Humanitarian emergencies increase the risk of transmitting disease. Disease outbreaks, such as malaria, measles and cholera, are often a major cause of illnesses and death during crises.
The global Early Warning and Response System (EWARS) project is a WHO initiative to catch disease outbreaks early on to be able to contain them in emergencies. It supports Ministries of Health and health partners by providing technical support, training and field-based tools.
EWARS is committed to supporting disease surveillance, alert and response even in the most difficult operating environments. “EWARS in a box” is a kit of durable, field-ready equipment needed to establish and manage surveillance or response activities in field settings.
This photo essay illustrates how the first “EWARS in a box” was set-up in Mingkaman, an internally displaced persons (IDPs) settlement, in South Sudan.
WHO/C. Haskew
Since October 2015, almost 30 000 internally displaced persons (IDPs) have crossed the River Nile to reach Mingkaman from neighbouring Jongelei State. Large numbers of displaced people, combined with lack of adequate shelter, poor water, sanitation and hygiene, contribute to high risk factors for disease outbreaks inside the crowded settlement.
WHO/C. Haskew
The first step in using "EWARS in a box" is to provide basic training to health workers who will collect and report data in the field. The training of up to 2 days can be adapted to the setting and time available.
The first priority area in South Sudan was identified with the Ministry of Health, as Mingkaman IDP settlement. Here participants from all health partners in Mingkaman, and the local County Health Department, received training on how to report cases of disease using mobile phones.
The first priority area in South Sudan was identified with the Ministry of Health, as Mingkaman IDP settlement. Here participants from all health partners in Mingkaman, and the local County Health Department, received training on how to report cases of disease using mobile phones.
"EWARS in a box" contains equipment needed to establish surveillance and response in areas without reliable internet or electricity. It contains mobile phones, laptops and a local server to collect, report and manage disease data. Solar generators and chargers allow the system to function without 24-hour electricity.
A single kit costs approximately US$ 15 000 and can support surveillance for 50 fixed or even mobile clinics, or roughly 500 000 people.
A single kit costs approximately US$ 15 000 and can support surveillance for 50 fixed or even mobile clinics, or roughly 500 000 people.
WHO/C. Haskew
In Mingkaman, the “EWARS in a box” kits arrive by UN helicopter. Due to poor road conditions access to more remote areas or those in conflict is only possible by air, especially during the rainy season.
In Mingkaman, the “EWARS in a box” kits arrive by UN helicopter. Due to poor road conditions access to more remote areas or those in conflict is only possible by air, especially during the rainy season.
The kit can be rapidly configured and deployed within 48 hours of an emergency being declared.
In Mingkaman, the “EWARS in a box” kits arrived by UN helicopter. Due to poor road conditions access to more remote areas or those in conflict is only possible by air, especially during the rainy season.
In Mingkaman, the “EWARS in a box” kits arrived by UN helicopter. Due to poor road conditions access to more remote areas or those in conflict is only possible by air, especially during the rainy season.
WHO/C. Haskew
Mingkaman IDP settlement is located in Lakes State, and is home to more than 71 000 internally displaced persons (IDPs).
Health services are provided by the Ministry of Health as well as nongovernmental organizations: Health Link South Sudan (HLSS), International Medical Corps (IMC), Sudan Medical Care (SMC) and Comitato Collaborazione Medica (CCM).
Health services are provided by the Ministry of Health as well as nongovernmental organizations: Health Link South Sudan (HLSS), International Medical Corps (IMC), Sudan Medical Care (SMC) and Comitato Collaborazione Medica (CCM).
WHO/C. Haskew
The kit is designed with frontline health workers in mind. Julius Opio, clinical officer-in-charge with Health Link South Sudan (HLSS), sees patients in a health facility in Mingkaman.
Julius collects disease data from patients every day during routine consultations. If any diseases are seen that require an urgent response, such as measles, the County Health Department can be notified immediately using the mobile phone. Then the County Health Department can consider next steps, such as alerting colleagues to respond immediately, investigate further or take laboratory samples.
Julius collects disease data from patients every day during routine consultations. If any diseases are seen that require an urgent response, such as measles, the County Health Department can be notified immediately using the mobile phone. Then the County Health Department can consider next steps, such as alerting colleagues to respond immediately, investigate further or take laboratory samples.
WHO/C. Haskew
At the end of each week, Julius prepares his weekly report and submits it to the County Health Department.
Previously, the reports were submitted on paper and took a lot of time to reach the state and national levels. Reporting by mobile phone speeds up the process and makes the information available to the Ministry of Health and WHO staff in real-time.
Previously, the reports were submitted on paper and took a lot of time to reach the state and national levels. Reporting by mobile phone speeds up the process and makes the information available to the Ministry of Health and WHO staff in real-time.
WHO/C. Haskew
Lasu Robert Martin, data manager in the Ministry of Health in Juba, uses the online EWARS application to view and manage reports that have been submitted. Laptops and a local server allow the data to be compiled for analysis at coordination hubs at state and national level.
WHO/C. Haskew
If the reports trigger an alert or notification, an SMS will be sent back to the phone to allow immediate public health action. This can prompt an outbreak investigation and the collection of laboratory samples, to confirm if a disease outbreak is present or not.
Lasu Robert Martin works with Kenyi Nason Felix, a laboratory technician from a health facility in Mingkaman, to review the actions needed if an outbreak alert is received on the phone.
Lasu Robert Martin works with Kenyi Nason Felix, a laboratory technician from a health facility in Mingkaman, to review the actions needed if an outbreak alert is received on the phone.
WHO/C. Haskew
Nationwide, less than 50% of disease outbreaks are reported in South Sudan. The roll-out of "EWARS in a box" to other areas of the country aims to increase this to more than 80%.
The performance of EWARS is regularly monitored to identify where support is needed. At 3 to 6 month intervals, in-depth evaluations are used to document successes and challenges, and to obtain feedback from frontline users.
The performance of EWARS is regularly monitored to identify where support is needed. At 3 to 6 month intervals, in-depth evaluations are used to document successes and challenges, and to obtain feedback from frontline users.
WHO
WHO is working with the Ethiopian Ministry of Health and partners to respond to the public health consequences of El Niño. Millions have been affected by drought. Following the success of the “EWARS in a box” pilot in South Sudan, Ethiopia requested WHO to expand the project there. WHO is working towards distributing 20 EWARS in a box kits to 1000 health centres across Ethiopia.