End-to-End Disease Surveillance in Developing Nations

Developing nations are limited in their ability to closely monitor their populations for outbreaks, due to resource constraints and underdeveloped public health and communications infrastructures. We sought to address this challenge by building a suite of open-source disease surveillance tools, with support from the U.S. Department of Defense Global Emerging Infections Surveillance and Response System, and in partnership with the Naval Medical Research Center Detachment in Lima, Peru.

These tools may be used by themselves or in concert. When used in concert, they provide health authorities with an end-to-end disease surveillance capability that automates the collection of disease reports from remote locations, visualizes collected data, and analyzes data for unusual disease activity. Since the costs to field and maintain a disease surveillance capability have traditionally been prohibitively expensive, these tools have been developed with the intent to minimize deployment costs, and impose no recurring software licensing costs.

We decided to exploit the worldwide proliferation of cellular phones as a means to instantaneously collect health data from rural areas that lack most other forms of technology. Rural health workers enter data over the phone with an automated system, which is based upon interactive voice response (IVR) technology. Health authorities can then visualize, analyze, and query against the collected data using a secure open-source Web application called “OpenESSENCE.” OpenESSENCE is written from the ground-up to support user interfaces in more than one language. To build OpenESSENCE, we tapped years of experience with the ESSENCE disease surveillance system, which is deployed in jurisdictions across the United States.

As part of our talk, we will briefly demonstrate the IVR data collection capability, and present OpenESSSENCE's features and capabilities. In closing, we will discuss the successes, lessons learned, and future directions from the initial deployment of this suite of disease surveillance tools in Peru.