report suspected cases of infectious diseases in near-real time using mobile phone technology. Upon examination of the patient, the health facility worker submits an SMS report to a short code, and the report syncs via RapidPro to DHIS2. The local DSO is also notified to conduct a follow-up case investigation, and enter updated case data into an Offline Tracker application. The DSO’s report is likewise synced to DHIS2. The system also includes a Lab Feedback function, which enables laboratory officers to update case reports using the Offline Tracker based on sample testing results. The system then sends a feedback message to the health facility worker, to provide updates on the status and results of sample tests. Finally, the system includes a weekly reporting feature, which prompts health facility workers to report prior to a regular weekly deadline to confirm the number of cases received over the course of the week. This feature allows the DSOs and the central MOH to monitor usage of the system, and to identify opportunities for follow-up mentoring and supervision. Currently, eHA, the MOH, and other partners have piloted this eIDSR system in 78 health facilities in two counties (Margibi and Grand Cape Mount). The Ministry plans to launch phase two in early 2018, in which the system will be scaled to an additional four counties. The ultimate goal is for eIDSR to scale nationwide in the coming year, providing all public and private health facilities with the means to instantaneously report potential disease outbreaks for rapid investigation and response.

eIDSR provides Liberia’s Emergency Management system with actionable data on which to mobilize and coordinate emergency response resources by pinpointing potential outbreaks and providing real time case information. Upon notification of a potential outbreak, Liberia’s Emergency Operations Centers (EOCs), based throughout the country, activate. The system also adds value to health facility workers by making it possible to receive feedback regarding sample tests. Based on sample status (positive, negative, or rejected), health workers can then be notified to prepare for additional potential cases. Furthermore, eIDSR creates a demand for data from several additional solutions, some of which are currently under development. These include the Health Facility Registry, which provides the MOH with a single true and accurate source of data for all health facilities throughout the country. The eIDSR system can integrate with data from the master facility list, providing coordinates and contact information for all facilities. In addition, the eIDSR authentication system uses iHRIS, which is the MOH’s health human resources database. eIDSR pulls health worker information for identifying the facility they are based at, and for checking reporting authorisation based on contact info (SIM/phone-related data). This enables health facility workers enabling them to send case reports via SMS which will sync directly with DHIS2.