Presented as part of the End of Project webinar series.

1. Sustaining the Impact
MEASURE Evaluation
Conversation on
Strengthening Real-Time
Surveillance Stephanie Watson-Grant, DrPH
Derek Kunaka, MSc
MEASURE Evaluation
End of Project Webinar
September 11, 2019

2. Focus countries

3. Key contributions
Embedding technical assistance to respond to
Ebola and help health systems to recover
(2015 – 2016)
• GUINEA, LIBERIA, and SIERRA LEONE
Piloting/deploying information systems for
surveillance beyond Ebola (2016 – 2018)
• CÔTE D’IVOIRE, GUINEA, MALI, and SENEGAL
Strengthening One Health (2017 – present)
• BURKINA FASO, MALI, and SENEGAL
1
2
3

4. Embedding two technical
advisors in Guinea, Liberia,and
Sierra Leone for three months
1
Building resilient systems

5. Embedding technical assistance
• Rapid start-up and access to PRISM
results indicated this need:
o Strengthen MOH health informatics
and the health management
information system (HMIS) with
organizational development
Our response:
• Prioritized advocacy for DHIS2
• Developed HIS strategy and
capacitated TWG to plan for
upgrading required infrastructure
Guinea: The situation
https://www.measureevaluation.org/resources/publications/tr-17-158

6. Embedding technical assistance
DHIS2 not functioning optimally
Our response:
• Mapped health information system (HIS)
stakeholders
• Re-established technical working group
(TWG)
• Assessed HIS and information and
communications technology (ICT) infrastructure
• Developed HIS strategy for 2016–2021 and supported capacity
to implement it
• Set requirements for DHIS2 interoperability, better access
Liberia: The situation
https://measureevaluation.org/resources/publications/tr-17-158

7. Embedding technical assistance
Nascent DHIS2; data quality issues
Our response:
• Hybrid of PRISM/HMN/Management and Organizational
Sustainability Tool (MOST) to assess HIS capacity of
Ministry of Health (MOH)
• Mentorship of MOH on data use
o First health bulletin in five years!
• Stronger HIS TWG produced national master facility list
(MFL) to improve data quality
Sierra Leone: The situation
https://www.measureevaluation.org/resources/publications/tr-17-158

8. Piloting or deploying
information systems to facilitate
disease surveillance and
detection, beyond Ebola, in
Côte d’Ivoire, Guinea, Mali,
and Senegal
2
https://www.measureevaluation.org/resources/publications/tr-18-248

9. Pilot or deploy systems
Results of our robust
presence:
• Addition of integrated
disease surveillance and
response (IDSR) module to
DHIS2 for Ebola early
warning system
• SMS notification in DHIS2 for
surveillance data
• Interoperability of DHIS2
and Magpi mobile platform
Côte d’Ivoire
https://www.measureevaluation.org/resources/publications/fs-16-199fr

10. Pilot or deploy systems
• Roadmap for national rollout of
DHIS2
• Fostered culture of data-driven
decision making through training
• Led technical team to configure
and customize HMIS
• Developed health facility registry
(HFR) to manage MFL
• Hosted DHIS2, built capacity to use
it, and transitioned it to MOH
Guinea
Results of DHIS2 advocacy:
https://www.measureevaluation.org/resources/publications/gr-18-021

11. Pilot or deploy systems
• Developed IDSR beyond
Ebola—deployed to 52
districts (more than the 36
requested)
• Boosted surveillance data
quality and reporting rate in
target districts with 200
digital tablets
Mali
Results of HIS strengthening efforts:
https://www.measureevaluation.org/resources/publications/fs-18-315

12. Pilot or deploy systems
Results of strong community
focus:
• Piloted Rapid-pro based
mobile app (mInfosante)
for community surveillance
• Workaround for poor
Internet: provided DHIS2-
compatible tablets
• Harmonized data analysis
tools and trained MOH to
examine alert data
Senegal
https://www.measureevaluation.org/countries/senegal

13. Strengthening the One
Health approach in Burkina
Faso, Mali, and Senegal for
the Global Health Security
Agenda
3
https://www.measureevaluation.org/our-work/global-health-security/global-health-security

14. GHSA countries supported

15. GHSA action packages

16. Country capacity
to prevent, detect, and rapidly
respond to public health threats
Source: WHO Joint External Evaluation (JEE) mission reports, 2017
Indicators—Capacity Level Burkina Faso Mali Senegal
P.2.1. A functional mechanism is established for the
coordination and integration of relevant sectors I the
implementation of IHR
N/A 1 1
P.4.1. Surveillance systems in place for priority zoonotic
diseases/pathogens
3 2 2
P.4.2. Veterinary or Animal Health Workforce 1 2 3
P.4.3. Mechanisms for responding to zoonosis and potential
zoonosis are established and functional
1 2 1
D.2.1 Indicator and event-based surveillance systems 3 3 3
D.2.2. Interoperable, interconnected, electronic real-time
reporting system
2 2 3
D.2.3. Analysis of surveillance data 3 4 3
D.2.4. Syndromic surveillance systems 3 N/A 4
1 – no capacity 2 – limited capacity 3 – developed capacity 4 – demonstrated capacity 5 – sustainable capacity 
 a cell with a dotted pattern is not an
area contributed by MEASURE Evaluation

17. Support One Health
• PRISM assessment to identify areas for surveillance system
strengthening
• Multisectoral TWG to coordinate One Health efforts and fill
surveillance gaps
Burkina Faso
• Interoperability layer in DHIS2
enabled real-time reporting of
event-based surveillance data
from three ministries
• Trained 400 community agents
from the three sectors, based
on our curricula from Senegal,
to improve reporting rate and
provide real-time status
MEASURE Evaluation Technical Advisor with training
participants from health, animal and fisheries
resources, and environment sectors
https://www.measureevaluation.org/resources/publications/tr-18-306-fr

18. Support One Health
Strategy to streamline and focus on what matters
• Established functioning multisectoral TWG to guide effort
• Prioritized surveillance from 33 diseases in WHO guidance
to 12 priorities in Mali (52 variables vs. 1,190)
• Expanded IDSR beyond border communities to detect
public health threats at
facility level
Mali
https://www.measureevaluation.org/resources/publications/fs-18-315
• Customized DHIS2 reports
for priority diseases, with
data exchange among
three sectors

19. Support One Health
• Expanded real-time
surveillance to two regions
beyond mInfosante pilot
• Trained 3,000+ community
volunteers for community-
based surveillance
• Convened One Health TWG
and developed national
surveillance guidelines
Senegal
https://www.measureevaluation.org/resources/publications/tr-18-255

20. Trends
1. Fundamental information technology (IT)
infrastructure to enable electronic real-time
surveillance
2. Assistance to establish multisectoral platforms
to coordinate stakeholders and facilitate
collaboration
3. Focus on strengthening community detection
of health threats
4. Emphasis on cross-border data sharing;
demand for appropriate interoperability tools
and standards
Country demand

21. Recommendations
1. Monitor collaboration mechanism functioning
to increase stakeholder accountability
2. Build capacity of animal health workforce in
established zoonotic surveillance systems
3. Advocate stakeholder involvement to improve
infrastructure for electronic real-time reporting
systems, especially in communities
4. Assure skills are available to analyze
surveillance data used for reporting and risk
assessment
Future investment

22. Resources
HIS Strengthening Resource Center
https://www.measureevaluation.org/his-strengthening-resource-center

23. This presentation was produced with the support of the United States
Agency for International Development (USAID) under the terms of
MEASURE Evaluation cooperative agreement AID-OAA-L-14-00004.
MEASURE Evaluation is implemented by the Carolina Population
Center, University of North Carolina at Chapel Hill in partnership with
ICF International; John Snow, Inc.; Management Sciences for Health;
Palladium; and Tulane University. Views expressed are not necessarily
those of USAID or the United States government.
www.measureevaluation.org