Mobile Phone–based Syndromic Surveillance System, Papua New Guinea

Alexander Rosewell

, Berry Ropa, Heather Randall, Rosheila Dagina, Samuel Hurim, Sibauk Bieb, Siddhartha Datta, Sundar Ramamurthy, Glen Mola, Anthony B. Zwi, Pradeep Ray, and C. Raina MacIntyre

Author affiliations: World Health Organization, Port Moresby, Papua New Guinea (A. Rosewell, H. Randall, S. Datta); University of New South Wales, Sydney, New South Wales, Australia (A. Rosewell, A.B. Zwi, P. Ray, C.R. MacIntyre); National Department of Health, Port Moresby (B. Ropa, R. Dagina, S. Hurim, S. Bieb); Datanets, Port Moresby (S. Ramamurthy); University of Papua New Guinea, Port Moresby (G. Mola)

Abstract

The health care system in Papua New Guinea is fragile, and surveillance systems infrequently meet international standards. To strengthen outbreak identification, health authorities piloted a mobile phone–based syndromic surveillance system and used established frameworks to evaluate whether the system was meeting objectives. Stakeholder experience was investigated by using standardized questionnaires and focus groups. Nine sites reported data that included 7 outbreaks and 92 cases of acute watery diarrhea. The new system was more timely (2.4 vs. 84 days), complete (70% vs. 40%), and sensitive (95% vs. 26%) than existing systems. The system was simple, stable, useful, and acceptable; however, feedback and subnational involvement were weak. A simple syndromic surveillance system implemented in a fragile state enabled more timely, complete, and sensitive data reporting for disease risk assessment. Feedback and provincial involvement require improvement. Use of mobile phone technology might improve the timeliness and efficiency of public health surveillance.

Papua New Guinea has been described as a fragile state (1). Health care systems in such settings are characterized by limited infrastructure, lack of equity, management capacity issues, and inadequate disease information (1). In Papua New Guinea, insufficient investment by government, weak management and leadership capacity, and an inadequate number of health care personnel play a crucial role in the suboptimal performance of the health care system (2). Despite these limitations, the country is working toward reaching the minimum requirements of disease surveillance for the International Health Regulations (IHR 2005) (3).
Health indicators for Papua New Guinea illustrate some of the country’s challenges: 87% of the population lives in rural areas, the number of primary health care facilities has decreased by 40% over 20 years (2), and only 3% of roads are paved. The average life expectancy is 53 years, and the maternal mortality rate of 733/100,000 live births is likely underestimated. Communicable diseases remain the primary causes of illness and death in all age groups, and outbreaks are frequently reported. Lack of health system access and preparedness are particular problems in remote, rural settings (4,5), whereas migration to informal, periurban settlements and weak infrastructure have been identified as risk factors for disease outbreaks in urban areas (6). When compared with other countries in the region, Papua New Guinea often sees more severe effects from outbreaks of commonly occurring pathogens, particularly in remote settings (4,7–11). Special populations, such as internally displaced persons, may be particularly vulnerable to disease outbreaks.
The Papua New Guinea National Health Information System (NHIS) monitors trends for public health syndromes (12); in recent years, the Hospital Based Active Surveillance (HBAS) system has been the cornerstone of surveillance for suspected cases of measles, poliomyelitis, and neonatal tetanus (13). However, the surveillance system for diseases targeted for elimination or eradication is not achieving globally established performance targets (14), and systems for the timely monitoring of endemic diseases, such as diarrheal diseases, are also weak (15). Syndromic surveillance offers a useful adjunct to diagnosis-based disease surveillance in developing countries (16) and has recently been successfully implemented in the Pacific region (17). These systems can be used to detect outbreaks early, to follow the magnitude and geographic distribution of outbreaks, to monitor disease trends, and to provide reassurance that an outbreak has not occurred (1).