Strengthening Data-Driven Public Health Systems: Lessons from a Year of Integrated Surveillance Reviews

Introduction

As part of the DIDIDA digital diagnostics project in Kisumu County, Kenya, quarterly data review workshops are organized that bring together the Kisumu Department of Health, DIDIDA implementers, technical experts, and researchers to assess progress in disease surveillance, diagnostics, and health system performance. These recurring sessions created a structured environment for analysing data, comparing systems, quality improvement and aligning operational priorities.

Rather than functioning as isolated reporting exercises, the workshops have evolved into a continuous learning mechanism. Each session builds on the previous one(s), enabling stakeholders to identify persistent challenges, test interventions, and track measurable improvements over time. The result is a progressively more coherent and responsive approach to public health decision-making in the area of epidemic diseases.

Moving from Fragmented Reporting to Integrated Data Systems

At the beginning of the review cycle, one of the most pressing issues was the lack of IDSR data collection from private healthcare facilities and their alignment with public systems. The DIDIDA network of facilities was carefully chosen to cover the top 25 public and private facilities (out of a total of over 250) that serve almost 40% of the Kisumu population. The goal was to prepare this network for digital diagnostics and next generation diagnostics developed under DIDIDA. Thus, a partly parallel system was developed for this temporary function.

While analyzing the DIDIDA results, in comparison of the DoH IDSR results, discrepancies could be rapidly identified, often driven by inconsistent (paper) documentation practices, varying case definitions, operational constraints such as staff turnover and lengthy data verification processes. However, these discrepancies helped to identify flaws in epidemic data collection in both systems and provided detailed information for targeted improvement efforts. Over time, these efforts to harmonise IDSR systems began to show results. Facilities that adopted more direct data entry practices and assigned dedicated personnel demonstrated significantly improved completeness and consistency. Moreover, the DIDIDA digital tools proved particularly valuable during temporary public sector system disruptions as a result of USAID funding withdrawal, ensuring continuity of surveillance activities when primary reporting systems were unavailable.

This transition marked a critical shift: data systems were no longer viewed as competing sources, but as complementary components of a more complete epidemic surveillance ecosystem in which DIDIDA data (on a duly representative sample) helped improve general quality and completeness of County’s IDSR performance.

Translating Data into Targeted Action

A key strength of the review process was its ability to transform the improved data into actionable insights, supported by markedly increased timeliness due to digitalization. Rapid analyses for example identified elevated malaria positivity rates within children and adolescents. This helped Kisumu DoH to perform targeted interventions at pertinent primary and secondary schools, in terms of information sharing, bed net distribution and expanded access to malaria testing and treatment.

Subsequent data reviews revealed measurable improvements. Malaria positivity rates amongst children and adolescents declined, suggesting that these interventions were both timely and (at least partly) effective. Such outcomes underscored the value of iterative monitoring combined with rapid, data-driven responses.

The Growing Role of Digital Tools and Predictive Analytics

Digital innovation played an increasingly central role throughout time. Beyond basic reporting, data systems evolved to include real-time dashboards, outbreak monitoring tools, and predictive models built on historical datasets. These tools will enable stakeholders to start anticipating potential outbreaks rather than reacting to them. Early warning signals allow for more proactive allocation of resources and targeted interventions.

As stated, the resilience of digital platforms became evident during periods of public sector system downtime. When traditional reporting mechanisms were disrupted, alternative digital tools maintained visibility of critical surveillance data, reinforcing the importance of some overlap in health information systems.

Expanding the Scope of Surveillance

As the system matured, the scope of surveillance broadened significantly. Additional conditions (n=14) were incorporated into the standard IDSR monitoring framework (n=27), reflecting both emerging risks and previously underreported health concerns. This expansion enhanced the system’s ability to capture a more comprehensive picture of public health dynamics.

At the same time, new surveillance methodologies were introduced. Climate monitoring data (rainfall, humidity, temperature, etc.) are being obtained from multiple data sources and relations with geo- and time-tagged malaria (and other climate-dependent diseases) data are studied. This multi-layered approach marks an important ongoing evolution toward more robust and sensitive surveillance systems.

Addressing Diagnostic Gaps through Innovation

Parallel to improvements in data systems, the workshops consistently highlighted limitations in diagnostic capacity, particularly at the primary care level. The far majority of epidemic diseases are diagnosed based on clinical assumptions, not on confirmatory diagnostic tests. Most facilities relie on a relatively narrow set of tests (mostly RDTs for malaria, HIV, syphilis), with (slightly) more complex diagnostics requiring referral to higher-level laboratories. This creates delays, increases costs, and reduces the effectiveness of early detection efforts.

This very situation is one of the key drivers behind DIDIDA’s mission to develop next generation, DNA-based (multi-)plex RDTs. These efforts are ongoing and some will be tested in the digital network of healthcare facilities in the Kisumu County ‘laboratory’. These efforts aim not only to improve accessibility but also to reduce reliance on external supply chains of RDTs, which has proven to be vulnerable to disruptions. At the same time, attention is given to strengthening quality assurance processes, following the identification of performance issues linked to storage conditions and handling practices.

Together, these innovations represent a shift toward more self-reliant and context-appropriate diagnostic systems.

Strengthening Health System Resilience

The current DIDIDA review period also included the management of a significant cholera outbreak, which served as a real-world test of the system’s resilience. DIDIDA dashboards contributed importantly to the DoH coordinated actions across multiple levels, including the activation of emergency structures, deployment of rapid response teams, and expansion of treatment and laboratory capacity.

Thus, digital surveillance tools played a critical role in this outbreak context, enabling real-time tracking of cases and supporting targeted interventions. Community engagement efforts further complement such measures, helping to contain spread and mitigate impact.

This experience demonstrated that resilience is not solely a function of infrastructure, but also of coordination, adaptability, and the effective use of data.

Linking Quality of Care and System Performance

Beyond surveillance and response, the workshops also explored the relationship between quality of care and broader system performance. Initiatives aimed at improving facility standards showed measurable gains across multiple domains, suggesting that investments in quality can have a direct impact on health outcomes.

At a systemic level, evolving financing and policy frameworks were identified as key enablers of sustainability. These changes are expected to support continued access to essential diagnostics and services, particularly in the context of shifting funding landscapes.

The collaboration between Kisumu DoH and DIDIDA as exemplified by these workshops resulted in unique reports, that uniquely are shared (anonymized) on DIDIDA’s website for external learning and information sharing.

Persistent Challenges and Need for Continuous Improvement

Despite significant progress, several challenges persisted throughout the year. Data completeness remained sensitive to staffing changes, variable connectivity to the internet, while continued usage of paper-based tools continued to limit efficiency and continuity. Diagnostic capacity at lower levels of care also required further strengthening, and ongoing training and mentorship were essential to maintain gains in data quality and system performance.

These challenges highlight that transformation is an ongoing process. Sustained effort and investment will be required to consolidate progress and scale successful interventions.

Conclusion

The experience of these quarterly reviews demonstrates the transformative potential of integrated, data-driven digital approaches to public health. By combining improved data quality, digital innovation, expanded diagnostics, and coordinated response mechanisms, the system has evolved toward greater resilience and effectiveness. Digitalization allowed for significant local contributions to the co-development of new tools and platforms for epidemic preparedness and monitoring. Perhaps most importantly, the process itself—continuous review, adaptation, and learning—has become a cornerstone of progress. As health systems face increasingly complex challenges, this iterative, evidence-based approach will be essential for maintaining and advancing public health outcomes.