Assessment and exploratory analysis of the indicator-based surveillance (IBS) system in Rwanda

Abstract Introduction: Rwanda, like other countries, is facing emerging and re-emerging infectious diseases. Since 2002, Rwanda has implemented indicator-based surveillance through the Integrated Disease Surveillance and Response (IDSR) framework. This study aimed to explore the completeness and timeliness of reporting and use of the tool in Rwanda. Method: In this study, we used a cross-sectional descriptive approach using a structured questionnaire for IDSR focal persons and data managers in 46 public hospitals accompanied by a secondary data analysis of monthly records from the National HMIS for the period of 2018–2021 from 564 public health facilities (HFs) and 283 private HFs. Exploratory analysis and correlation assessments complemented the dataset analysis. Results: This study revealed that public HF consistently achieves or surpasses the 80% completeness (96.7%) and timeliness (80.8%) targets. In contrast, private HF demonstrates 42.8% and 25.3% completeness and timeliness, respectively. Eight-seven percent (87%) of the interviewees reported having received feedback from the central level, with varying frequencies. Hospitals provide feedback to HFs in their catchment area (91%), but the frequencies differ. Regarding the data accuracy, 95.7% of the respondents possessed standard case definitions, and 87% regularly referred to them. Two-thirds (67.6%) reported that they monitored weekly trends, but only 34.9% produced and shared weekly reports promptly. The challenges identified included internet issues (30%), other competing duties (30%), and forgetting to report (26%). A total of 84.8% of HFs used the system to detect outbreaks in their catchment areas; 71.7% of these HFs responded to the system according to national guidelines. Furthermore, 92.3% of all HFs used the eIDSR system for planning purposes. Conclusion: The IDSR system was highly useful because it provided evidence for decision-making in early detection and response to outbreaks as well as for hospital program planning. Maintaining timely reporting, enhancing data quality and timely use, and improving health workers' knowledge and practices are vital for a surveillance system user to detect outbreaks early. More focus should be placed on private health facilities.