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ACT-Accelerator Transition Report

The Transition Report includes a summary of achievements against each transition objective, related monitoring and coordination activities (e.g., supported by the ACT-A Tracking and Monitoring Task Force), and a Pillar-by-Pillar update on implementation progress. It reflects inputs from across the ACT-A partners as well as from recent reports and meetings, including the 3rd meeting convened by the ACT-A Council Tracking and Monitoring Task Force on 31 March 2023. 

Reflections on the way forward are provided in the final section of the report, with quarterly information (for Q4 2022 and Q1 2023) included as annexes. It also provides insights into how ACT-A partners have mainstreamed their COVID-19 work and will carry forward ongoing activities as part of their regular programmes and support.

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Third Access to COVID-19 Tools (ACT) Accelerator Tracking & Monitoring Taskforce Outcome Statement Report – 31 March 2023

This report is an outcome of the third meeting of the ACT-Accelerator Tracking and Monitoring Taskforce, held on 31st March 2023. This taskforce – co-chaired by India and the United States – continues key elements of the work of the Facilitation Council and its working groups. The report includes an outcome statement by the Co-Chairs and provides a briefing on the current status of the rollout of COVID-19 tools, including the institutional arrangements being put in place by ACT-A agencies to ensure ongoing access to COVID-19 tools.  More information on the taskforce can be found here.

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Update on the rollout of COVID-19 tools: a report from the ACT-A Tracking & Monitoring Task Force – 15 February 2023

This report is an outcome of the second meeting of the ACT-Accelerator Tracking and Monitoring Taskforce, held on 15th February 2023. This taskforce – co-chaired by India and the United States – continues key elements of the work of the Facilitation Council and its working groups. The report includes an outcome statement by the Co-Chairs and provides a briefing on the current status of the rollout of COVID-19 tools, including the institutional arrangements being put in place by ACT-A agencies to ensure ongoing access to COVID-19 tools.  More information on the taskforce can be found here.

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Using digital tools data science to strengthen COVID-19 management – case study Rwanda

Rwanda has raised the bar in using digital tools to scale up community-based testing in its COVID-19 response. 

A national Joint COVID Task Force, established in February 2020 before the first case was confirmed, led the pandemic response of this African country. The team gave both high-level strategic guidance and day-to-day operational support. 

This had, however, been preceded by years of investment in the broader digital health infrastructure, where digital technologies were expanded to support service delivery – a longstanding government priority.

Institutions in Rwanda were therefore able to combine resources and capacities to respond to emerging problems.  Adopting a multi-sectoral approach from the start has allowed rapid deployment of interventions and more efficient troubleshooting.

It also helped the country to build COVID-specific digital systems to strengthen the areas of testing, contact tracing, patient support and surveillance. 

Rwanda’s numbers

First registered COVID-19 case: 14 March 2020
14 March 2021: more than 20 000 cases diagnosed, with mortality rate of 1.4%

Sharpest peak in cases: late 2020 and early 2021. This prompted stringent restrictions on movement that led to a rapid decline in new cases.


Testing the toolbox

Rwanda has used District Health Information Software (DHIS-2) to survey and monitor disease since 2011 and, in early 2020, this system was adapted to capture data on COVID-19 diagnosis and case management. 

DHIS-2 is integrated with the laboratory information system which allows for automated transmission of data. 

COVID-19 Command Posts, the sub-national operational centres of the Joint COVID Task Force, receive and analyse surveillance data from these different systems to inform policy and programme decisions. 

Rwanda also devised a stringent port of entry system to avoid importing COVID-19 cases. 

Other technologies were deployed in selected settings, including the internal Visitor Tracking Record and the e-ASCOV pilot, a locally developed application to help give access to rapid antigen testing.

Patient-facing tools

  • WhatsApp help line 
  • Unstructured supplementary service data (USSD) platform, which provides basic information on COVID-19 on any phone with no data or airtime requirements
  • WelTel app, where patients can report symptoms
  • Standard electronic medical record (EMR) system 
  • Online results portal
  • Open Data Kit (ODK) application which captures data for targeted surveillance activities outside of health facilities, particularly in hotspots. 

Impact of digital tools 

The use of digital tools in Rwanda has had a significant impact.  For example, through integrating laboratory and health management information systems, the testing process is now paperless. All facilities capture data in the same central system. 

Patient unique health codes (UHCs) also allow data transfer between different digital solutions. This cuts down the time taken by health care workers to record and report data, as it is captured in real-time at the point of care. 

Application programming interfaces have also been developed for a number of tools to enable interoperability. 

Mobile-data collection tools for community-based surveillance have generated valuable insights to inform timely responses to outbreaks. 

Monitoring cases and contacts remotely using digital tools has reduced the burden on the health system. This has allowed the country to focus limited capacity on delivering services to the most at-risk individuals, while consistently monitoring other patients.

Key success factors in Rwanda

  • Pre-existing digital infrastructure  
  • Political will, with digital infrastructure bolstered by political commitment at the highest levels of government
  • National ownership of systems, minimising the challenge of isolated pilots, duplicate interventions and “data fog”
  • Building on existing tools
  • Multisectoral collaboration
  • Providing patients with direct access to results. 

Challenges

The lack of readiness of health care workers to adopt new digital tools can be a barrier to successful implementation. 

This is worsened in a crisis such as COVID-19, where systems are already overwhelmed with new protocols and interventions. 

Resource requirements are also unpredictable due to the rapidly evolving nature of the pandemic. 

It is important to coordinate decisions on selection of digital tools from among numerous vendors.

KEY INSIGHTS

  • Ensuring integration of national COVID-19 data (public and private sector) into one platform enhances understanding of the pandemic and simplifies data management. 
  • Leveraging databases in other areas can minimise the time and effort required for individual data capture. 
  • Digital tools, particularly on mobile devices, are key in providing decentralised testing services. 

While Rwanda is still in the early stages of rolling out its approach, it shows potential to expand and standardise testing outside of health facilities. 

FIND_Digital-Health-Report_RWANDADownload
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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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Using digital tools data science to strengthen COVID-19 management – India Case Study

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

India’s digital ecosystem for COVID-19 management has centred around Aarogya Setu – Sanskrit for “Bridge to Health” – a public-facing mobile application designed in response to the pandemic. 

Software engineers, epidemiologists, statisticians, social scientists and legal experts from across India started to work with the Indian government to develop a digital response to the pandemic in March 2020.

The resulting systems, new digital tools as well as adapted existing tools, aimed to help test-trace-isolate (TTI) programme activities, predict emerging hotspots and identify high-risk individuals in need of targeted testing. 

This case study examines how India leveraged these digital solutions in their COVID-19 response.

INDIA_Executive-summary_20201102_v1.0-1Download

India’s numbers

First confirmed COVID-19 case: 28 January 2020.

1 March 2021:  11-million cumulative cases detected from 227-million tests. 

15 March 2021: 2,19,262 active cases, a cumulative recovery rate of 96.7% and death rate of 1.4%.

The digital backbone of Aarogya Setu 

Aarogya Setu, the backbone of India’s COVID-19 management strategy, is a mobile application launched on 2 April 2020. By November 2020, it had 170 million registered users, or 13% of the country’s population.

Users download the app free and register using their mobile number, following which a de-identified identification (DID) is generated to enable anonymised transfer of their data in the system. It captures two key sets of data:

  • Self-reported symptoms – for case management and hotspot mapping 
  • Location (via Bluetooth) for contact alerts

Aarogya Setu then scores user risk based on exposure to confirmed cases to determine who is at high risk of infection and should be prioritised for testing. Based on this, follow-up actions are recommended: Caution, Quarantine or Test.

Information on high-risk individuals is also transmitted to the Ayushman Bharat call centre, which follows up with them by phone to support linkage to testing and care.

Within the first eight weeks of the app’s introduction, more than 900 000 users identified through the algorithm had been contacted. 

India’s response also leveraged the pre-existing electronic infrastructure of Ayushman Bharat, the National Health Authority (NHA) scheme to provide free healthcare to 500-million citizens. 

The IT-enabled Integrated Hotspot Analysis System (ITIHAS) uses syndromic data submitted by Aarogya Setu users to map future hotspots. This in turn informs targeted testing strategies.

ITIHAS also generates hotspot predictions using the historic location data, based on cell phone tower signals, of confirmed positives diagnosed in the Indian Council of Medical Research (ICMR)’s network of approved labs. 


Digital tools: the benefits 

Digital health solutions can help address high-priority gaps, particularly in India, which has high overall digital maturity and a rapidly evolving digital health landscape. 

Digital solutions tailored to support the integration and/or bundling of tests provide an opportunity to identify at-risk patients earlier and intervene faster. 

Practical ways to scale

India’s government has established a positive and enabling environment for ICT intervention in health. 

In August 2020 the country launched the National Digital Health Mission, in which every Indian was due to receive an electronic health account in the form of a mobile application.

Challenges

Despite its digital maturity, India’s health system is underfunded, with government healthcare spending only 0.96% of its GDP. 

This is lower than spend in other low- and middle-income countries (1.3%), and BRIC countries (3.0%). It contributes to a lack of adequate public health services, especially in rural areas. 

India’s population relies heavily on private health providers, in the face of an under-resourced and unregulated health system, skilled staff shortages and disparate management systems.  

KEY INSIGHTS

India has an increasingly low-cost and fast digital infrastructure, with high mobile phone penetration and growing smartphone penetration. This has enabled extensive use of the Aarogya Setu mobile app.

As mobile penetration and ICT literacy in India is growing rapidly, scale-up of digital health tools will be necessary to optimise the nation’s limited resources, bridge inequity in healthcare access and strengthen the availability of quality diagnostics. 

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WHO: In vitro diagnostics for COVID-19

Safe and effective in vitro diagnostics (IVDs) are a critical component of an overall strategy to control the COVID-19 pandemic.

WHO prequalification of in vitro diagnostics (IVDs) provides a valuable service to manufacturers and regulators in both quality assurance and product selection.

It has developed an Emergency Use Listing (EUL) procedure to hasten the availability of IVDs in public health emergencies such as COVID-19.

WHO reviews all documentation submitted for EUL and checks the evidence on a product’s safety, quality and performance. This procedure helps agencies and Member States decide on which IVD is suitable for their use. 

The IVD part of the WHO prequalification website also provides key prequalification outputs as well as detailed information about submission of IVDs.

·       Read more here

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R&D blueprint expands for COVID-19 epidemic and beyond

The R&D Blueprint is a global strategy and preparedness plan that allows the rapid activation of research and development activities during epidemics. 

It aims to fast-track the availability of effective tests, vaccines and medicines that can be used to save lives and avert large scale crises. 

With WHO as convener, WHO Member States welcomed the development of the Blueprint at the World Health Assembly in May 2016.

As part of WHO’s response to the coronavirus pandemic in 2020, the R&D Blueprint was activated during COVID-19 to accelerate diagnostics, vaccines and therapeutics for the novel virus. 

This aims to improve coordination between scientists and global health professionals, accelerate the research and development process, and develop new norms and standards to inform the global response.

Building on the response to recent outbreaks of Ebola virus disease, SARS-CoV and MERS-CoV, the R&D Blueprint has facilitated a coordinated and accelerated response to COVID-19.

In 202, WHO published the final version of Target Product Profiles (TPP) for priority COVID-19 diagnostics. These TPPs describe the desirable and minimally acceptable profiles for four tests.

  • Read more on the R&D Blueprint here
  • Read more on COVID-19 Blueprint  here
  • Read more on TPP here
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Framework to safeguard personal data in a public health emergency

The Access to COVID-19 Tools Accelerator (ACT-A) was established to respond to the COVID-19 pandemic by scaling up development and equitable distribution of tests, treatments and vaccines, and strengthening underlying health systems infrastructure.

Key takeaway: Protecting individual right to privacy is vital both during and after a pandemic response.

Early on, the Research and Development and Digital Working Group of the ACT-A Diagnostics Pillar recognised that it was essential to collect, link and share timely access to data.

However, during this public health emergency (PHE), government states of emergency were declared, and fundamental human rights, including the right to privacy, were limited as part of national COVID-19 responses. 

As the world’s first pandemic where digital technologies and personal data have been used on such a large scale, this has highlighted the issue of how personal data is used. 

It also raised the related issue of how to ensure that use remains in the public interest.

Proactive response The Framework for the Governance of Personal Data for the Access to COVID-19 Tools Accelerator  was developed as a guide to promoting best practice and responsible use of personal data by all initiatives funded under the ACT-A. 

Published in January 2021, it outlines how using personal data in responding to COVID-19 must safeguard privacy and the rights of vulnerable groups. 

The framework aims to:

  • Promote best practice
  • Support the safeguarding of the rights of vulnerable groups 
  • Complement national laws and policies
  • Guide the development of national regulations on the governance of data for COVID-19 related activities
  • Guide the development of mechanisms for appropriate levels of community reviews and oversight
  • Be a dynamic framework. 

Six substantive principles guide decisions on data and data use:

  • Solidarity
  • Respect for persons and communities
  • Equity
  • Non-exploitation
  • Privacy
  • Data stewardship.

There are also three procedural principles:

  • Transparency
  • Accountability
  • Engagement.

The nine principles provide overarching guidance on both managing personal data and balancing collective interests with individual rights during a COVID-19 response. 

The framework provides detailed guidance on data management, including data collection and storage, retention, access, and the responsibilities of those processing personal data during COVID-19. 

Read more here

Guidelines on equitable access to data and public engagement are included in the framework.

Governance of this personal data must extend to its use in a post-pandemic world; hence it also calls for the establishment of national independent Data Stewardship Oversight Committees for COVID-19. 

During a pandemic, these should monitor the collection and use of personal information in line with public expectations, human rights and clear and accountable processes. 

In a post-COVID-19 world, these national committees should be tasked with determining access to COVID-19 data and conditions for access. 

Importantly, they also should ensure decisions on access continue to be driven by public and not private or commercial interests. link page text ends 

The framework will be updated and refined based on recommendations and experiences, and reviewed every six months. Feedback is encouraged and may be sent to the ACT-Accelerator Diagnostics Pillar at email ACTAdiagnostics@finddx.org

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In-house test development for molecular detection of SARS-CoV-2

Roadmap to create diagnostic tests available in English, French and Portuguese.

This document provides guidance on the development of a new, in-house, real-time RT-PCR test for SARS-CoV-2 aimed at laboratories which have established molecular biology capabilities. 

The information – available in English, French and Portuguese – will also provide a roadmap for the creation of new molecular diagnostic tests for other emerging pathogens. 

It acknowledges the constraints  of resource-limited laboratories, and outlines  requirements for good molecular biology practices, including quality control and quality assurance.

Steps to success
When a new virus such as SARS-CoV-2 emerges, laboratories rely on time-tested methods of developing diagnostic tests when commercial assays are unavailable. 

These LDTs are rarely perfect on the first attempt. 

Ideally, these tests continue to develop and gain validation until formally certified for in vitro diagnostic use by a regulatory body.

Most LDTs do not progress to the point of formal certification for use. However, they should still be held to the highest standard of quality possible to mitigate the health and economic impacts of the emerging disease and help protect vulnerable populations.

Read the report here