Assessment of the integrated disease surveillance and response system implementation in North Kivu, Democratic Republic of the Congo, following a major Ebola outbreak, 2021

Background: The Democratic Republic of the Congo (DRC) experienced its largest Ebola Virus Disease Outbreak in 2018-2020. As a result of the outbreak, significant funding and international support were provided to Eastern DRC to improve disease surveillance. The Integrated Disease Surveillance and Response (IDSR) strategy has been used in the DRC as a framework to strengthen public health surveillance, and full implementation could be critical as the DRC continues to face threats of various epidemic-prone diseases. In 2021, the DRC initiated an IDSR assessment in North Kivu province to assess the capabilities of the public health system to detect and respond to new public health threats. Methods: A descriptive cross-sectional survey was conducted using mixed quantitative and qualitative methods. Performance in IDSR core functions was assessed at multiple levels of the tiered health system through observations, key informant interviews, and analysis of health data. Qualitative data were also collected through focus groups and open-ended questions to guide the interpretation of the findings. Data were collected at the North Kivu provincial public health office, five health zones, 66 healthcare facilities, and from community health workers in 15 health areas. Results: Data completeness was 100% at the provincial and health zone levels, and timeliness was 100% and 97% at the provincial and health zone levels, respectively. Healthcare facility data had an average completeness of 86%, and timeliness varied between health zones from 41 to 100%. The use of electronic Integrated Disease Surveillance and Response is not widely implemented. Data analyses are conducted mainly at the provincial and health zone levels, and are regularly disseminated to all levels. Preparedness capabilities were low, with 44% of health zones in North Kivu having a preparedness and response plan and 41% having a functional rapid response team. Conclusion: Comparing the results of this assessment to the last IDSR assessment conducted in DRC in 2016, slight improvements in disease reporting have been made, despite several limitations in materials, equipment, infrastructure, and workforce training. This assessment highlights the need to move from outbreak-focused support and funding to building systems that can improve the long-term functionality of the routine disease surveillance system.