ONE HEALTH E-SURVEILLANCE INITIATIVE (OHSI)
Goal
To 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)
Objectives
To 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.
Human
Human
Animal
Animal
One Health
Environmental
Environmental
TRADITIONAL PUBLIC HEALTH
MODEL
ONE HEALTH APPROACH
Source: Gael Lamielle
WHAT IS 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
Public Health
Veterinary
Medicine
Ecology
Health
Economics
Molecular and
Microbiology
Human
Medicine
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
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
Leadership, governance, and multi-sector engagement
coordinate at national level, enable adoption of e-Surveillance components, support and
implementation, monitor results
Strategy and Investment
ensure comprehensive, multi-sectoral engagement
coordination in planning and financing
Standards and
Interoperability
ensure consistent
data collection
and exchange
Services and
Applications
tools 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
Workforce
grow eSurveillance
knowledge and
skills, build
networks,
establish
education and
training
programs
Adapted from source: WHO National e-Health Strategy Toolkit
E-SURVEILLANCE CAPACITY BUILDING
E-Surveillance tools are only as useful and capable as the underpinning infrastructure that
supports it.
Electronic Tools
Enable effective
use of…
Require…
Systems and Standards
Facilities, Infrastructure, & Equipment
Structures, Institutions, & Departments
Institutional Capacity
Revised IHR (2005) Model for Health Systems
Strengthening
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.
Adapted from source: WHO International Health Regulation Monitoring
Framework (2023)
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
acceptance of e-Surveillance
development and
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
BACKGROUND: PILOTITIS IN UGANDA
Timeline
2008-9
20 m-health pilots
abandoned
2011
37 NGOs operating in mHealth (see map)
April 2012
Ugandan MoH places
moratorium on new eHealth projects
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
development
of eSurveillance
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 eSurveillance
•Topical training on
public health
informatics
Phase 2: 2014-2015
•Stakeholder
engagement &
advocacy
•Country-specific
strategic plans
PHASE 1: CLWG FORMATION & ORIENTATION
Appointed 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
ASSESSMENT FOR E-SURVEILLANCE
Tool and protocol
development
Pilot
Final
development
Developed in collaboration
between CDC, WHO/AFRO,
AFENET, and PHP
Conducted by Ugandan CLWG
Final draft completed by CDC,
AFENET, PHP
Approved by AFRO
CLWG training
for
assessment
Data
collection and
validation
Final report
In-person training of CLWGs
provided by AFENET and PHP
Each CLWG to conduct
assessment for their respective
country. AFENET will provide
technical support to CLWGs
during process.
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 & ADVOCACY
An 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
Forum discussion
Facilitated
in-person
meeting
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.
Strategic
plan
development
Vetting with
stakeholders
Finalized
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.
The final strategic
plan will be
approved and
adopted by the
ministries of each
respective country
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 eSurveillance 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
LEADERSHIP
FACILITATION
FUNDING
ASIGB
Surveillance
Informatics
Technical Advisory
Group (SITAG)
AFENET - One Health
Informatics Workgroup
(OHIWG)
Burkina
Faso
Uganda
Nigeria
Cameroon
Kenya
LEADERSHIP
FUNDING
FACILITATION
POLICY & COORDINATION
SUPPORT & IMPLEMENTATION
African Surveillance Informatics
Governance Board (ASIGB)
One Health e-Surveillance Initiative
(OSHI)
Advise
Inform
Advise
Govern
Surveillance Informatics
Technical Advisory Group
(SITAG)
POTENTIAL STAKEHOLDERS
Blue – Pilot Countries
Yellow – AFENET Members
REFERENCES
Blaschke 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-onehealth/
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-ict4dpilotitis/
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.