ONE HEALT

H E-S

URVEILLANCE

INIT

IATI

VE (OHSI)

PR

OJ E

CT

OR

I EN

TA

TI O

N A

ND

OV

ER

VI E

W

J AN

20

14

ONE HEALTH E-SURVEILLANCE INITIATIVE (OHSI)GoalTo support the implementation of the Integrated Disease

Surveillance and Response (IDSR) plan by contributing strategies that can embed public health informatics, thereby making IDSR more effective and efficient

To this end…OHSI will assist pilot countries to develop a targeted strategy

for leveraging electronic surveillance (e-Surveillance) tools to meet their needs and IDSR objectives using a one health approach

ONE HEALTH E-SURVEILLANCE INITIATIVE (OHSI)ObjectivesTo establish national workgroups that will develop country-

specific, transnationally aligned, and globally informed strategic plans for implementing e-Surveillance abiding by IDSR and International Health Regulations (IHR[2005]) strategies and guidelines

To provide evidence-based information to inform the African Surveillance Informatics Governance Board (ASIGB), the regional workgroup led by the World Health Organization’s African Regional Office (WHO/AFRO) for e-Surveillance

WHAT IS ONE HEALTH?

A one health approach recognizes the relationships between the human, animal, and environmental health, and applies interdisciplinary tools to solve complex public health problems.

TRADITIONAL PUBLIC HEALTH MODEL

ONE HEALTH APPROACH

Human Animal

Environmental

One Health

Human Animal

Environmental

Source: Gael Lamielle

WHAT IS ONE HEALTH?

One Health

A one health approach may incorporate a variety of fields.

Our project, the One Health e-Surveillance Initiative will focus on public health, veterinary medicine, human medicine, and microbiology (laboratory) fields

Environmental

Health

Ecology

Veterinary Medicine

Public Health

Human Medicine

Molecular and

Microbiology

Health Economics

Source: One Health Initiative/One Health Sweden

WHY ONE HEALTH IS IMPORTANT

Approximately 70% of emerging and reemerging infections are vector-borne or zoonotic.

Source: International Livestock Research Institute

WHAT IS E-SURVEILLANCE?

“Public health surveillance is the continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice.” (WHO)

Electronic surveillance (e-Surveillance) utilizes information technologies, such as specialized software for epidemiological statistics or outbreak management, to perform public health functions.

An e-Surveillance tool is a means to streamline manual processes to reduce opportunity for human error, improve the flow and timeliness of surveillance data for public health action, and increase surveillance capacity and data quality.

E-SURVEILLANCE COMPONENTS

Leadership, governance, and multi-sector engagement coordinate at national level, enable adoption of e-Surveillance components,

support and implementation, monitor results

Strategy and Investmentensure comprehensive, multi-sectoral

engagement coordination in planning and financing

Standards and

Interoperability

ensure consistent

data collection and exchange

Services and Applicationstools for data

access, exchange, and management

Infrastructure

physical infrastructures (e.g., internet) and supporting

services

Legislation, Policy, and Compliance

adopt enabling

policies and legislation, create legal

and enforcement environment

Workforcegrow e-

Surveillance knowledge and skills,

build networks, establish education

and training programs

Adapted from source: WHO National e-Health Strategy Toolkit

The e-Surveillance environment is comprised of various components, each of which are included in a robust e-Surveillance strategy.

Role of Components: Enabling, Information Communications Technology

Facilities, Infrastructure, & Equipment

Structures, Institutions, & Departments

Institutional Capacity

Systems and Standards

Electronic Tools

E-SURVEILLANCE CAPACITY BUILDING

To maximize…• Usability• Sustainability• Acceptability• Trust• Accountability

…we should select tools should that meet public health needs; optimize the ability of the users; leverage existing resources within the country’s infrastructure; and strictly abide by national guidelines and standards supporting data security, privacy, and integrity.

E-Surveillance tools are only as useful and capable as the underpinning infrastructure that supports it.

Revised IHR (2005) Model for Health Systems Strengthening

Adapted from source: WHO International Health Regulation Monitoring Framework (2023)

Req

uir

e…

Enab

le

eff

ect

ive u

se

of…

BACKGROUND: E-HEALTH COMPARISON

e-Health initiatives in Africa are primarily driven by non-governmental organizations (NGOs)

>90 NGOs working on e-Health in Africa including World Health Organization International Telecommunications Union Rockefeller Foundation World Bank Health Metrics Network

The vast number of NGOs working independently have lead to “pilotitis”

Likewise, pilotitis can negatively impact the development and acceptance of e-Surveillance

Pilotitis (n.)A proliferation of pilot projects that do not scale up, do not contribute to widespread best practices, and eventually disappear without substantial or long-lasting impact

Timeline

2008-9

20 m-health pilots abandoned

2011

37 NGOs operating in m-Health (see map)

April 2012

Ugandan MoH places moratorium on new e-Health projects

BACKGROUND: PILOTITIS IN UGANDA

Source: Unicef Uganda

BACKGROUND

Factors contributing to pilotitis include Lack of vision for full implementation at outset of pilot Development of beta tools without informed buy-in or robust input

from end users Utilization of seed capital without feasible and apparent funding

options for future scalability and maintenance Siloed development of tool, leading to a lack of necessary standards

or coordination between all stakeholders Sole focus on funding novel methods or tools in lieu of tried-and-true

options based on best practices and incremental changes thereof Failure to share results with community

LESSONS LEARNED FROM E-HEALTH

Develop roadmap and business plan for e-Surveillance capacity building, including workforce development, based on best-practices

Conduct e-Surveillance assessment to identify needs and limitations of country with respect to:

Impact Cost Demand

Develop and enforce e-Surveillance policies (e.g., IT standards) for scalability and integration/interoperability with 2nd generation or external tools

LESSONS LEARNED FROM E-HEALTH

Establish multi-disciplinary and multi-sectoral collaborations to facilitate national surveillance

Public health Laboratory Information technology Animal health (for one health surveillance, if applicable)

Establish regional and international collaboration to facilitate cross-border surveillance

Share standards and best practices Develop community to strengthen knowledgebase

LESSONS LEARNED FROM E-HEALTH

Identify and secure funding for all stages of e-Surveillance capacity building

Assessment and planning Development and pilot Full-implementation Evaluation Maintenance

STRATEGIC VISION FOR E-SURVEILLANCE

Disparate initiatives & institutional knowledge

Country-specific, yet transnationally

aligned and globally informed

plans for e-Surveillance

Strategic and

sustainable developme

nt of e-Surveillance

OHSI - PROJECT AIMS

Establish Country Level Work Groups (CLWG) with one health expertise in five African Field Epidemiology Network (AFENET)-member countries1

Conduct assessment of e-Surveillance To identify scope of one health surveillance and the capabilities of each

sector relevant to e-Surveillance To identify limits to e-Surveillance as defined by the country’s infrastructure

Inventory and evaluate global e-Surveillance tools to inform country planning for e-Surveillance capacity building

Develop country-specific, transnationally aligned and globally informed strategic plans to improve one health e-Surveillance

Enable countries to build e-Surveillance capability and infrastructure through sustainable coordination

1 AFENET is an affiliation of various Field Epidemiology and Laboratory Training Programs (FELTP) and Field Epidemiology Training Programs (FETP) in Africa

HIGH-LEVEL APPROACH

Phase 1: 2013-2014

• Country Level Workgroup formation and orientation

• Literature review• Country

assessments for one health e-Surveillance

• Topical training on public health informatics

Phase 2: 2014-2015

• Stakeholder engagement & advocacy

• Country-specific strategic plans

PHASE 1: CLWG FORMATION & ORIENTATIONAppointed in coordination with WHO Country Representative

(WR), FET(L)P, MoH, and ministries associated with animal health

CLWG members will provide ~20% time to OHSI project

CLWGs will be composed of government-employed experts in: Public health Medicine Veterinary science Laboratory Informatics

Orientation will be conducted in-person by AFENET and its technical partner, Public Health Practice, LLC (PHP)

LITERATURE REVIEW

Conducted by PHP staff to inform development of country assessment for one health e-Surveillance

Includes preliminary review of each country’s… One health surveillance capacities e-Surveillance system, if applicable Electricity and communications infrastructure Priorities

Each CLWG to conduct assessment for their respective country. AFENET will provide technical support to CLWGs during process.

ASSESSMENT FOR E-SURVEILLANCE

Tool and protocol development Pilot

Final developme

nt

CLWG training for assessment

Data collection

and validation

Final report

Developed in collaboration between CDC, WHO/AFRO, AFENET, and PHP

Conducted by Ugandan CLWG

Final draft completed by CDC, AFENET, PHPApproved by AFRO

In-person training of CLWGs provided by AFENET and PHP

Final report will be developed in collaboration between all stakeholders involved in assessment process

PHASE 1: CLWG TRAINING

CWLGs will participate in topic trainings to attain a common understanding of public health informatics and e-Surveillance concepts and applications. Topics include:

1. Public and veterinary health informatics and governance

2. Electronic disease reporting, vocabulary and messaging formats

3. Integration of data streams and systems

4. Application of global e-Surveillance systems and tools

STAKEHOLDER ENGAGEMENT & ADVOCACYAn effective strategy for e-Surveillance will have…

Involvement of all stakeholders that contribute to the e-Surveillance process

Leadership endorsement Champions to maintain the momentum of ongoing e-Surveillance

initiatives during and after development of the strategic plan

CLWG members will be responsible for identifying key person(s) within their respective ministries for the purposes of…

Vetting policies and operating procedures with impacted stakeholders Fostering financial and political support for future development of e-

Surveillance Implementing and enforcing policies

STRATEGIC PLAN FOR E-SURVEILLANCE

The final strategic plan will be approved and adopted by the ministries of each respective country

Forum discussionFacilitated in-person meeting

Strategic plan

development

Vetting with stakeholder

s

Finalized plan

A web forum will be established to solicit discussions on strategic planning throughout the course of phase 1 to inform the facilitated meeting for strategic planning

CLWGs will participate in regional and country-specific facilitated in-person meetings to develop ideas for first draft of strategic plan.

CLWGs will develop their respective strategic plans, which may be new plans specific to e-Surveillance or an update of existing strategic plan to incorporate additional details. Development is planned to occur iteratively in conjunction with stakeholder vetting.

CLWGs will iteratively vet their respective strategic plans with impacted stakeholders and industry experts.

BENEFITS TO COUNTRIES

Supports implementation of IDSR

Facilitates FELTP/FETP support of Ministries of Health, Agriculture or Wildlife and other partners in achieving one health e-Surveillance

Trains workforce in public health informatics to enhance coordination of e-Surveillance and increase workforce competencies

Supports the development or update of country-specific strategic plans to coordinate the implementation of one health e-Surveillance upon existing infrastructures

Provides additional context means of coordination for ongoing e-Health initiatives

Encourages African-wide regional coordination of e-Surveillance to improve surveillance

OHSI TOOLKIT

One health e-Surveillance country assessment

e-Surveillance tool inventory

Public health informatics training modules

Strategic plan framework

Library of best practices in e-Surveillance

Online forum for African e-Surveillance discussions

STAKEHOLDERS

Surveillance Informatics Technical

Advisory Group (SITAG)

AFENET - One Health Informatics Workgroup

(OHIWG)

Burkina Faso

KenyaNigeria Uganda

Inform

Advise

ASIGB

Cameroon

LEADERSHIPFACILITATIONFUNDING

Blue – Pilot CountriesYellow – AFENET Members

One Health e-Surveillance Initiative (OSHI)

African Surveillance Informatics Governance

Board (ASIGB)

Surveillance Informatics Technical Advisory Group

(SITAG)

FUNDING FACILITATION

SUPPORT & IMPLEMENTATIONPOLICY & COORDINATION

Advise

Inform

LEADERSHIP

Advise Govern

POTENTIAL STAKEHOLDERS

REFERENCESBlaschke S. Map of mHealth pilots in Uganda. Unicef Uganda. Retrieved from

http://www.flickr.com/photos/texttochange/5178727492/

Lamielle G. About One Health. Global Health Vet. Retrieved from http://globalhealthvet.com/2010/08/21/about-one-health/

International Livestock Research Institute. Mapping of poverty and likely zooneses hotspots. Retrieved from http://www.ilri.org/node/1244

Kuipers P, Humphreys JS, Wakerman J, Wells R, Jones J, Entwistle P. Collaborative review of pilot projects to inform policy: A methodological remedy for pilotitis? Australia and New Zealand Health Policy 2008, 5:17

One Health Initiative. About the One Health Initiative. Retrieved from http://www.onehealthinitiative.com/about.php

One Health Iniatitive. Emerging and Reemerging infections. Retrieved from http://www.onehealthinitiative.com/map.php

Vota W. 7 ways we can scale ICT4D pilotitis. Retrieved from http://www.ictworks.org/2013/10/09/7-ways-to-scale-ict4d-pilotitis/

World Health Organization. IHR Core Capacity Monitoring Framework: Checklist and Indicators for Monitoring Progress in the Development of IHR Core Capacities in States Parties. Geneva: World Health Organization; April 2013. 67 pgs.

World Health Organization and International Telecommunication Union. National e-Health Strategy Toolkit. Geneva: World Health Organization; 2012. 233 pgs.