A proposed framework for the evaluation of cholera surveillance systems in Africa

Abstract

Background: Despite the global roadmap to end cholera by 2030, the disease remains a major public health challenge in Africa, compounded by weak surveillance systems, inadequate multisectoral coordination and delayed case detection. A significant impediment is the absence of a comprehensive surveillance evaluation framework for African nations to systematically identify and address these critical capacity deficits.
Aim: This study builds upon prior research that highlighted the wide variations in existing surveillance evaluation frameworks, aiming to propose a comprehensive conceptual framework for assessing cholera surveillance systems in Africa.
Setting: This study focused on empirical data and feedback gathered from eight cholera-affected countries: Democratic Republic of Congo, Nigeria, Zambia, Zimbabwe, Mozambique, Somalia, Kenya, and Ethiopia.
Methods: This was a mixed-method study and leveraged insights from a previous systematic review lasted 7 months (July 2024 to January 2025). The approach involved a detailed assessment of existing frameworks and consultations with eight cholera-affected countries.
Results: The assessment of 10 existing frameworks revealed consistent gaps, notably the absence of essential components such as cross-border surveillance, digitisation, effective linkages between surveillance and laboratory systems, and sustainable financing mechanisms. Our conceptual framework is structured around three key pillars: resource allocation, system structures and core functions, all underpinned by strong governance and leadership.
Conclusion: This study recommends the adaptation and integration of our proposed comprehensive framework into broader surveillance strategies and guidelines to significantly improve cholera surveillance across Africa, thereby enhancing early detection and response capabilities.
Contribution: This study presents a novel comprehensive framework for cholera surveillance system evaluation and recommends its adaptation and integration into broader surveillance strategies and guidelines to significantly improve cholera surveillance in Africa.