5.3 Demonstrate progress and communicate success
Routine collation and synthesis of 7-1-7 data (Step 4) can help demonstrate progress and highlight persistent bottlenecks. Routine reports (quarterly, annual) can also provide evidence of performance improvement to stakeholders (government, civil society, and funders) and detailed feedback on the value of their investments.
Using timeliness metrics to advocate for investments and show returns
Containing yellow fever is a unique challenge. Effective vaccines exist but are in limited supply for a variety of reasons, including their substantial cost. Yellow fever can be difficult to distinguish from other infectious diseases because the virus that causes it is similar to other viruses and can elicit a similar immune response.
Strong diagnostic capacity is required to differentiate yellow fever from other diseases that may require different containment strategies. On the African continent it took an average of 105 days to complete yellow fever testing. Recognizing this challenge, Gavi implemented a program to scale up diagnostic testing capacity in Africa, which quadrupled the number of laboratories able to complete yellow fever testing. To demonstrate the impact of the investment, Gavi highlighted that the average time to complete yellow fever testing had decreased to 39 days by 2020.
In Nigeria, the results were even more dramatic: yellow fever specimens can now be confirmed within 24 hours at the national reference laboratory, accredited by WHO for molecular confirmation in 2021.
If performance against the 7-1-7 metrics is not progressing as expected, the data can be used to communicate where additional investments are needed. Data collected through the 7-1-7 approach should also be used to identify enablers and those aspects of the system that are working. Demonstrating the success of public health efforts in preventing epidemics and other health threats is a challenge, because the mark of success is when nothing happens. The 7-1-7 approach not only makes the successful containment of public health threats more concrete, but also identifies the specific system factors and investments responsible for success.
Accelerated responses in Nigeria after a bottleneck analysis
The use of timeliness metrics and the 7-1-7 target can help countries identify catalytic investments and communicate their success.
From 2017 to 2019, it took the Nigeria Centre for Disease Control and Prevention (NCDC) a median of six days to undertake essential early response action upon detection of an outbreak — and more than one month to respond to one in five (20%) outbreaks. For instance, an outbreak of meningitis in Zamfara (a state in northwestern Nigeria with large agricultural and gold mining industries) went 108 days without a response from NCDC due to a complex interplay of factors.
To remedy this problem, on February 1, 2019, the NCDC established the Revolving Outbreak Investigation Fund (ROIF), which enables the rapid release of funds to investigate, verify and control infectious outbreaks. Since then, the median time to respond to a viral threat has dropped to two days, a 67% improvement over the previous two years. These results have been used by advocates to promote the creation of a rapid response funding line in the federal budget.
Global health security is only as strong as the weakest link.
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