In the 1990s, several countries across the WHO Africa Region (WHO-AFRO) experienced devastating outbreaks of largely preventable diseases including yellow fever, cholera, and ebola. These outbreaks had significant death tolls and affected biosecurity in the region. In response, ministries of health from the AFRO region partnered with the WHO to develop systems with a robust capacity to detect, confirm, and respond to public health events in a timely and reliable fashion and strengthen surveillance at every level of the health system.21 In 1998, they adopted what is now known as the Integrated Disease Surveillance and Response (IDSR) strategy which aims to develop and implement integrated, comprehensive surveillance and response systems that meet African priorities and improve data collection and use at each level of the health system.21 39
The IDSR has since been adopted by 43 out of 46 African countries in the WHO-AFRO region. Each country’s national IDSR strategy uses a priority setting process to define its disease priorities, administrative processes, and the roles and responsibilities of key partners and stakeholders at every level of the health system (in both the private and public sector). It also aligns with IHR requirements, priority health threats to include priority diseases, syndromes, conditions, and events of international concern and encourages the integration of both traditional indicator-based and event-based surveillance. The coordinated exchange of information, resources, and tools between the private and public sector and sourcing of event-based data have served to enhance surveillance capacities, including more timely detection and response to priority communicable and noncommunicable diseases through community-based surveillance.21 40
While the IDSR focuses on priority diseases, syndromes, and other conditions that afflict the 43 African countries that have adopted the strategy, the model offers two considerations that countries outside the AFRO region can adapt to support more effective surveillance systems in their context. First, the IDRS strategy is adaptable to changing health system needs.40 Every country adapts their IDRS strategy to meet the national context while ensuring that surveillance tools and processes comply with global recommendations for control and response (in alignment with the International Health Regulations). This targeted approach is vital for creating a sustainable and acceptable surveillance system that stakeholders will use across the health system. Secondly, the IDRS strategy is coordinated and comprehensive. The IDSR strategy coordinates multiple disease surveillance activities by tracking both indicator and event-based data reported by national disease reporting systems in the public and private sector.40 This multisectoral, coordinated approach strengthens the ability of the surveillance system to capture a comprehensive range of information on population health needs and events of public health significance. However, various studies have revealed challenges in the implementation of the IDSR system.41 42 For example, in Malawi, significant gaps existed between technical IDSR guidance and case identification and timely reporting in practice. Common challenges to IDSR implementation were related to resource and structural issues, such as the availability of a sufficient cadre of trained staff, laboratory capacities, and communication systems.42 Users can read more about the experience of implementing IDSR in the WHO African region here, challenges and lessons learned here, and the study on Malawi here.