Since the onset of the COVID-19 pandemic, data has been a major determinant of the public health response strategy by various countries including Nigeria. It enables public health authorities to understand the transmission patterns of the virus as well as strategically target funding and resources for response activities. In Lagos State, the data generated daily also drives the coordination of the state’s response activities by its Public Health Emergency Operations Centre (PHEOC).
During the 2014 Ebola outbreak, Nigeria initially had a surveillance system that depended on paper-based reporting and the use of Microsoft Excel spreadsheets. This was a major challenge as it caused a delay in reporting from Local Government Areas (LGAs) to states, and from states to the national level (NCDC). An ad-hoc platform was developed during the response, but it was immediately obvious that a better surveillance platform was needed.
As part of lessons from the Ebola response, NCDC worked with partners to develop a new tool called Surveillance Outbreak Response Management and Analysis System (SORMAS). SORMAS is an open-source software deployed to all 774 Local Government Areas (LGAs) in Nigeria that enables states to analyse and report data on infectious diseases in real-time.
Through SORMAS, cases of diseases are reported digitally from health facilities, LGAs and states. As soon as data is entered through SORMAS, the entire surveillance chain which includes LGA, States, and NCDC at the national level, can view the report immediately. The adoption of a digital surveillance system in Nigeria has reduced delays that arise from sending data through physical forms and collating Excel spreadsheets.
According to the NCDC, only 17 states had begun to use SORMAS (not covering all LGAs) as of January 2020. Given the critical need for improved data collection during the COVID-19 pandemic, NCDC began the rapid scale-up of SORMAS deployment in Nigeria. As of the end of November 2020, all states in Nigeria and the FCT, as well as 774 LGAs had begun to use SORMAS for disease reporting. This has enabled rapid analysis of cases, contact tracing and other disease surveillance functions at the state and national levels. The data collected through SORMAS forms the basis of reports announced daily by NCDC on the COVID-19 situation in Nigeria.
Tayo Mabayoje is a data analyst for the Nigeria Centre for Disease Control (NCDC), deployed in April 2020 as a member of the National Rapid Response Team. His role has been to support the State Ministry of Health’s leadership of the State’s COVID-19 response activities. Specifically, he has been supporting the state’s use of SORMAS in Lagos State. In this question and answer(Q&A) interview, Tayo shares how Nigeria is using data and technology through its digital surveillance system, to respond to the pandemic.
Q: What kind of data do you need for your work and how do you collect the data?
A: We have different points for data collection. At the LGA Level, there are walk-in sites where individuals who wish to get tested can do so at no cost. Currently, all 20 LGAs in Lagos State have a walk-in site for COVID-19 testing established by the Lagos State Ministry of Health, with support from NCDC and WHO.
When people come to test, we require their personal information, travel history and other information to support contact tracing and response activities.
If a person tests positive for COVID-19, the next phase is contact tracing. This is done to identify individuals who have come in contact with the confirmed case and are at risk of contracting the disease. Contact tracing is usually managed by state public health teams in this case, a Lagos State Contact Officer. The officer monitors each contact for known symptoms of COVID-19 for 14 days and if they develop symptoms, their samples are taken for testing. In line with the national guidelines for case management, all positive cases are either managed in a designated treatment centre or at home after appropriate risk assessment. The contact tracing cycle is repeated after every new case is detected.
We sometimes experience difficulties in identifying contacts because some clients refuse to provide the required information. Some, out of fear, skepticism or superstition, say things such as “God forbid! It’s your family that has COVID-19” to the contact officers. These are some of the challenges hindering our data collection efforts.
Q: How much manpower does it take to get this done?
A: The data team consists of up to 50 officers, mostly from the Lagos State Monitoring & Evaluation Team who we work with closely for data collection and analyses. Given the number of cases reported daily from Lagos State, the epicentre of the pandemic in Nigeria, adequate human resources is critical.
Q: What are the major challenges being faced?
A: One of the major challenges is manpower. Then also people’s mindset; imagine a COVID-19 patient is reluctant to provide information to enable state teams to trace their contacts or provides fake information or fake COVID-19 results. Such challenges lead to delays in identifying people at risk of infection.
Q: How do you respond to people trying to falsify their COVID-19 results?
A: When returnees come back into the country, they are required to self isolate for seven days. At the beginning of the pandemic, when travel protocols were being introduced, returnees were expected to submit their passport to Immigration Authorities until after the mandatory repeat COVID-19 test is conducted. They were required to present their result certificate to collect their passport.
However, some people attempted to present fake COVID-19 results just to retrieve their passports. There is a data team in the state that worked with Port Health Services, to ensure adherence to travel protocols and verify that the COVID-19 result certificates presented were genuine. The verification of travel-related results is done through an inbuilt security code on the certificate that links back to the database and pulls the information on the SORMAS software.
Q: How is SORMAS helping you to track the COVID-19 response?
A: SORMAS was already being used for real-time surveillance in Nigeria in response to outbreaks of Lassa fever, Cholera etc. even before the COVID-19 outbreak.
For COVID-19, once the sample is taken, the information is updated on SORMAS and the laboratory focal person gets a notification that the sample is coming. When the result comes out, it is updated on the SORMAS platform and feedback is gotten by national, state and LGA public health teams in real-time.
This enables the prompt sharing of results with patients unlike at the beginning of the response where results had to be collated at a central point. This was a big challenge in the COVID-19 response before the disease was integrated into SORMAS for real-time reporting. Now, individuals tested can receive their results at the LGA level two to three days after testing is done.
In line with NCDC’s continuity plan for Lagos State, the national RRT continues to support the state to sustain the data reporting and management structure of the response. A SORMAS Team at the national level also monitors activities and provides offsite support.
This narrative was done in December 2020 as part of the #COVID19NigeriaStories documentation project on state-level responses to COVID-19, implemented by the Nigeria Centre for Disease Control and Nigeria Health Watch with support from the Ford Foundation.