Structure, functions, Performance and Gaps of Event-Based Surveillance (EBS) in Sudan, 2021: A Cross-Sectional Review

Abstract

Background Event-based surveillance (EBS) is an essential component of Early Warning Alert and Response (EWAR) as per the International Health Regulations (IHR), 2005. EBS was established in Sudan in 2016 as a complementary system for Indicator-based surveillance (IBS). This review will provide an overview of the current EBS structure, functions and performance in Sudan and identify the gaps and ways forward. Methods The review followed the WHO/EMRO guidelines and tools. Structured discussions, observation and review of records and guidelines were done at national and state levels. Community volunteers were interviewed through phone calls. Directors of Health Emergency and Epidemic Control, surveillance officers and focal persons for EBS at the state level were also interviewed. The quantitative data was analysed using SPSS, and the qualitative data were analysed using a thematic analysis, paying particular attention to the health system level allowing for an exploration of how and why experiences differ across levels. Written and verbal consents were obtained from all participants as appropriate. Results Sudan has a functioning EBS; however, there is an underestimation of its contribution and importance at the national and states levels. The link between the national level and states is ad hoc or is driven by the need for reports. While community event-based surveillance (CEBS) is functioning, EBS from health facilities and from non-health sectors is not currently active. The integration of EBS into overall surveillance was not addressed, and the pathway from detection to action is not clear. The use of electronic databases and platforms is generally limited. Factors that would improve performance include training, the presence of a trained focal person at state level, and regular follow-up from the national level. Factors such as staff turnover, income in relation to expenses and not having a high training degree (Diploma or MSc) were noticed as inhibiting factors. Conclusion The review recommended revisiting the surveillance structure at national and state levels to put EBS as an essential component and to update guidelines and standard operation procedures SOPs to foster the integration between EBS components and the overall surveillance system. The need for strengthening the link with states, capacity building and re-addressing the training modalities was highlighted.

Key Considerations: Community-Based Surveillance in Public Health

“…3 CBS volunteers in many settings have described the benefits of being involved in a CBS programme including increasing their social network, having opportunities for training, and being recognised for contributing to disease control. 3,17 Involving people from diverse groups can help spread the material and symbolic benefits of volunteer employment. Equity-based and gendersensitive approaches to volunteer recruitment can also help CBS programme designers consider the anticipated and unanticipated social consequences of CBS programmes.…”

Strengthening Health Information Surveillance: Implementing Community-Based Surveillance in Sudan

“…The EBS programme was intended to complement the passive detection of epidemic information from the one-third of public health facilities participating in a sentinel surveillance programme. 1 In 2018, a CBS programme was introduced in 11 of the country's 26 states as part of the broader EBS programme. CBS was the largest component of the EBS programme and had specific funding from the WHO and other donors (Sudan Humanitarian Fund, Central Emergency Response Fund, and disaster assistance departments of the USA, Qatar, Japan, and Italy).…”

“…These include the gap in information reporting from two-thirds of public health facilities and a perceived deficit in trust in local health systems. 1,2 Both issues are most acute for rural populations due to the long history of government focus on the capital and centre of the country, and armed conflicts in peripheral areas.…”