How data enabled Senegal to respond to COVID-19 while continuing to fight malaria
When word reached Senegal of the COVID-19 pandemic spreading across the globe, health practitioners in the country immediately thought back to what happened during the Ebola crisis of 2014.”There was a real fear that this new disease would lead to lethality similar to Ebola,” says Dr Alioune Badara Ly, the Deputy Director of the Health Emergency Operations Centre, Ministère de la Santé et de l'Action Sociale in Dakar, Senegal. Amid the Ebola outbreak, mortality rose across West Africa not only because of the disease, but because fear of contracting the disease led people to avoid seeking out care for other health concerns, like malaria.
“There was also a concern at the beginning of COVID-19 that the same thing would happen, and that all the gains that we've made in the past several years on malaria would be lost,” says Hana Bilak, malaria technical advisor at PATH, a longtime Tableau Foundation partner and global health nonprofit that works with countries to strengthen health systems and advance health equity.
Not only did Senegal not abandon the focus on malaria in the face of the new threat, but these health data systems allowed Senegal to move quickly and layer COVID-19 case data into their pre-existing dashboards that track malaria and health-center visits to analyze key indicators around the diseases in tandem. “The country must be able to monitor or manage several diseases and or several epidemics at the same time,” Ly says. “To do this, having up-to-date data on these diseases or epidemics is essential.”
This approach—using data to gather a holistic view of health issues and systems in a country—represents the goal of PATH’s collaborations with countries like Senegal, Zambia, and the Democratic Republic of the Congo, and has been the cornerstone of the successful Visualize No Malaria initiative, incarnations of which are now running in six countries across the continent.
Allowing health workers to move beyond crisis-specific data systems and instead track multiple diseases and outcomes has given health officials at all levels a chance to move quickly, allocate healthcare resources, and focus public information campaigns where they will have the most impact in preventing the spread of COVID-19, malaria, and a host of other communicable diseases. Senegal’s success with COVID-19 response shows the benefit of this approach. The country has largely kept the pandemic at bay, and after a spike in cases in February following lightened restrictions, Senegal was able to move quickly to bring numbers back down.
“At PATH, we were able to support the team in Senegal with continuing to use the malaria dashboards, but adding a tab that showed case counts for COVID as well as attendance at health facilities,” Bilak says. This multi-layered data enabled the Ministère de la Santé et de l'Action Sociale to persist in its strong response to COVID-19 while ensuring other threats like malaria stay in focus. “Data allows us to monitor the impact of COVID on the provision of health services and the operation of programs, such as the fight against malaria,” Ly says. “These data make it possible to take, on the basis of evidence, the corrective measures necessary to achieve the objectives set in terms of elimination or control.”
Senegal’s dashboard to track COVID cases and health center visits (courtesy of PATH).
Rather than trying to manage health issues in siloes, PATH is focusing on working with in-country partners to grow disease monitoring digital health capability in the broadest possible sense.
“If [Senegal’s Ministry of Health] identified a specific area in the country in the dashboard where health facility attendance had dropped really badly, they could ramp up their communication to the population there that it was still important to go in and get treated if you had a fever because malaria hadn’t disappeared,” Bilak says. “Health workers were able to use the dashboard in a very flexible way, and this kind of access to information is very powerful.”
A comprehensive approach to data-driven health
This success represents a breakthrough that is part technological: An increased comfort level with tools like Tableau allowed Ministry of Health officials to quickly adapt systems and dashboards to meet the new challenge. But it is also evidence of a changing data culture within governments and evolving relationships with public and private funders of global health programs around the world.
“A lot of people or program managers in the countries where we work see data as something maybe a bit scary, because it’s been a tool for reporting—to report back to their boss, or to donors about outcomes. With this digital approach to health, it’s really a mindset shift from using data as a reporting tool, to really using it proactively as a decision-making tool,” Bilak says. “When that shift happens, people begin to see that with better data, they can make informed decisions and potentially maximize their resources and respond more immediately to outbreaks.”
With this digital approach to health, it’s really a mindset shift from using data as a reporting tool, to really using it proactively as a decision-making tool.
While COVID-19 certainly sped up the process for Senegal integrating its approach to health-system data, the idea was already in the works. Prior to the pandemic, PATH had received funding from the Bill and Melinda Gates Foundation to increase the strength and data capacity of Emergency Operations Centers—facilities that are activated in times of crisis to coordinate a response across a range of stakeholders. Because EOCs are intended to respond to emergencies, it’s difficult for them to retain staff and capacity over time. The idea, with the funding from BMGF, was for PATH to work with local EOCs to integrate malaria response into their work. While malaria often spikes seasonally, it is a more consistent presence in countries, and building the capacity of EOCs to manage malaria on an ongoing basis could strengthen their ability to quickly respond to new crises—rather than having to ramp up and ramp down as threats occur.
“Our aim was to help build the Emergency Operations Center capacity to build and manage dashboards for malaria—but then, that capacity could then be used to also track other diseases through similar dashboards,” Bilak says.
Senegal’s integration of COVID-19 data into their malaria dashboards, Bilak says, represents a first phase of the country’s move toward an integrated, data-driven EOC. Tracking COVID-19 case data closely along with health facility attendance enabled Senegal to stay responsive in the face of uncertainty. “In the early months of COVID, there was indeed a slight decrease in the use of in the attendance of health facilities in Senegal,” Bilak says. “But when we look at the numbers at the end of 2020, attendance data actually looks similar to other years—it shows how useful it was for the program to be able to track and respond to this data.”
The future of data-driven health
Similarly, in the Democratic Republic of the Congo, PATH is working with the in-country EOC and partners at Bluesquare to build a Tableau dashboard to track 22 different diseases. DRC is the largest country in sub-Saharan Africa, and disease outbreaks are common on top of endemic malaria that accounts for 12% of all cases globally. “You can imagine how useful it would be to have a dashboard to track diseases and identify outbreaks as they happen, so it’s possible to prepare a response that doesn’t affect the delivery of other health services,” Bilak says.
It sounds like a straightforward solution, but part of PATH’s focus as an organization—and what makes it such a strong partner for countries in their public health work—is accounting for the different circumstances in countries that might present challenges for the adoption of digital health approaches.
In contrast to Zambia and Senegal, which are relatively smaller countries with more digital infrastructure in place, DRC is a massive country, composed of 26 provinces with varying degrees of mobile connectivity and digital infrastructure. “There’s a big movement in DRC and a lot of excitement about a move to digital health,” Bilak says. “But right now, it’s very decentralized and they don’t rely much on digital tools at the moment, so this is the beginning of a transition process.”
Ultimately, PATH’s goal is that the digital systems they are co-creating now with countries like Senegal become self-sustaining. Data capacity building and training programs are critical components to meeting this goal. In Zambia, the country that pioneered the data-driven Visualize No Malaria approach in 2015, the program took hold when health workers—down to the community health facility level—realized the benefit of collecting and sharing their data to a centralized repository that informed the programmatic dashboards. ““There was a feedback loop between the data they uploaded and the data they were able to use to make decisions,” Bilak says. Their efforts around data collection and reporting created a system that “made their lives easier and their jobs easier, because they had all this data in one place—they didn’t have to go searching through spreadsheets,” Bilak says.
In Senegal, health workers and PATH had to move quickly to integrate COVID-19 data into their systems—but rather than the response to the pandemic serving as an isolated incident, Bilak says it’s setting a new precedent for managing health data going forward. “Depending on where you sit in the health system, it’s maybe not obvious right away what these dashboards and data can do for your work—but as time goes by and as we look at the situation over the past year, it’s clear that it makes a difference,” Bilak says. “It’s about people realizing the power of data and what they can do with it.”
To learn more about PATH’s work with countries on COVID-19 data, register for the PATH Live forum on June 16, 2021 at 8 a.m. PDT on advancing health equity with data and analytics.
To learn more about Tableau’s support of a data-driven response to COVID-19, visit the Tableau COVID-19 Data Hub.