Documenting the development, adoption and pre-ebola implementation of Liberia’s integrated disease surveillance and response (IDSR) strategy

Abstract Background In the immediate aftermath of a 14-year civil conflict that disrupted the health system, Liberia adopted the internationally recommended integrated disease surveillance and response (IDSR) strategy in 2004. Despite this, Liberia was among the three West African countries ravaged...

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Main Authors: Tolbert G. Nyenswah, Laura Skrip, Mardia Stone, Jessica L. Schue, David H. Peters, William R. Brieger
Format: Article
Language:English
Published: BMC 2023-10-01
Series:BMC Public Health
Subjects:
Online Access:https://doi.org/10.1186/s12889-023-17006-7
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author Tolbert G. Nyenswah
Laura Skrip
Mardia Stone
Jessica L. Schue
David H. Peters
William R. Brieger
author_facet Tolbert G. Nyenswah
Laura Skrip
Mardia Stone
Jessica L. Schue
David H. Peters
William R. Brieger
author_sort Tolbert G. Nyenswah
collection DOAJ
description Abstract Background In the immediate aftermath of a 14-year civil conflict that disrupted the health system, Liberia adopted the internationally recommended integrated disease surveillance and response (IDSR) strategy in 2004. Despite this, Liberia was among the three West African countries ravaged by the worst Ebola epidemic in history from 2014 to 2016. This paper describes successes, failures, strengths, and weaknesses in the development, adoption, and implementation of IDSR following the civil war and up until the outbreak of Ebola, from 2004 to early 2014. Methods We reviewed 112 official Government documents and peer-reviewed articles and conducted 29 in-depth interviews with key informants from December 2021 to March 2022 to gain perspectives on IDSR in the post-conflict and pre-Ebola era in Liberia. We assessed the core and supportive functions of IDSR, such as notification of priority diseases, confirmation, reporting, analysis, investigation, response, feedback, monitoring, staff training, supervision, communication, and financial resources. Data were triangulated and presented via emerging themes and in-depth accounts to describe the context of IDSR introduction and implementation, and the barriers surrounding it. Results Despite the adoption of the IDSR framework, Liberia failed to secure the resources—human, logistical, and financial—to support effective implementation over the 10-year period. Documents and interview reports demonstrate numerous challenges prior to Ebola: the surveillance system lacked key components of IDSR including laboratory testing capacity, disease reporting, risk communication, community engagement, and staff supervision systems. Insufficient financial support and an abundance of vertical programs further impeded progress. In-depth accounts by donors and key governmental informants demonstrate that although the system had a role in detecting Ebola in Liberia, it could not respond effectively to control the disease. Conclusion Our findings suggest that post-war, Liberia’s health system intended to prioritize epidemic preparedness and response with the adoption of IDSR. However, insufficient investment and systems development meant IDSR was not well implemented, leaving the country vulnerable to the devastating impact of the Ebola epidemic.
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spelling doaj.art-593ab3024c724cd09d4645055449e9412023-11-20T11:11:22ZengBMCBMC Public Health1471-24582023-10-0123111210.1186/s12889-023-17006-7Documenting the development, adoption and pre-ebola implementation of Liberia’s integrated disease surveillance and response (IDSR) strategyTolbert G. Nyenswah0Laura Skrip1Mardia Stone2Jessica L. Schue3David H. Peters4William R. Brieger5Department of International Health, Johns Hopkins Bloomberg School of Public HealthSchool of Public Health, University of LiberiaDivision of Global Psychiatry, Boston University School of Medicine, Boston Medical CenterDepartment of International Health, Johns Hopkins Bloomberg School of Public HealthFaculty of Health, York UniversityDepartment of International Health, Johns Hopkins Bloomberg School of Public HealthAbstract Background In the immediate aftermath of a 14-year civil conflict that disrupted the health system, Liberia adopted the internationally recommended integrated disease surveillance and response (IDSR) strategy in 2004. Despite this, Liberia was among the three West African countries ravaged by the worst Ebola epidemic in history from 2014 to 2016. This paper describes successes, failures, strengths, and weaknesses in the development, adoption, and implementation of IDSR following the civil war and up until the outbreak of Ebola, from 2004 to early 2014. Methods We reviewed 112 official Government documents and peer-reviewed articles and conducted 29 in-depth interviews with key informants from December 2021 to March 2022 to gain perspectives on IDSR in the post-conflict and pre-Ebola era in Liberia. We assessed the core and supportive functions of IDSR, such as notification of priority diseases, confirmation, reporting, analysis, investigation, response, feedback, monitoring, staff training, supervision, communication, and financial resources. Data were triangulated and presented via emerging themes and in-depth accounts to describe the context of IDSR introduction and implementation, and the barriers surrounding it. Results Despite the adoption of the IDSR framework, Liberia failed to secure the resources—human, logistical, and financial—to support effective implementation over the 10-year period. Documents and interview reports demonstrate numerous challenges prior to Ebola: the surveillance system lacked key components of IDSR including laboratory testing capacity, disease reporting, risk communication, community engagement, and staff supervision systems. Insufficient financial support and an abundance of vertical programs further impeded progress. In-depth accounts by donors and key governmental informants demonstrate that although the system had a role in detecting Ebola in Liberia, it could not respond effectively to control the disease. Conclusion Our findings suggest that post-war, Liberia’s health system intended to prioritize epidemic preparedness and response with the adoption of IDSR. However, insufficient investment and systems development meant IDSR was not well implemented, leaving the country vulnerable to the devastating impact of the Ebola epidemic.https://doi.org/10.1186/s12889-023-17006-7Ebola Virus DiseaseHealth Management Information SystemIntegrated Disease Surveillance and ResponsePublic Health EmergencyLiberiaWest Africa
spellingShingle Tolbert G. Nyenswah
Laura Skrip
Mardia Stone
Jessica L. Schue
David H. Peters
William R. Brieger
Documenting the development, adoption and pre-ebola implementation of Liberia’s integrated disease surveillance and response (IDSR) strategy
BMC Public Health
Ebola Virus Disease
Health Management Information System
Integrated Disease Surveillance and Response
Public Health Emergency
Liberia
West Africa
title Documenting the development, adoption and pre-ebola implementation of Liberia’s integrated disease surveillance and response (IDSR) strategy
title_full Documenting the development, adoption and pre-ebola implementation of Liberia’s integrated disease surveillance and response (IDSR) strategy
title_fullStr Documenting the development, adoption and pre-ebola implementation of Liberia’s integrated disease surveillance and response (IDSR) strategy
title_full_unstemmed Documenting the development, adoption and pre-ebola implementation of Liberia’s integrated disease surveillance and response (IDSR) strategy
title_short Documenting the development, adoption and pre-ebola implementation of Liberia’s integrated disease surveillance and response (IDSR) strategy
title_sort documenting the development adoption and pre ebola implementation of liberia s integrated disease surveillance and response idsr strategy
topic Ebola Virus Disease
Health Management Information System
Integrated Disease Surveillance and Response
Public Health Emergency
Liberia
West Africa
url https://doi.org/10.1186/s12889-023-17006-7
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