World Health Organization (WHO) , 2023

Implementing Partners: Ethiopian Public Health Institute, WHO Ethiopia Country Office

Published In: COP28 Prospectus of Climate-Health Solutions, 2023

Implementing early warning, alert and response systems (EWARS) as an important building block of climate resilient health systems, through enhanced information technology infrastructure and sentinel surveillance sites.

Context

Climate change increases the risk of climate-sensitive diseases worldwide, which include a wide range of infectious and non-communicable diseases. In Ethiopia, climate-sensitive diseases such as malaria, yellow fever, dengue fever, meningitis, leishmaniasis and diarrheal diseases pose a significant threat to the population’s health. As part of climate adaptation efforts, there is a need for surveillance mechanisms and early warning, alert and response systems (EWARS) that can anticipate risks and trigger early responses to avoid or reduce impact and enhance preparedness. In the context of rapidly changing environments and risks, EWARS are a valuable tool to build the adaptive capacity and climate resilience of health systems. 

Approach

The Ethiopian Public Health Institute has developed an EWARS for climate sensitive diseases in Ethiopia with support from WHO. Two key actions have been to establish sentinel sites across the country, and to develop a decision support tool to model and forecast climate-sensitive diseases in key areas during peak seasons, enabling targeted public health interventions and health system preparedness. 

A critical enabler of this program has been the early involvement of stakeholders such as national and sub-national health officials, and local focal points at sentinel sites. A series of workshops enabled collaboration with partner organizations such as Resolve to Save Lives, US Centers for Disease Control and Prevention (CDC), United Nations Children’s Fund (UNICEF), Family Health International (FHI) 360 and Oxford Policy Management (OPM). 

Sentinel sites have been established across different geographic and climatic zones of Ethiopia since 2017 to collect and integrate climate, environmental health and diseases surveillance data for the EWARS. Information technology infrastructure and computers were installed at sentinel sites to enhance their capacity. 

Impact & Next steps

Following the establishment of sentinel sites, data from these sites was used to validate the EWARS modelling and forecasting tool for malaria and meningitis in several regions of Ethiopia. The incidence and distribution predicted by the model were validated with health data collected from sentinel sites for the modelled period. 

The refined modelling and forecasting of malaria and meningitis allowed the implementation of targeted preparedness and public health actions to prevent these climate-sensitive diseases. For example, by using EWARS in 2020, Bahir Dar city administration was able to detect a malaria outbreak that exceeded endemic levels. The tool also provided an alert regarding the probability of a malaria outbreak throughout the year in the area. As a result, the sentinel site implemented an emergency preparedness plan for malaria and reduced the risk of further disease outbreaks. 

The Ethiopian Public Health Institute has funded the EWARS program, with support from WHO and external donors. However, further funding would allow the scale up of this program across additional sites. WHO and the Ethiopian Public Health Institute are providing support with data server infrastructure and technical expertise. Another point of support is capacity building at the national and regional levels to improve the utilisation and uptake of EWARS. 

EWARS is a highly scalable model that has had success in many parts of the world, both prior to and in the aftermath of climate events. Further financing can help to strengthen climate-sensitive disease surveillance – an important building block of climate resilient health systems.