JMIR Publications

ABSTRACT

Background:

In the last two decades, many countries have recognised the use of electronic systems for disease surveillance and outbreak response as an important strategy for disease control and prevention. In low and middle-income countries (LMIC), the adoption of these electronic systems remains a priority and has attracted support of global health players and international development partners. These benefits and support notwithstanding, the successful implementation and institutionalisation of electronic systems in LMIC have been challenged by local capacity to absorb technologies, decisiveness and strength of leadership, implementation costs, workforce attitudes to innovation, and organisational factors. In November 2019, Ghana piloted the Surveillance Outbreak Response Management and Analysis Systems (SORMAS) for routine surveillance and subsequently used it for the national COVID-19 response.

Objective:

To identify facilitators and barriers to the sustainable implementation and operating of SORMAS in Ghana.

Methods:

Between November 2021 and March 2022, we conducted a qualitative study among 22 resource persons representing different stakeholders involved in the implementation of SORMAS in Ghana. We interviewed study participants via telephone using in-depth interview guides developed in keeping with Greenhalgh et al.’s model of diffusion of innovations in health service organisations. We transcribed the interviews verbatim, performed independent validation of transcripts, and pseudonymisation. We performed deductive coding using seven a priori categories namely, innovation, adopting health system, adoption and assimilation, diffusion and dissemination, the outer context, institutionalisation, and linkages among the aspects of implementation. We used MAXQDA analytics pro for transcription, coding, and analysis.

Results:

The facilitators of SORMAS implementation included its coherent design in keeping with Integrated Disease Surveillance and Response (IDSR) system, adaptability to evolving local needs, relative advantages for task performance (e.g., real-time reporting, generation of case-base data, improved data quality, mobile offline capability, and integration of laboratory procedures), intrinsic motivation of users, and a smartphone savvy workforce. Other facilitators were: its alignment with health system goals, dedicated national leadership, political endorsement, the availability of in country IT capacities, and the financial and technical support from inventors and international development partners. The main barriers were: unstable technical interoperability between SORMAS and existing major health information systems, reliance on a private IT company for data hosting, unreliable internet connectivity, unstable power supply from the national grid, inadequate numbers and quality of data collection devices, substantial dependence on external funding.

Conclusions:

The facilitators and barriers of SORMAS implementation are multiple and interdependent. Important success conditions for implementation include enhanced scope and efficiency of task performance, strong technical and political leadership, and a self-motivated workforce. Inadequate funding, limited IT infrastructure, and lack of software development expertise are mutually reinforcing barriers to progress of implementation and ownership. Some barriers are external, relate to overall national infrastructural development and are not amenable even to unlimited project funding.