Building from One Emergency to the Next

By Jim Thomas, PhD. Health information systems strengthening in response to Zika virus can build on the insights and priorities identified for Ebola.

Photo by Alan Dehmer /

By James Thomas, PhD, Project Director, MEASURE Evaluation, University of North Carolina at Chapel Hill

CHAPEL HILL, NC—Ebola has once again surfaced in Guinea. Meanwhile, the battle with Zika virus continues in Latin America. American responses to outbreaks tend to be disease-specific, driven in part by the latest images in the media. The US Administration recently requested $1.8 billion of emergency funds to respond to the Zika outbreak. This follows $5.3 billion of emergency funds allocated in 2014 to fight Ebola. Can these disease-specific responses be used in a way that lays a coherent public health foundation capable of responding to both of these, as well as future outbreaks?

Some of the funds are needed to understand the organisms and develop vaccines or cures. These, of course, will be disease-specific. However, the health information system (HIS) that collects data on the occurrence of individual cases and the allocation of prevention and treatment resources is the same for all infections. The HIS is a critical brick in foundation of public health. In developing countries, HIS are often poorly funded and in need of strengthening.

As the Ebola epidemic was waning in West Africa, ministry of health staff from throughout the region met with representatives from donor agencies to identify needed improvements to their HIS. The report on the three-day meeting in Accra, Ghana is available on the website of the meeting co-organizers, the USAID-funded MEASURE Evaluation project. The meeting participants reflected on previous epidemics in West Africa, including meningitis, measles, and cholera—in addition to Ebola. In each epidemic, there was a need to use data from two information systems that tend to operate independently of each other: the national health information system (addressing, for example, prenatal care) and the integrated disease surveillance and response system (IDSR; addressing, for example, contact tracing). Based on needs common to each epidemic, the participants identified nine recommendations, including establishment of multi-stakeholder coordinating bodies for the coordination and management of health information, advocacy for ministries of health to establish and implement clear national strategies to manage the integration of HIS, and the creation of a regional HIS center of excellence. Since the meeting, USAID has funded activities in West Africa to implement these recommendations.

Disease control for Zika virus will also entail making connections between clinic patients, such as mothers seeking prenatal care, and contacts between infected and susceptible people. Not all Latin America countries will need the system improvements that are essential in West Africa. But they will all need the same system functionalities, and some countries will have more capacity to improve than others. Of course, if the current Zika epidemic reaches Africa, where it was first discovered in 1947, the same health information system functions—including those allowing data exchange and facilitating data analysis and use—will be needed there. HIS strengthening in response to Zika virus can build on the insights and priorities identified for Ebola.

Our preparedness for any epidemic would be more assured and more sustained if resources were not allocated in waves and not dependent on the latest news cycle. But a lack of coherence does not mean we need to start from square one with each new outbreak. From the categorical efforts that have gone before, there are lessons learned, pieces of the systems in place, and priority next steps already identified. Let’s ensure that we build on the gains from the last wave, and make investments that will be useful in responding to other known and emerging public health threats. 

This article was published March 21, 2016 in Science Speaks and is reprinted with permission.

For more information on MEASURE Evaluation’s work on Ebola, see: