Factors of success and challenges in the implementation of the integrated disease surveillance and response systems in Africa

Disease surveillance is a critical public health tool for early detection, prevention and response to disease threats. To improve their surveillance systems, African countries adopted Integrated Disease Surveillance and Response (IDS) in 1998. The World Health Organization Regional Office for Africa (WHO/AFRO), provided support for the implementation of the strategy. The adoption of the International Health Regulations (IHR 2005) and emergence of new disease priorities led WHO/AFRO and its technical partners to revise the IDSR Technical Guidelines. Part of the process involved a rapid assessment of IDSR implementation conducted between May and June 2010 in 45 countries. National surveillance officers completed questionnaires to report progress with implementation measured by IDSR core indicators. Respondents also provided narrative comments on perceived factors of success and challenges for meeting indicator targets. We conducted a content analysis of the narrative responses using Atlas.ti to code responses and identify themes. Themes were ranked according to number of responses. Findings from the analysis suggested critical areas for achieving satisfactory outcomes from surveillance systems. These include adequately trained and supported workforce, access to training for staff at sub-national levels, effective supervision, and the ability to communicate information, sufficient financial resources and infrastructure for surveillance including laboratory capacity. The 2010 IDSR Rapid Assessment identified priority areas to be considered by programs, institutions, and donors for inclusion in future workplans and activities aimed at supporting Ministries of Health to strengthen surveillance systems. Seeking views of surveillance personnel provides useful insights into practical problems requiring attention during the planning stage.