eHealth Africa

Going digital improves Disease Surveillance in Sierra Leone

By Sahr Ngaujah and Nelson Clemens

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According to WHO, Sierra Leone is the first country in the Africa region to fully transform its national disease surveillance system from a paper-based system to a  web-based electronic platform. This is due to the introduction of the electronic Integrated Disease Surveillance and Response solution.

Sierra Leone was one of the hardest-hit countries during the 2014 EVD outbreak in West Africa. The country’s poor disease surveillance infrastructure highlighted the need for a robust disease surveillance mechanism. Introducing an electronic method for disease surveillance reporting became one identified remedy for improving disease surveillance in a country that was still trying to catch up with the rest of the world in terms of digital technology. 

Paper-based health data recording and reporting from across Sierra Leone’s 1300 health facilities became increasingly inadequate and inaccurate and was also characterized by late reporting, incomplete district-level reports, multiple data entry errors, and difficulty storing and retrieving data.

With an expertise in health informatics, eHealth Africa (eHA) designed the electronic Integrated Disease Surveillance and Response (eIDSR) solution and has been implementing the solution in collaboration with Sierra Leone’s Ministry of Health and Sanitation (MoHS), the U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization, Focus 1000, and GIZ since 2016, with  the objective to enhance disease prevention and control through the digital capture and submission of data on epidemiologically-important diseases. The eIDSR project was funded by the CDC. 

eHA customized an open source health information tool from DHIS2 for the purpose-built digital data collection and reporting. The eIDSR tool is integrated into the national health system through its compatibility with the health information systemDHIS2, which is used in over 45 countries, especially those with vulnerable health systems like Sierra Leone. eHA developed the web form and custom mobile application, piloted both, and created a Short Message Service (SMS) submission solution for health workers to submit their weekly surveillance reports in locations where internet access is weak.

Nwanyibuife Obiako, Senior Programs Manager, eHA Sierra Leone, making a statement during the eIDSR rollout closing ceremony

Nwanyibuife Obiako, Senior Programs Manager, eHA Sierra Leone, making a statement during the eIDSR rollout closing ceremony

As of June 2019, 2758 health care workers at the health facility and district level were trained by eHA on the use of eIDSR across Sierra Leone. These health care workers now monitor 26 disease categories digitally. Digitizing health-related data has yielded positive outcomes in Sierra Leone. eHA has supported the rollout of eIDSR to all 14 administrative districts in Sierra Leone and a ceremony was held on June 6th in Tonkolili district, with participants from the MoHS and other implementing partners, to celebrate the milestone achieved.

Thanks to eIDSR, we have seen an improvement of multiple surveillance indicators, such as reporting completeness and timeliness. It’s evident that a critical part of this success is partnership and collaboration.
— Nwanyibuife Obiako, Senior Programs Manager, eHA Sierra Leone
Nelson Clemens, eHA’s eIDSR Project Coordinator presenting during the eIDSR rollout closing event

Nelson Clemens, eHA’s eIDSR Project Coordinator presenting during the eIDSR rollout closing event

The eIDSR system has also enhanced:

  •  Reduced data entry errors

  •  Reporting completeness, timeliness, and efficiency

Reducing data entry error

Optimal data management and quality are crucial to the delivery of high-quality healthcare services. Accurate data is essential to informed decision making and appropriate public health action. In the past, when health care workers submitted their reports, there was no opportunity for their superiors to perform data quality assurance. This sometimes resulted in erroneous data being sent to the national level, reducing the quality of data used for disease surveillance in Sierra Leone. With eIDSR, digital data is now managed in an efficient manner at District and National levels and made available to all relevant parties in the quickest way possible.

The electronic system has reduced the number of data entry errors in half, and is capturing and verifying data 60% faster than the paper-based IDSR system.
— CDC

Reporting completeness, timeliness, and efficiency 

The eIDSR tool was created to improve the speed of the flow of information within health systems. Through the electronic Integrated Disease Surveillance Response (eIDSR) solution, disease prevention, and control is enhanced through timely electronic capture and submission of data on epidemiologically-important diseases as data can now be submitted, reviewed and acted upon near real-time.

...My colleague Surveillance Officers would agree with me that eIDSR has relieved our stress. eIDSR roll-out commenced in the Kambia district in November 2018. A week following the roll-out, we achieved 98% of timeliness of reporting and has not gone below 90% since.
— Usman Barrie, District Surveillance Officer, MoHS, Kambia district.

Disease surveillance plays an important role in disease prevention, control and elimination. 

eHA continues to work with its partners to ensure eIDSR is sustainable in Sierra Leone.

Fighting Cholera with the Power of Geospatial Mapping

By Ayodele Adeyemo & Hawa Kombian

The Cholera Threat

According to the World Health Organization (WHO), cholera (an infectious disease which causes acute watery diarrhea) remains a global threat to public health with an annual average of 82,000 deaths. In Nigeria, the cholera burden has been an average of 10,000 cases annually with over 70% of the cases coming from Bauchi, Yobe, and Zamfara states.

Following the review and recent publication of WHO guidelines on cholera control, the Nigeria Centre for Disease Control (NCDC) has begun the implementation of innovative approaches to tackle cholera via:

  • Strengthening disease surveillance for early detection and quick response through innovative use of technology and data.

  • Improving coordination for technical support, resource mobilization, and partnership.

  • Adopting a multi-sectoral approach to meet the 2030 cholera elimination by working with the environment and Water and Sanitary Hygiene sectors to ensure that communities have good water and sanitary facilities which will prevent further outbreaks

The Digital Health Advantage

What does an innovative model for cholera prevention and control look like?

In 1854, John Snow mapped out the cholera deaths during an outbreak and observed that they all occurred within short distances and were clustered around the Broad Street pump. He went ahead to carry out statistical tests to illustrate the connection between the source of water and the cholera cases.

In synergistic partnership, NCDC and eHealth Africa (eHA) used advanced geographic information systems (GIS) technologies to build on John Snow’s ideas of mapping. eHA uses data-driven solutions and tools to improve community health, with specific expertise in the design, development, validation, and deployment of predictive models for diseases like cholera.

GIS allow experts to explore different aspects of a geographical point. The identification of patterns can drive insights and enable health stakeholders to make informed decisions about how to best plan public health interventions. Due to computational and technological advancement, GIS has been used in public health for epidemiology, resource planning, and surveillance among others.  

NCDC and eHA were able to utilize GIS capabilities to enhance the data management within the NCDC National Incident Coordination Centre (ICC). The ICC serves as a the emergency operations center for coordinating disease outbreaks at the national level.


eHA’s GIS and Data Analytics team works with the NCDC to map cholera hotspots (areas where cholera persists) across Nigeria’s Local Government Areas (LGAs). At the start of the outbreak, hotspot analysis helps determine where to vaccinate and what quantity of vaccines are required per LGA. This exercise ensures the effectiveness of the oral cholera vaccine immunization campaigns which are rolled out to stop the spread of disease.

In planning, data from 2012-17 displays the spread of cholera outbreaks and also shows the relative risks of the various LGAs which have reported an outbreak during the five year period.

The Big Picture   Data Source: Nigeria Centre for Disease Control

The Big Picture Data Source: Nigeria Centre for Disease Control

Data Source: Nigeria Centre for Disease Control

Data Source: Nigeria Centre for Disease Control

We layered the 2018 outbreak data with the historical hotspot analysis to identify specific trends and possible overlaps. The result of the hotspot analysis identified 83 LGAs as hotspots, with 87% reporting at least one case with over 70% of the burden from Bauchi, Kano, and Zamfara states. The LGAs identified as hotspots have enabled the government to make informed decisions about where to request vaccines to ensure that the most vulnerable areas are supported.

Data Source: Nigeria Centre for Disease Control

Data Source: Nigeria Centre for Disease Control

We continue to collaborate with the NCDC to strengthen cholera surveillance in Nigeria. The partnership ensures that data management and analysis expertise contribute to faster response and informed decision making before, during and after outbreaks.

This work was done in collaboration with the following partners:

  • Yennan Sebastian- NCDC

  • Adesola Ogunleye - NCDC

  • Heloise Lucaccioni - UNICEF

  • Helen Adamu - UMB

  • Kobi Ampah- WHO Geneva