Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
School of Public Health, University of Liberia, Monrovia, Liberia.
BMC Public Health. 2023 Oct 25;23(1):2093. doi: 10.1186/s12889-023-17006-7.
In the immediate aftermath of a 14-year civil conflict that disrupted the health system, Liberia adopted the internationally recommended integrated disease surveillance and response (IDSR) strategy in 2004. Despite this, Liberia was among the three West African countries ravaged by the worst Ebola epidemic in history from 2014 to 2016. This paper describes successes, failures, strengths, and weaknesses in the development, adoption, and implementation of IDSR following the civil war and up until the outbreak of Ebola, from 2004 to early 2014.
We reviewed 112 official Government documents and peer-reviewed articles and conducted 29 in-depth interviews with key informants from December 2021 to March 2022 to gain perspectives on IDSR in the post-conflict and pre-Ebola era in Liberia. We assessed the core and supportive functions of IDSR, such as notification of priority diseases, confirmation, reporting, analysis, investigation, response, feedback, monitoring, staff training, supervision, communication, and financial resources. Data were triangulated and presented via emerging themes and in-depth accounts to describe the context of IDSR introduction and implementation, and the barriers surrounding it.
Despite the adoption of the IDSR framework, Liberia failed to secure the resources-human, logistical, and financial-to support effective implementation over the 10-year period. Documents and interview reports demonstrate numerous challenges prior to Ebola: the surveillance system lacked key components of IDSR including laboratory testing capacity, disease reporting, risk communication, community engagement, and staff supervision systems. Insufficient financial support and an abundance of vertical programs further impeded progress. In-depth accounts by donors and key governmental informants demonstrate that although the system had a role in detecting Ebola in Liberia, it could not respond effectively to control the disease.
Our findings suggest that post-war, Liberia's health system intended to prioritize epidemic preparedness and response with the adoption of IDSR. However, insufficient investment and systems development meant IDSR was not well implemented, leaving the country vulnerable to the devastating impact of the Ebola epidemic.
在经历了长达 14 年的内战，导致卫生系统崩溃之后，利比里亚于 2004 年采用了国际推荐的综合疾病监测和应对（IDSR）策略。尽管如此，利比里亚仍是 2014 年至 2016 年历史上最严重的埃博拉疫情肆虐的三个西非国家之一。本文描述了在 2004 年内战后至 2014 年埃博拉疫情爆发之前，利比里亚在发展、采用和实施 IDSR 方面的成功、失败、优势和劣势。
我们查阅了 112 份政府官方文件和同行评议文章，并于 2021 年 12 月至 2022 年 3 月对来自利比里亚的 29 名关键信息提供者进行了深入访谈，以了解冲突后和埃博拉前时期利比里亚的 IDSR 情况。我们评估了 IDSR 的核心和支持功能，如优先疾病的通报、确认、报告、分析、调查、应对、反馈、监测、人员培训、监督、沟通和财务资源。通过新兴主题和深入描述来呈现数据的三角关系，以描述 IDSR 引入和实施的背景以及围绕它的障碍。
尽管采用了 IDSR 框架，但在 10 年期间，利比里亚未能确保支持有效实施所需的资源——人力、后勤和财政资源。文件和访谈报告表明，在埃博拉之前存在许多挑战：监测系统缺乏 IDSR 的关键组成部分，包括实验室检测能力、疾病报告、风险沟通、社区参与和工作人员监督系统。资金支持不足和大量垂直项目进一步阻碍了进展。捐助者和关键政府信息提供者的深入描述表明，尽管该系统在利比里亚发现埃博拉方面发挥了作用，但它无法有效应对以控制该疾病。
我们的研究结果表明，战后，利比里亚的卫生系统打算通过采用 IDSR 来优先考虑疫情的预防和应对。然而，投资和系统开发不足意味着 IDSR 没有得到很好的实施，使该国容易受到埃博拉疫情的破坏性影响。
