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Abstract
PROBLEM: Vaccine-preventable disease (VPD) surveillance information systems are essential for monitoring disease trends, guiding immunization strategies, and responding to disease outbreaks. However, in the WHO African Region, surveillance systems remain fragmented, with significant variations in the use of digital systems, their readiness, system maturity, and data quality. Ongoing challenges related to infrastructure, interoperability, and sustainability continue to hinder progress toward fully integrated and responsive digital health systems.OBJECTIVES: This study aimed to assess the current landscape of VPD surveillance information systems across the 47 WHO African Region member states and evaluate system maturity and implementation challenges through in-depth case studies in two selected countries, Mali and Uganda.
METHODS: A two-phase, mixed-methods approach was used in this study. The first phase involved a landscape review of VPD surveillance systems across all 47 member states of the
WHO African Region, utilizing peer-reviewed and grey literature. The second phase featured in-depth case studies in Mali and Uganda. These included a structured maturity assessment adapted from the Digital Health Platform Maturity Assessment Tool (DHPMAT) and the Information Systems for Health Maturity Model (IS4H-MM), as well as key informant interviews (KIIs) and focus group discussions (FGDs). Data were analyzed thematically across seven domains: governance, infrastructure, workforce, system lifecycle, interoperability, data quality, and data use.
RESULTS: The landscape highlighted variation in the transition from paper-based to digital systems, with hybrid models seeming to be most common. DHIS2 was the prominent platform, though variations existed in its implementation. In the case studies, Uganda demonstrated higher maturity in information systems, particularly in terms of interoperability, data utilization, and strategic alignment. In Mali, there was strong governance but weaker infrastructure and capacity to support it. Despite some progress, both countries face challenges, including limited data exchange, inadequate capacity at the subnational level, and workforce shortages.
CONCLUSIONS: Addressing the challenges in interoperability, infrastructure, and sustainable financing is essential. These investments have to be targeted at capacity-building efforts and aligning standards to strengthen the use of digital VPD surveillance in low-resource settings.