The year 2014 remains a stark reminder of the cost of silence in global health. When Ebola first surfaced in West Africa, the virus spread out in communities through a vacuum of information. In a remote village, that’s where the cases emerged but because our systems were designed to wait for a sick patient to walk into a clinic, the virus had months to spread further. By the time the world noticed, rumors had already replaced facts, and traditional healers, unaware of the threat, became “the vectors.”
We learned a hard lesson then, that even a rumor in a community can, and should prompt a quick intervention. Since that tragedy, Event-Based Surveillance (EBS) has become our approach. However, after years of working in the East, Central and Southern Africa region, I have come to realise that while the intent is there to avert these outbreaks early, many countries in our region still lack the foundational capacity for early detection, early reporting, and early response.
This is why I believe we need to firmly establish the 7-1-7 goal into the foundation of our public health systems in the countries across this region, which entails that whenever there is a potential outbreak, it must be detected within seven days of emergence. Once detected, it must be reported to health authorities within one day (24 hours). Finally, all essential early response activities must be initiated within seven days.
We have been working to achieve this through the AFE–Health Emergency Preparedness, Response and Resilience Project(HEPRRP) in collaboration with IGAD, with support from the World Bank, and what we want to achieve is to move beyond passive observation.
Currently, there is evidence that many outbreaks in our region go unreported for weeks because of our porous borders, a shortage of health workers, and an over-reliance on Indicator-Based Surveillance (IBS) which means waiting for a patient to show symptoms and seek help. But in the Eastern and Southern Africa ( AFE) region, we are ensuring that the “front line” isn’t a hospital ward. It should be the village somewhere in the continent, the local pharmacy, or even a primary school.
Let’s focus on going digital
With Event-Based Surveillance, we focus on “signals”, the unstructured information from the community. It means listening when a school teacher notices a sudden spike in absenteeism of pupils due to fever, or when a traditional healer mentions an unusual cluster of rashes. It means acting when a farmer reports unusual deaths among livestock.
In our project, we categorize these signals into four streams, the Community-Based: Reports from village chiefs and community health workers, the Facility-Based: Internal alerts within hospitals for unusual clinical patterns, Media Scanning: Monitoring radio, television, and internet reports and Hotlines: Toll-free numbers and WhatsApp groups where citizens can report concerns directly.
Once a signal is picked up, we trigger a “triage” and “verification” process. We don’t wait for a laboratory confirmation to start moving; we verify the incident and conduct an immediate risk assessment. We cannot achieve 7-1-7 with paper and pens. Manual reporting is the enemy of speed. In the AFE region, we are aggressively pushing for digitalization. By using AI-driven applications and mobile reporting tools, we have seen tangible results.
In Rwanda, for instance, digital EBS apps have screened over a million reports, allowing health officials to catch potential threats before they escalate. In Zambia and Kenya, we have seen similar success in containing outbreaks within their areas of origin.
Historically, countries have been hesitant to share data about outbreaks for fear of trade or travel repercussions. However, sharing “rumors” or “signals” is less sensitive than sharing confirmed case counts. If for instance Zambia reports unusual animal deaths near the border to the DRC, it allows both nations to conduct joint investigations. This collaborative spirit is essential when dealing with zoonotic diseases that do not respect national boundaries.
As we prepare for the inevitable “Next Public Health Emergency or Pandelic,” the regional focus is on building the capacity of our community health workers to recognize signals, and we must provide the digital infrastructure to send those signals up the chain instantly.
With the 7-1-7 goal, we can ensure that the next time a rumor starts in a village, it doesn’t end in a global catastrophe. We have the strategies, and the digital tools. Now, we must have the regional collective will to make them take root.
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