Performance Evaluation of the Disease Early Warning System (DEWS) Project

USAID supports the Afghanistan Ministry of Public Health (MoPH) to implement DEWS by channeling funding and technical support through the World Health Organization (WHO). One aspect of the DEWS strategy involves indicator-based surveillance, where focal points gather and analyze information on a set of diseases and conditions on a weekly basis. If the threshold for a specific disease or condition is reached, an alert is declared, DEWS staff investigate and respond within 48 hours, and confirmed outbreaks are reported to the provincial and national DEWS offices. As a result of gradual expansion, surveillance now takes place at 368 functional sentinel sites across all 34 provinces of Afghanistan (as of December 30, 2013). These sites exist in a variety of government-run facilities, including basic health centers, comprehensive health centers, and district and regional hospitals, allowing data capture in even remote areas of rural Afghanistan. Every week, DEWS focal points at sentinel sites compile and send morbidity and mortality data, disaggregated by sex and two age groups (<5 years and ≥5 years), for 16 diseases and conditions to provincial DEWS offices, which, in turn, send compiled data to the national DEWS office. The national DEWS office at the MoPH produces a DEWS Weekly Epidemiological Report, which is distributed to relevant departments and published online at the MoPH website and the ANPHI Facebook page. DEWS is mandated to coordinate with other surveillance programs, provide logistical support to ensure that specimens reach the Central Public Health Laboratory in good condition, and ensure laboratory quality control through standard operating procedures and external quality assurance measures. As a signatory to the International Health Regulations (IHR 2005), Afghanistan has pledged to meet global standards for preventing, detecting, and responding to the international spread of disease. DEWS is one of the most important tools Afghanistan has to be able to meet IHR obligations. This evaluation assesses the performance of DEWS from December 2006 until December 2013 against the objectives agreed upon by the MoPH, USAID, and WHO. The evaluation focuses on the following questions: How has the DEWS program performed programmatically and financially? Has DEWS contributed to the reduction of the morbidity and mortality rates of various health-related problems in Afghanistan? What key lessons has the MoPH learned through DEWS implementation, and how can local and national authorities apply these lessons to improve the effectiveness of DEWS? The evaluation aimed to identify and evaluate the strengths and weaknesses of DEWS, identify effective program components and lessons learned, and provide actionable recommendations for the future. The evaluation design and methods involved a comprehensive review of DEWS documents, interviews with key stakeholders, and a review of DEWS data and reports. The evaluation also considered the limitations of the DEWS program, including the challenges of implementing a surveillance system in a conflict-affected country with limited resources and infrastructure. The evaluation found that DEWS has made significant contributions to the reduction of morbidity and mortality rates of various health-related problems in Afghanistan. The program has also improved the capacity of the MoPH to detect and respond to public health events, and has enhanced the coordination and collaboration among different stakeholders in the health sector. However, the evaluation also identified several challenges and limitations of the DEWS program, including the need for improved data quality and timeliness, the need for enhanced capacity building and training for DEWS staff, and the need for increased funding and resources to support the program. Based on the findings of the evaluation, the report provides several recommendations for the future of DEWS, including the need to improve data quality and timeliness, enhance capacity building and training for DEWS staff, and increase funding and resources to support the program. The report also recommends that the MoPH and USAID work together to develop a comprehensive plan to strengthen the DEWS program and ensure its sustainability in the long term.