September 2007

An Initiative Towards Affordable Surveillance : Adele Waugaman

Recognising that good information is essential to every aspect of public health planning – from outbreak response, to identification of priorities, and evaluation of programs – the United Nations Foundation and The Vodafone Group Foundation launched a health data surveillance programme in 2006

Up-to-date, accurate data is a necessity for public health, and providing that data requires affordable information technology. That’s the premise behind a joint project of the United Nations Foundation and The Vodafone Group Foundation to support digital health data systems in developing countries. Through a partnership with the UN World Health Organization and, a non-governmental organization, the foundations have launched a programme that empowers developing country public health professionals to use sustainable technologies to save lives.  The programme strives to make quality health data as accessible as the mobile phone by putting effective health data-gathering tools in the hands (literally) of health workers on the ground.

Most information about public health in developing countries is collected on paper, usually by means of house-to-house surveys. The process of collecting and then entering this information into computers, so that it can be aggregated and analyzed can take months or even years. The same data-entry process can also introduce errors.

Recognising that good information is essential to every aspect of public health planning � from outbreak response, to identification of priorities, and evaluation of programs � the United Nations Foundation and The Vodafone Group Foundation launched a health data surveillance programme in 2006. Powered by the free, easy to use, open source, EpiSurveyor mobile software tool, the programme enables health experts to get critical health information more quickly and accurately, even in resource poor environments. With the Episurveyor, governments and international organisations can now access more timely and accurate data on which to base crucial public health decisions.

From Measles to Mobiles

The partnership between the United Nations Foundation and The Vodafone Group Foundation began in 2003 when Vodafone became the largest corporate sponsor of the Measles Initiative�a coalition of NGOs, governments, and international organizations including the World Health Organization, U.S. Centers for Disease Control and Prevention, the American Red Cross, UNICEF, and the United Nations Foundation.

The Measles Initiative supported the vaccination of millions of children against measles, the number one vaccine-preventable killer of children in Africa. Together with the WHO and UNICEF, the Measles Initiative pursued the goal to reduce measles mortality by 50% in just five years, between 2000 and 2005.  Hard work by country governments, with support from the Measles Initiative partners, enabled countries to surpass this goal and reduce global measles deaths by 60 percent�an impressive 2.3 million lives saved. Having exceeded the 50% reduction target, WHO, UNICEF, and country governments, with support from Measles Initiative partners, are redoubling their efforts to reduce mortality from measles. In 2006, WHO and UNICEF announced a new goal: reduce global measles deaths by 90% by the year 2010.

Reaching the Measles Initiative goal

To meet the new 90-10 goal, Measles Initiative partners require a high standard of information. Programme leaders must have access to accurate and timely data to determine the initial rate of measles deaths, number of children vaccinated, and subsequent decreases in mortality rates. Experience has shown that handheld digital data collection is far superior to paper-based systems. Prior to the use of EpiSurveyor, the available commercial software required expensive consultant programmers every time a new form was needed, or an old form needed to be modified. To help fill this gap, the United Nations Foundation and The Vodafone Group Foundation have built on their support for the Measles Initiative by funding the development of the pioneering EpiSurveyor mobile health technology�a software tool with the power to overcome one of the greatest challenges facing international public health: the collection of timely, accurate, reliable data to support analysis and decision-making.

DataDyne’s EpiSurveyor

Joel Selanikio, a technologist, a physician, and an epidemiologist, had just the right combination of experience to come up with the powerful idea behind this mobile health solution.  Through the course of his work as a Wall Street computer consultant, a pediatrician, and a medical officer at the U.S. Centers for Disease Control and Prevention, Dr. Selanikio developed an interest in applying computer science to the public health domain.  In 2003 he and technologist Rose Donna, formerly of the American Red Cross, created DataDyne to improve the quantity and quality of public health data. With support from the UN Foundation and The Vodafone Group Foundation, Selanikio created EpiSurveyor, DataDyne’s premier software solution, shortly thereafter.

EpiSurveyor allows anyone with average computer skills � the ability to use a word processor or email, for example � to create and share mobile data collection systems in minutes, and without the need for consultant programmers. In keeping with its mission to break down the barriers that block access to health data in developing countries, EpiSurveyor is free�anyone with internet access can download the programme.  EpiSurveyor is also open source, enabling those with higher-level programming skills to manipulate the programme to respond to health needs as they arise.  Finally, EpiSurveyor is built to run on mobile devices, enabling maximum mobility and ease-of-use for health workers who spend most of their time in the field. EpiSurveyor operates using a Java-based engine and a Windows-based Designer application that allows fast and easy creation of forms and data systems.

In addition to pioneering DataDyne’s open source solutions for international public health, Dr. Selanikio also works hand-in-hand with public health officials � including those with the health ministries and the WHO � to develop “train the trainer” sessions that enable in-country officials to use the EpiSurveyor software. EpiSuveyor’s adaptable and scalable software makes it ideal for tracking integrated health campaigns, such as those organized by the Measles Initiative that frequently distribute Vitamin A and anti-malaria bed nets during measles vaccination campaigns. Once trained in its use, health professionals can use EpiSurveyor for a range of activities: from household surveys to clinic surveillance, from outbreak investigation to medical recordkeeping.  Local capacity is greatly enhanced, while dependence on consultants is correspondingly eliminated.

Kenya and Zambia Pilots

With funding from the UN Foundation and The Vodafone Group Foundation, and in partnership with the World Health Organization (WHO), DataDyne launched pilot programmes to build digital health systems in Kenya and Zambia. The goal of these pilots was to replace paper-based health surveillance systems used to collect measles data in Africa with more efficient and effective digital systems that use PDA-based systems.

In both countries, programmes began by training health supervisors in every province on the use of the EpiSurveyor software running on low-cost Palm Zires.  Selanikio conducted the training along with WHO officials, and worked closely with National Ministries of Health to support the programme’s local integration. Trainees have since trained scores of other local health staff, advancing sustainability and reducing future costs.

Initial data received from the field in these countries confirmed that the programme was gathering increasing amount of information related to a variety of issues: measles, HIV, maternal/child health, clinic management, and others.  In some cases, the programme provided data faster than before; in others, it provided data that had never been collected at all. The result has been to provide health workers in the participating countries with a flexible tool for the collection and rapid analysis of a whole variety of health data. This in turn has enabled them to understand better the strengths and shortcomings of current health systems, to investigate outbreaks faster, and in general to better understand complex but critical public health issues in their countries.

Meeting Other Challenges

In addition to providing information for monitoring and fighting communicable diseases, EpiSurveyor’s flexible epidemiological surveillance software enables health workers to implement an early warning system for epidemics. This was demonstrated recently in Kenya, where EpiSurveyor was used to help contain an outbreak of polio�a disease nearing total eradication in Kenya.

The last native case of polio in Kenya was seen as far back as the 1980s, but in early 2007 political unrest and fighting in neighboring Somalia brought unvaccinated refugees, and a new wave of the poliovirus, back within Kenya’s borders. Titus Kolongei, a health officer with the KEPI (Kenya Expanded Programme on Immunizations) and member of the first group of EpiSurveyor trainees, adapted the software to track infected children and those with whom they had come into contact, thereby tracing the path of the virus as it moved through Kenya. Kolongei also used EpiSurveyor to evaluate the success of an accompanying effort to immunize almost two million children in areas surrounding the outbreak.  Previously, the use of such “advanced” handheld tools would have required the enlistment of expensive consultants from overseas, but empowered with EpiSurveyor, KEPI officials like Kolongei were able to contain a potentially catastrophic disease outbreak without outside assistance.

In Zambia, health workers have likewise modified EpiSurveyor to meet needs as they arise.  After an initial training, health officials there developed new digital health data forms for a range of monitored illnesses, from yellow fever to diarrhoea.  Health officials in Zambia also modified EpiSurveyor to digitize their daily administrative report, facilitating important communications between provincial field offices and headquarters.


The success of this sustainable, mobile health data surveillance system in empowering the measles control effort, and in developing fast, creative solutions to containing other life-threatening diseases, has led the WHO to adopt EpiSurveyor as a standard for data collection in sub-Saharan Africa.  The WHO will soon expand the use of EpiSurveyor throughout the continent to equip health workers with sustainable tools to save lives by fighting a range of diseases, and supporting related data collection and analysis.

EpiSurveyor allows anyone to very easily create a handheld data entry form, collect data, and then transfer the data back to a desktop or laptop for analysis. By cutting  down on data collection time, it helps to rapidly identify stock-outs and other supply shortages. By eliminating the need to transfer data from paper to computer, it avoids unnecessary errors. And because it can be customized for unique applications by health officials, it empowers developing country health officials to develop and maintain their own surveillance programmes without using expensive consultants.

For their part, the United Nations Foundation and The Vodafone Group Foundation plan to continue their support of developing countries’ transition to digital public health data systems, using low cost, open source software�technology that leverages the burgeoning mobile computing network to put tools for efficient public health management squarely within the hands of developing country health practitioners.  As the success of the Measles Initiative shows, this unique public-private alliance of NGOs, individuals, governments, and intergovernmental organizations can open the door to the to stunning advances with the potential to revolutionize international public health.

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