Plan for Strengthening Integrated Disease Surveillance Systems

The Opportunity
The COVID-19 pandemic has exposed weaknesses in disease surveillance in nearly all countries (Lancet commentary). Early identification of COVID-19 cases and clusters for rapid containment was hampered by inadequate diagnostic capacity, insufficient contact tracing, fragmented data systems, incomplete data insights for public health responders and suboptimal governance of all these elements. Public health decision-making relies on real-time, accurate surveillance. As communities and economies struggle to recover from the consequences of these surveillance deficiencies, now is the time for countries and multilateral agencies to take a hard look at what failed and to act boldly to implement the necessary improvements to disease surveillance.

Future disease surveillance should comprise well-integrated national systems based on five principles. First, a strong surveillance foundation should monitor the population in a systematic, consistent and statistically sound way. Second, surveillance systems must incorporate laboratory confirmation appropriately scaled for different diseases and risks. Third, surveillance systems must be digitized, with unique health identifiers to connect individual-level data and with privacy safeguards. Fourth, surveillance programs must use standardized case definitions and common data elements, with appropriate access for the public, local and national health authorities, regional bodies and WHO. Fifth, disease surveillance must be adequately financed.

The Challenge
The purpose of this call is to solicit proposals from National Public Health Institutes (NPHIs), or in- country equivalent institutions, for planning programs to strengthen the integration of disease surveillance systems that follows the five principles, as outlined above. Note that the funding associated with this opportunity will not be used for implementation, but the intent of this call is to develop robust plans such that the Bill & Melinda Gates Foundation (BGMF) can identify opportunities for future in-country implementation activities that will potentially be funded at a later date. Preferred countries for proposals include: Benin, Burkina Faso, Democratic Republic of Congo, Ethiopia, Kenya, Nigeria, Mozambique, Sierra Leone, Uganda, or Pakistan.

Each proposal should tackle one or more of the following program areas:

Building population-representative surveillance via sample registration or vital statistics systems
Improving lab data digitization and interoperability
Integrating vertical disease-specific surveillance outputs at the NPHI
Strengthening existing surveillance tools and systems, rather than building new ones
Developing ongoing serological surveillance for monitoring population immunity
Engagement of local expertise and understanding of the implementation context will be crucial for successful proposals. All proposals must be submitted either directly by a NPHI, or equivalent in-country entity, with the inclusion of a principal investigator or co-investigator from the institution. Proposals should clearly state how data generated from the proposed program/activity will be used to inform timely public health decision making by in-country stakeholders, as well as demonstrate the inclusion of one or more of the five principles for integrated disease surveillance systems.

What we are looking for:

NPHIs, or in-country equivalent institutions, with interest and commitment to plan a more integrated and effective disease surveillance system suitable for the Covid-19 era
Assessment or design of an existing integrated disease surveillance program area, followed by development of recommendations or added-value propositions for improvement activities with a robust, costed, action plan for future implementation
Identification of in-country partners to support future implementation plans
All applications should:

Describe the approach to developing the action plan
Describe proposed activities for assessment and/or redesign of program areas (activities at a high level only) and expected outcomes
Outline what skills will be needed to design, support and implement the project will be incorporated
Suggest important phasing, timeline and sequencing of activities
Include a brief assessment of risks and challenges to successful implementation and how those will be mitigated
Explain the rationale for and potential benefits of conducting this type of planning exercise in their setting
Address one or more of the five principles outlined in The Opportunity section above
Describe how plans and recommendations arising from the project will be shared with the MOH and other key stakeholders
We will not consider funding for:

Proposals that do not address one or more of the program areas as defined above
Proposals that do not include an investigator from a NPHI or equivalent institution
Proposals that do not include an explicit partnership with the MOH or other authority responsible for disease surveillance in the country / region

NOTE: This opportunity was open to an invited set of investigators in ten countries.