Centre for International Health, University of Otago, Dunedin, New Zealand
Planning Research and Development, Republic of Liberia Ministry of Health, Monrovia, Liberia.
BMJ Glob Health. 2023 Aug;8(8). doi: 10.1136/bmjgh-2023-012369.
Liberia was heavily affected by the 2014-2016 Ebola virus disease (EVD) outbreak. With substantial investments in interventions to combat future outbreaks, it is hoped that Liberia is well prepared for a new incursion. We assessed the performance of the current EVD surveillance system in Liberia, focusing on its ability to promptly detect a new EVD outbreak.
We integrated WHO and US Centers for Disease Control and Prevention guidelines for public health surveillance system evaluation and used standardised indicators to measure system performance. We conducted 23 key informant interviews, 150 health facility assessment surveys and a standardised patient (SP) study (19 visits) from January 2020 to January 2021. Data were summarised and a gap analysis conducted.
We found basic competencies of case detection and reporting necessary for a functional surveillance system were in place. At the higher (national, county and district) levels, we found performance gaps in 2 of 6 indicators relating to surveillance system structure, 3 of 14 indicators related to core functions, 1 of 5 quality indicators and 2 of 8 indicators related to support functions. The health facility assessment found performance gaps in 9 of 10 indicators related to core functions, 5 of 6 indicators related to support functions and 3 of 7 indicators related to quality. The SP simulations revealed large gaps between expected and actual practice in managing a patient warranting investigation for EVD. Major challenges affecting the system's operations across all levels included limited access to resources to support surveillance activities, persistent stock out of sample collection materials and attrition of trained staff.
The EVD surveillance system in Liberia may fail to promptly detect a new EVD outbreak. Specific improvements are required, and regular evaluations recommended. SP studies could be crucial in evaluating surveillance systems for rarely occurring diseases that are important to detect early.
利比里亚在 2014-2016 年埃博拉病毒病（EVD）疫情中受到严重影响。由于对防控未来疫情的投入大量增加，人们希望利比里亚已为新的疫情做好充分准备。我们评估了利比里亚目前的埃博拉病毒病监测系统的性能，重点关注其及时发现新的埃博拉病毒病疫情的能力。
我们整合了世界卫生组织和美国疾病控制与预防中心的公共卫生监测系统评估指南，并使用标准化指标来衡量系统性能。我们于 2020 年 1 月至 2021 年 1 月进行了 23 次关键知情人访谈、150 次卫生机构评估调查和一项标准患者（SP）研究（19 次就诊）。对数据进行了总结和差距分析。
我们发现，用于功能监测系统的基本病例发现和报告能力已经到位。在较高（国家、县和区）层面，我们发现与监测系统结构相关的 6 项指标中有 2 项、与核心功能相关的 14 项指标中有 3 项、与质量相关的 5 项指标中有 1 项以及与支持功能相关的 8 项指标中有 2 项存在绩效差距。卫生机构评估发现，与核心功能相关的 10 项指标中有 9 项、与支持功能相关的 6 项指标中有 5 项以及与质量相关的 7 项指标中有 3 项存在绩效差距。SP 模拟结果显示，在管理需要调查埃博拉病毒病的患者方面，预期和实际做法之间存在较大差距。影响各级系统运作的主要挑战包括支持监测活动的资源有限、样本采集材料持续缺货以及经过培训的工作人员流失。
利比里亚的埃博拉病毒病监测系统可能无法及时发现新的埃博拉病毒病疫情。需要进行具体改进，并建议定期进行评估。SP 研究可能对于评估罕见发生但对于早期发现很重要的疾病的监测系统至关重要。
