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Use of Digital Tools to Strengthen COVID-19 Management – Case Study Nigeria


Integrating data into one platform: a better analysis of the cascade of care

Nigeria’s experience containing the Ebola epidemic of 2014 highlighted the critical need for a comprehensive data management system to deal with health outbreaks.

Using digital tools data science can strengthen disease management, as the country’s Covid-19 case study (FIND Digital Health Report, April 2021) shows. 

This included integrating real-time surveillance and case management, aiming at more agile and efficient responses to future outbreaks.


Data in detail

Nigeria registered its first Covid-19 case on February 27, 2020. 

Working closely with state health teams and partners, the Nigeria Centre for Disease Control (NCDC) led the response. 

By March 29, 2021, more than 160 000 cases had been diagnosed from over 1.7-million tests.


Structure and data flow: SORMAS

The outbreak of Ebola resulted in the NCDC and partners developing Nigeria’s Surveillance, Outbreak Response Management and Analysis System (SORMAS).  

This system expanded to support managing other priority diseases, including Covid-19, in January 2020, and was rapidly scaled up across Nigeria over the pandemic. 

SORMAS is an end-to-end digital solution that captures geocoded data on all steps of the Test-Trace-Isolate cascade of Covid-19.  

Using this tool, Nigeria has been able to capture data at multiple levels to guide policy and programme interventions.


By 2021 Nigeria had several additional patient-facing tools, including: 

  • The NCDC ChatBot accessed via the NCDC’s website
  • The self-assessment web application developed by Wellvis with NCDC
  • The Interactive Voice Response solution available as a call-back service
  • The USSD self-assessment solution
  • The Disease Control Hotlines established in many states. 

Covid-19 screening, testing and management


The graphic below shows how the NCDC ChatBot and Wellvis channels feed data to the dashboard, and to SORMAS, in the areas of screening, testing and management.

Why it works

  • Different dashboards are tailored to users at various levels of the health system
  • Data is transmitted to the NCDC website to provide to the public
  • Built-in algorithms generate early warnings for outbreaks, and SORMAS also generates data for surveillance and epidemiological analysis.


BENEFITS: Nigeria’s digital tools

  • Improvement in data quality 
  • Better decision-making: SORMAS ensures all key demographic, epidemiological and clinical variables are recorded
  • Trigger warnings: users are notified of missing or incorrect key variables, preventing the next step until these are resolved
  • Central platform: routine recording of all metrics (test-trace-isolate phases) helps avoid additional data collection
  • Complete visibility: real-time supervision for health workers, motivating improved performance and guideline compliance. 

Practical steps to develop scale

SORMAS was developed through a multi-institutional collaboration led by NCDC, the HZI, the African Field Epidemiology Network and German IT institutions. It transitioned from proprietary to open-source software in 2016 and its source code is accessible to software developers through the GitHub website. 

In rolling out SORMAS, a training-of-trainers approach was used and, as new disease modules are added, this same approach is used. 

Key success factors in Nigeria

  • Strong national ownership of SORMAS from the start. 
  • As the NCDC actively promotes it as the preferred digital solution for Covid-19 management, there is less risk of multiple overlapping digital tools. 
  • Integration into the broader health system, as it pre-dates the pandemic and was already in use.  
  • “Design thinking” approach. SORMAS was responsive to the context in which the app was deployed, building on practical insights from the Ebola response. 
  • Can be used offline. Data stored on the platform is automatically uploaded with connectivity. 
  • Flexibility. A module-based approach means new ones can be rapidly added.

Operational challenges 

One challenge is that mobile devices with old operating systems are unable to optimally support the SORMAS software. 

Too few staff at implementation level can lead to delays in data being entered into SORMAS, negating the benefit of a real-time data capture system. However, the public should be able to input more data in the future, reducing the time taken by health care workers.

Key takeaways for other countries

SORMAS has led to improved data management and containment of the epidemic in Nigeria. 

Ensuring automated data transmission between digital tools, and consolidating this using unique patient IDs, helps with comprehensive management of the pandemic. 

Agility in digital tool development is vital, with continual changes to SORMAS to improve it.

Nigeria’s experience shows that integrating data into one platform enables better analysis of the cascade of care. 

It also facilitates communication and referral between multiple players at different levels of the health system. 

FIND_Digital-Health-Report_NIGERIADownload
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Information Note for CSOs on COVID-19 Testing 

Health Poverty Action Visiting Hospitals at Kompong Chhnang & Battambong Province

As vaccines are rolled out globally, testing remains a critical way to manage and monitor COVID-19 outbreaks. Without testing, we cannot track or contain the spread of the virus, address urgent clinical needs, refer patients for treatment, test the efficacy of vaccination, and detect the emergence of new variants. 

A combination of different types of tests are needed to facilitate patient management and public health planning for effective control of COVID-19. The Global Fund encourages countries to include all appropriate types of tests when developing their COVID-19 Response Mechanism (C19 RM) funding proposals. 

This information note provides a breakdown of the different types of COVID-19 tests available at the time. 

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FIND and partners from the Access to COVID-19 Tools (ACT) Accelerator Diagnostics Pillar call on the G20 and G7 to prioritize diagnostics in its pandemic preparedness and response plans

Street scene outside the Lok Nayak Jai Prakash Narayan Hospital, Delhi.December 2017Photo credit: FIND / Ben Phillips

The COVID-19 pandemic has shown that access to timely, accurate diagnostics is fundamental to effective healthcare. The Access to COVID-19 Tools (ACT) Accelerator is a unique but time-limited partnership that was set up to respond to the acute phase of the COVID-19 pandemic.

As world leaders including the G7 and G20 are aligning efforts for future pandemic preparedness and creating a G7 Pact for Pandemic Readiness, FIND and ACT-Accelerator Diagnostics Pillar partners call on both G7 and G20 to reaffirm commitments relating to diagnostics as part of the 100 Days Mission put forward during the UK G7 Presidency in 2021.

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Call to G20 leaders to uphold diagnostics and equitable access to testing

A CALL TO ACTION ahead of the upcoming G20 health meetings, for world leaders to uphold diagnostics and equitable access to testing within their commitments to support sustainable recovery from COVID-19.

Ahead of the Global Health Summit on 21 May 2021 and the 74th World Health Assembly, the global health and development community, following the FIND high-level forum, Testing is the first line of defence against COVID-19 and the foundation for preparedness to prevent future pandemics, call upon the World Health Organization, the European Union, the African Union, and the Heads of State from the G20 and G7 Presidencies to take vital action to uphold diagnostics and equitable access to testing.

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ACT-Accelerator Diagnostics Pillar Explainer Tool

What is the ACT Accelerator?

The Access to COVID-19 Tools (ACT) Accelerator was created after the outbreak of the SARS-COV-2 pandemic in 2020. 

It is a global collaboration that uses existing public health infrastructure and expertise to accelerate the development and production of Covid-19 tests, treatments, and vaccines. It also focuses on providing equitable access to diagnostics and treatment.

The ACT Accelerator was launched in April 2020. 

It has played a significant role in supporting the fasted and best coordinated global effort in history to fight a disease.

Its current focus is on scaling up access to Covid-19 tools worldwide.

Who are the convenors?

The ACT-Accelerator is co-convened by leading global health organizations.

It consists of three pillars and two or three partner agencies managing these.

What are the three pillars?

The three pillars of the ACT-Accelerator are the vaccines pillar, the diagnostics pillar, and the therapeutics pillar.

What does each pillar do?

The Vaccines Pillar has set a goal to rapidly rollout at least 2 billion vaccine doses in 2021 to high risk groups. It also has a goal to expand research and development. 

Its third task is to identify new and emerging risks from variants of the SARS-COV2 virus.

The Diagnostics Pillar aims to identify new diagnostics and devliver 900 million high-quality tests by the end of 2021 to low- and low-middle income countries.

The Therapeutics Pillar promote research for effective treatments and ensure that countries optimize clinical care including the use of corticosteroids and medical oxygen for severe and critical patients. It also seeks to introduce new therapies and distribute up to 100 million treatment courses for populations in low and middle-income countries.

What does the Health Systems Connector do?

The Health Systems Connector (HSC) works across the three product pillars to identify and address bottlenecks in health systems worldwide and to enable the rollout of Covid-19 tools. The HSC also focuses on the rollout of personal protective equipment to health workers. 

 What is the role of the Access & Allocation workstream?

This workstream focuses on ensuring global equity and the allocation of Covid-19 resources. It also ensures that civil society and community engagement are integrated across all the pillars.

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Project STELLAR: Supporting the COVID-19 Response

Project Stellar to help countries expand diagnostic testing for Covid-19

In Sub-Saharan Africa, COVID-19 testing rates are still low in most

Countries. One of the reasons for this is inadequate investment in laboratory capacity. There is a similar trend in testing rates for HIV, TB, and malaria.

In addition, despite the availability of rapid antigen tests, many countries have not effectively decentralized testing to a community level. 

New investment 

Since February 2022, C19RM 2021, the response arm of the Global Fund, has been investing US$800 million across 100 countries to procure COVID-19 diagnostics and commodities.

Project Stellar was created in February 2022 within the Global Fund to support countries in reaching Covid-19 testing goals and strengthen laboratory systems over the longer term. 

Goals

It aims to offer assistance with planning, mobilizing resources, and creating a targeted advocacy program to encourage testing. Countries will also receive help in developing a diagnostics strategy and algorithm.

Other goals for the project that will run up to December 2023 are to scale up testing, including training and community outreach, and the management of data and surveillance systems.

The project will also aim to improve regulatory approvals of rapid antigen tests and coverage for COVID-19 testing.

Another goal is to advocate for wastewater-based surveillance and epidemiological monitoring at a country level. Wastewater surveillance often provides an early warning system of cases rising. 

Project Stellar will also help countries to strengthen data management and surveillance systems. 

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Low testing rates and constrained access to vaccines – a deadly combination?

Health Poverty Action Visiting Hospitals at Kompong Chhnang & Battambong Province

“Diagnostics constitutes the most significant funding gap within the ACT Accelerator”

Low testing rates and constrained access to vaccines – a deadly combination?


In this opinion piece Peter Sands, Director of the Global Fund to Fight AIDS, tuberculosis, and malaria, and Emma Hannay, Find’s Chief Access Officer, argue for a global refocus on testing to fight the COVID-19 pandemic.

They highlight the stark inequalities in COVID-19 testing between high-, middle- and low-income countries, saying that this can create conditions for a more severe and contagious mutation of SARS-COV-2 to emerge unnoticed.

The authors add that diagnostics constitutes the most significant funding gap within the ACT Accelerator.


The statistics:

  • Germany offers a free test a week
  • England offers two free tests a week
  • Lower-income countries can only test 7 people for every 100 000
  • For every test done in lower-income countries, high-income countries test 86 people
  • According to a survey of 24 African countries, only 11% could offer rapid COVID-19 tests, and only 8% could provide PCR tests
  • Globally, there is an $8.7-billion shortfall in testing and lab capacity. Box ends

“The low availability of testing, coupled with constrained access to vaccines, create a perfect environment for new, more contagious, and perhaps more deadly strains of the COVID-19 virus to emerge without initial notice, putting even vaccinated populations at risk” – Peter Sands and Emma Hannay.

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One year into the Covid-19 pandemic, testing is as vital as ever

Why do we not use antibody tests to diagnose COVID-19 infections?

Checking for antibodies is not the most accurate indicator of the presence of a SARS-COV-2 infection.

What are antibody tests?

This article explains the role antibody tests are playing in fighting the pandemic. 

Antibodies neutralize foreign cells the body sees as a threat. Most COVID-19 vaccines trigger the body to produce antibodies against the spike protein in the SARS-COV-2 virus. 

The spike protein is a molecule found on the surface of the virus, and it helps the virus to enter the host cells and spread from there. 

Why can’t we use antibody testing to measure vaccine efficacy?

COVID-19 serology tests were designed early in the pandemic to detect only a few antibodies generated by natural infection, not vaccine-induced immunity.

They detect antibodies produced to fight the protein capsule around the virus and not the spike protein, while most COVID-19 vaccines introduce the body to small amounts of the genetic material in the spike protein to elicit an immune reaction.

Can antibody testing determine if a vaccine worked?

Not precisely. It takes around two weeks for the body to generate antibodies after COVID-19 vaccination, so even tests to detect the “right” antibody could be negative in the first few weeks after vaccination. 

Can antibody tests be wrong?

The United States Food and Drug Administration (FDA) has recommended that antibody testing not be used to evaluate either immunity levels or protection levels from SARS-COV-2.

Why still do antibody tests?

Data from antibody tests are helpful for surveillance studies. In these studies, large numbers of people in a community are tested. These studies estimate how many people were infected in the past and how fast the virus spreads. 

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Investing in the COVID-19 Response through the ACT-Accelerator: Long-Term Benefits

This brief report covers the work of ACT-Accelerator agencies in not only addressing the immediate COVID-19 pandemic, but also providing long-lasting outcomes. 

Alongside increasing access to the tools needed to end the pandemic, the partnership is helping countries to build laboratory capacity and enhance the cold chain, create and maintain oxygen systems, train healthcare workers, and pilot the roll-out of test and treat protocols in communities.

This document outlines key investments in the global COVID-19 response through the ACT Accelerator that will have long-term benefits such as:

  • Strengthening the health workforce
  • Building surveillance systems
  • Boosting local manufacturing and technology transfer
  • Empowering healthcare workers to rapidly and accurately diagnose and treat patients not only for COVID-19, but also for other diseases.

Read the full document here


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COVID-19: Make it the Last Pandemic

This page contains the documents published in May 2021 when the Panel’s main report, entitled COVID-19: Make it the Last Pandemic, was released. These include the main report, a summary, an evidence-based narrative report, background documents, a report reflecting voices heard in townhall meetings, and multimedia materials including videos. Also included on this page is a sample of global public reaction following the report’s release.

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