Many of the world’s most common diseases can be treated even in low-resource settings. But those treatments aren’t always easily available. That’s why outbreak prevention is key to protecting lives in the displacement camps of Cox’s Bazar.
The Early Warning, Alert and Response System (EWARS) has helped the health sector stay ahead of threats since 2017. In partnership with the Government of Bangladesh and UNICEF, WHO leads the integration of EWARS with the District Health Information Software (DHIS2) platform. The integration ensures closer collaboration on disease prevention and detection. Government health specialists will have ongoing access to EWARS data, giving them a strong picture of the health situation in the Cox’s Bazar displacement camps.
Alongside the integration, WHO trains health-sector partners to report on health threats. Delawar Hossain, Statistician in Charge at Eidgaon Health DGHS Sub-centre, attended the EWARS training on July 20, 2022. He said, “all through the sessions, I’ve learned about the EWARS app—how to do reporting, how to edit reports using the laptop and a few other aspects of EWARS…If EWARS is used in all the localities in Cox’s Bazar, the local population will benefit through the early detection of any outbreak.”
Delawar Hossain listens intently to a presentation on the EWARS platform. Photo credit: WHO/James Carmichael
A flexible solution for evolving emergency contexts
Areas that are most in need of an early warning system are often the hardest to reach. EWARS is the perfect solution, offering a simple way to track and report emerging threats.
As an early response to the Rohingya crisis, WHO implemented the EWARS-in-a-box system. It's a single solution for complex monitoring needs. This system gave health workers the ability to report emerging threats instantly. The data would then go back to a dashboard for internal and external stakeholders.
Today in Cox’s Bazar, the EWARS system includes server capacities in Geneva and broad desktop and mobile access. It’s been used to monitor a range of health conditions, including acute watery diarrhoea (cholera), respiratory infection, measles, jaundice syndrome, haemorrhagic fever, tetanus, malaria, and diphtheria. It currently monitors nineteen of the most prevalent health threats in the region.
Though designed for use in emergency contexts, EWARS can be integrated into routine medical reporting using Application Programming Interface (API) technology. It is well-regarded by health professionals for its high sensitivity and positive predictive value—a value that indicates accuracy in reporting results.
Shared platforms, shared vision
Since 2010, the Bangladesh Ministry of Health has used DHIS2 as their main platform for daily health reporting. The system captures data at the health facility level to aid decision-making and campaign planning.
In the complex health settings of the Rohingya displacement camps, however, WHO teams want to go above and beyond the resolution of DHIS2 reporting.
“EWARS captures several critical dimensions of the health situation in Cox’s Bazar,” says Dr David Otieno, WHO Epidemiologist, “it measures the sensitivity of reporting tools, timeliness, flexibility, and much more. Now it’s been integrated with EWARS, DHIS2 gives us a platform for closer collaboration with national partners. We’ll have more clarity regarding the relationship between health situations in the host community and camps. The Government will also have instant access to health information.” Dr Otieno adds.
Dr Bardan Rana, WHO Representative to Bangladesh, explains how collaborative tools improve health outcomes for all. He says, “Collaboration isn’t just about working together—it’s about building systems that are collaborative by design. The integration of EWARS with DHIS2 is an important milestone in the relationship between WHO and health authorities. When we make data available to partners, we dramatically improve the sector’s ability to take rapid action.”
A health worker introduces herself to the class at an EWARS training session. Photo credit: WHO/James Carmichael
Why is disease prevention so important?
The benefits of preventing people from getting sick might seem self-evident. But given the infection rates of diseases like COVID-19, it’s wise to highlight the importance of preventive measures.
To stop an outbreak before it happens, the health sector needs to be able to report health threats as soon as they appear. That’s where systems like EWARS offer advantages over regular monitoring and reporting systems.
Disease prevention isn’t always cheaper than treatment. But it’s always a worthwhile investment. Protecting people before they become ill can avoid burdens that might otherwise be caused by sickness. This is important for vulnerable people such as women, children, displaced people, or people in poverty.
As a health Statistician in Charge, Delawar gets to see first-hand just how important EWARS can be in the field. He believes it has the potential to go even further to protect people in Cox’s Bazar.
“EWARS is right now operating for nineteen diseases,” says Delawar, “That’s a great thing. But if EWARS had another system that could detect any unusual event or any unusual disease that is not common to that locality—and if we can know it far, far prior to when the thing will be—then this will help the local population greatly. That would be a great achievement.”