Implementing Nationwide Facility-based Electronic Disease Surveillance in Sierra Leone: Lessons Learned

Area of Science:

• Public Health
• Epidemiology
• Health Informatics

Background:

• The Global Health Security Agenda emphasizes strengthening national capacities for infectious disease prevention, detection, and response.
• The International Health Regulations (2005) mandate robust surveillance systems for epidemic-prone diseases.
• Sierra Leone partnered with the US Centers for Disease Control and Prevention (CDC) to develop an Integrated Disease Surveillance and Response (IDSR) system.

Purpose of the Study:

• To describe the development and implementation of a national electronic Integrated Disease Surveillance and Response (eIDSR) system in Sierra Leone.
• To highlight technical innovations enabling the success of a large-scale mobile health (mHealth) surveillance project.
• To assess the feasibility and user acceptance of a national mHealth-based disease surveillance system.

Main Methods:

• Development of an Android-based mobile data entry system for health facility-based eIDSR.
• Implementation of technical innovations including data compression and dual-mode (internet/text) messaging.
• Iterative user feedback mechanisms for system refinement and issue remediation.

Main Results:

• The Sierra Leone eIDSR system is one of the largest mHealth projects documented, with over 1,100 reporting health facilities.
• High user acceptance was achieved for the health facility-based eIDSR system.
• The system demonstrated the feasibility of implementing a national-scale mHealth surveillance solution.

Conclusions:

• The Sierra Leone eIDSR system successfully enhances national capacity for infectious disease surveillance and response.
• Technical innovations were crucial for overcoming connectivity challenges and ensuring system usability.
• The project provides a scalable model for mHealth-based disease surveillance in resource-limited settings.