Enhancing community-based disease outbreak detection and response in East and Southern Africa

Project Location:
Ngorongoro (Tanzania)-Narok (Kenya) cross-border ecosystem and Morogoro municipality (Tanzania).
Project Duration:
14 months, from July 2015 to August 2016.
Project Summary:

Sectors of Intervention: Mobile health, epidemiology, One Health
Number of Direct Beneficiaries: Community Health Reporters (28), Integrated Disease Surveillance and Response strategy (IDSR) focal persons in participating districts (10) and District Medical Officers and District Veterinary Officers (6).

Number of Indirect Beneficiaries: Community members in the participating districts (1,627,312 people).

Date of Submission: June 8, 2015

Executive Summary
Early communication between sectors and neighboring countries, leading to faster detection and response to disease outbreaks, is a critical step to make a difference to emerging global public health threats. Infectious diseases have a significant impact on vulnerable populations and children across the world. Outbreaks of emerging diseases pose enormous challenges to affected countries. The negative impact of disease can be reduced by facilitating effective communication and early dialogues between countries.
The Southern African Centre for Infectious Disease Surveillance (SACIDS)[1], in partnership with EAIDSNet and InSTEDD proposes to implement a 14-month project, Enhancing community-based disease outbreak detection and response in East and Southern Africa. This work is based on a theory of change that aims at promoting community level One Health security that will progressively contribute to disease detection and response at community level and thence national, regional and global level. Our ultimate goal is to contribute to progressive reduction of disease spread of pandemic occurrences.
The project will promote a participatory disease surveillance model through completion and deployment of tools developed during EpiHack Tanzania 2014. These tools are those that will promote community active surveillance, facility-based surveillance and reporting and; feedback-two way communications. The project will improve capacities for neighboring communities to mobilize for action for streamlined and effective responses to disease in the Ngorongoro (Tanzania)–Narok (Kenya) cross-border ecosystem. Some work will also be carried out in Morogoro municipality where the SACIDS-NIMR hub is located. Beginning in the Ngorongoro-Narok ecosystem with focused interventions aims to provide a model that can be scaled up across the region, this project has the potential to revolutionize the speed and ability to respond to infectious disease and improve collaboration between animal and human health actors from the local to international levels. Mobile technologies are available and identifying and building on models that are feasible and effective will lead to their use for improved health across the spectrum of research and detection to resource mobilization, response and lifesaving interventions is critical to the general state of health of communities across Africa.
This project proposes a consortium led by SACIDS to develop innovative solutions which improve communication, collaboration, information sharing and speed of response to outbreaks by building cross-border local capacity.  
Problem Statement and Context
Surveillance of infectious disease is recognized as the foundation of human and animal health decision-making and practice. Complementing the international disease surveillance strategies with participatory engagement of local communities is expected to improve performance of disease surveillance systems in developing countries. However, there are a number of challenges facing human and animal health disease surveillance and response systems. Whereas the current disease surveillance systems and strategies are based on International Health Regulations (IHR 2005) and The World Organisation for Animal Health (OIE) Animal Health code which require flow of information from the grassroots/community to the global level, there has been relatively sub-optimal performance of such systems, particularly in some developing countries. The now wide use of mobile telephones offers the potential that disease surveillance reporting, including event reporting, could be timely and faster by using digital and mobile technology solutions. However, this needs to be conducted in a deliberate way where impacts and standard operating procedures are developed, adopted and promoted by local and national Governments, so as to avoid confusion of a multitude of parallel mobile reporting systems. To date, many mobile technology programs are implemented without sound evaluation and contingent on project funding and external actors with little buy-in from the ultimate end users, greatly limiting sustainability.
EpiHack Tanzania 2014 (see Annex I), an unprecedented meeting, brought together Information and Communication Technology (ICT) developers and health experts to jointly plan and develop digital solutions (prototypes) to health challenges facing the animal and public health sectors in Arusha, Tanzania from 8-12 December 2014. The event brought together 59 participants including developers (49%), public health experts (29%), animal health officials (17%) and other professionals (5%) from 14 countries and more than 20 different local and international organizations.
Through participatory problem identification, a list of challenges was developed and ICT developers were tasked to design prototypes aimed at solving identified challenges under close guidance of health experts. Major problems identified were: delayed submission and incompleteness of official disease surveillance data submitted by health facilities, failure to capture major disease events occurring at the community level, lack of feedback (two-way communication) to the disease surveillance data collectors and inability to trace individual humans and animals as well as their locations during disease outbreaks. Four prototypes that were developed by ICT developers during the EpiHack Tanzania 2014 are focusing on improving:
i)              facility-based disease reporting system;
ii)             Contact tracing;
iii)            community-based participatory disease surveillance; and
iv)             feedback (two-way communication between officials and data collectors)
This project, as described below, is the first step in concerted multi-disciplinary action to address these areas head-on, paving the way for improved disease surveillance and healthier populations in the targeted areas. It seeks to enhance and utilize digital and mobile technologies of SACIDS and InSTEDD platforms and those that are in operation in the countries represented at the EpiHack Tanzania 2004 event to address user challenges faced by the public and animal health systems. The work is based on hypothesis that by complementing the international disease surveillance systems and strategies with participatory engagement of local communities will improve performance of disease surveillance and response systems in developing countries.

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