Local initiatives and digitization of epidemic disease surveillance system

Abstract

Disease surveillance is one of the areas where digital health is increasingly being applied, particularly in low-income countries. In Burkina  Faso (BF), the liberalization of the telecommunications sector since 1996 has provided an opportunity for the adoption of Information and  Communication Technologies (ICT) in the health sector. In 2004, the Ministry of Health and Public Hygiene (MSHP) adopted an e- health policy aimed at covering 95% of health facilities with ICT solutions by 2020. This article paid particular attention to the innovations  emerging in the disease surveillance and response system (SIMR) in the face of the state’s inadequate integration of ICTs into the  healthcare system. More specifically, we will focus on innovations taking place in health and social promotion centers (CSPS). The study  was conducted in Dandé health district in the south-western part of BF. Based on qualitative methods, data were collected through semi- structured interviews with head nurses (ICP) (n=11), Expanded Program on Immunization (EPI) managers (n=10), CISSE members (n=2) and Community-Based Health Workers (CBHWs) (n=15), as well as through observations of ICTs uses. Content qualitative analysis was  performed by using concepts of tinkering and bricolage to discussing our results. With the advent of the wireless telephone, the  government has tried to build a digital infrastructure, equipping the CSPSs with MoovAfrica (ex-Telmob) telephone chips and a prepaid  “fleet” communication system of 5000 FCFA/ month for the collection and transfer of epidemiological data called The Telegram Official  Weekly Letter (TLOH). The results showed that the use of this “TLOH fleet” digital device encounters difficulties linked to the MoovAfrica  telephone network signal, which is not fluid, specifically in rural localities. Other difficulties lie in the fact that the standard model of telephone acquired by the CSPSs does not have the functionalities to enable How to cite this paper: them to adapt to the challenges of  call saturation on the CISSE fleet number. As the fleet is designed for telephone calls only, it is impossible, for example, for health workers  to send SMS messages or use the Internet or WhatsApp. To overcome such challenges, the majority of ICPs use their personal phones to send SMS or call CISSE’s personal number(s). As these personal numbers are not registered in the fleet system, ICPs are  obliged to bear the cost of calls and SMS messages. In the age of digital convergence, health workers’ strategies for adapting to the new  environment involve the use of smartphones and personal megadata. WhatsApp has thus become a palliative to the problem of queuing  and the telephone network. Since data is sent every Monday morning until 10 a.m., ICPs prefer to use their own megadata to transfer  TLOH via WhatsApp from Sunday evening onwards. Our results also show that, in addition to TLOHs, patient follow-up sheets and investigation sheets are now dematerialized via this WhatsApp application. Several WhatsApp groups (TLOH DS DANDE, INFO_CISSE DS  DANDE, for example) and the CISSE manager’s personal WhatsApp account are used as channels for sending data in the form of  manuscript photos, Excel or Word files. All in all, our results show the extent to which state efforts are negligible in the implementation of  the “e-health” policy, and thus call the attention of health authorities to the need to build a reliable public digital infrastructure that takes  into account the environmental challenges of rural localities.