How Senegal’s malaria-tracking helped beat Ebola

Philippe Guinot, PATH’s country program leader for Senegal, shares how that country was able to limit Ebola to only one case, with help from lessons PATH learned while building malaria surveillance systems there.

The first (and only) Ebola case in Senegal was confirmed on a Friday. I was at my desk in PATH’s office in Dakar, the country’s capital, when I was informed that a young man had traveled to Senegal from neighboring Guinea, bringing the deadly hemorrhagic fever with him.

It was April 29, 2014, and the Ebola epidemic was just beginning to gain international attention. My staff and I were shocked that the disease had struck Senegal. By Saturday, many Senegalese were in a panic.

Yet contrary to Guinea’s experience, where thousands have died, the disease was stopped in its tracks in Senegal. No one else was infected. Not one person died.

Senegal was able to contain Ebola by quickly identifying and testing 74 close contacts of the patient and monitoring them for 21 days. The country also did an extraordinary job reassuring the public that things were under control.

While PATH is not an emergency aid or health care delivery organization, our depth of experience in project management and strengthening health systems and our long-term relationship with Senegal’s Ministry of Health allowed us to jump in quickly to help the country build an emergency operation center.

From my vantage point as PATH’s country leader in Senegal, there are clear lessons to be leveraged from the country’s success in keeping this deadly, infectious disease at bay.

At the core of any health system is reliable, timely information. Without access to rigorous data about disease cases on the ground, reaction time is slow, decision-making is hampered, and crucial resources aren’t able to get where they’re most needed. Accurate information is fundamental not only for preventing epidemics and eliminating disease, but for the delivery of basic health care services like vaccines.

Imagine, then, countries where information at local health centers is written by hand in paper ledgers and then sent to district headquarters only once a month. From there it goes to regional headquarters quarterly, only finally reaching the national Ministry of Health almost a year later. Not surprisingly, by the time a new disease pattern is discerned, it may already be out of control.

Ebola—like other infectious diseases—can be stopped by recognizing the disease quickly and tracing and isolating everyone who has had contact with it. That takes a strong health system with robust monitoring and surveillance capabilities.

We knew we would be shooting blind in Senegal without an electronic monitoring and surveillance system—a gap that was hampering efforts Guinea and the other hard-hit countries. So we worked with the government to create a monitoring system quickly, based on our experience building a system for the campaign to eliminate malaria.

In these systems, local health workers are given mobile phones and digital apps to send in information. Through their uploaded weekly reports, we’re able to map cases, plan and monitor investigations, and adjust course as necessary.

And the flow of information goes both ways. Local- and district-level workers can see the analytics generated from their data, empowering them to make decisions that are more timely and targeted. This also builds trust and responsiveness in the system at all levels.

Senegal’s new Ebola surveillance system ensures that signs of the disease are quickly reported and that these alerts can be mapped, and responded to rapidly and efficiently. The new electronic system can track a large number of contacts at once, something that is virtually impossible with a paper system.

PATH is also supporting the country’s network of 127 government laboratories, testing a solution that would enable them to use mobile phones to immediately file reports if they see signs of any of 11 target diseases.

There’s no shortage of innovation in digital health solutions. When developed with the end user in mind, they can offer a huge return on investment in terms of illness prevented and lives saved.

Reform at international institutions like the World Health Organization (WHO) will never be enough to head off epidemics if country health systems are weak. A key lesson we must learn from this past year is the importance of working side-by-side with governments to strengthen their local capacity to tackle both ongoing and emergency issues. Doing so builds their ownership so that the work carries on after groups like PATH and the WHO’s emergency response teams are gone.

Senegal’s Ebola outbreak may be over, but the country remains vulnerable to imported cases, and to other pathogens as well, so we must stay vigilant. I’m gratified that the tools we helped put in place are helping the Ministry of Health and that our ongoing involvement will continue to contribute to a more resilient health system.

Just as important, the new tools are strengthening the country’s health system as a whole. They can be easily adapted when the next outbreak occurs, as it will, likely of a much more common disease like malaria, meningitis, cholera—the diseases that kill children regularly even when the rest of the world isn’t paying attention.