Strengthening a collaborative approach to implementing surveillance systems: Lessons from the Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) in Malawi and Zimbabwe

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Abstract Background With the number of antimicrobials available to effectively treat gonorrhoea rapidly diminishing, surveillance of antimicrobial–resistant Neisseria gonorrhoeae (NG) is critical for global public health security activity. Many low-and-middle-income countries (LMICs) have gaps in their existing sexually transmitted infections (STIs) surveillance systems that negatively impact global efforts geared towards achieving the United Nations (UN) Sustainable Development Goals (SDGs). This paper explains the contribution of collaborative surveillance systems to health systems strengthening (HSS) learning from integrating NG surveillance into existing Ministries of Health’s (MoH) antimicrobial resistance (AMR) surveillance services in Malawi and Zimbabwe. Methods We used the WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) implementation experiences in Malawi and Zimbabwe to demonstrate the collaboration in AMR and STI surveillance. We conducted qualitative interviews with purposively selected health managers directly participating in the AMR and STI programs using a standardized key informant guide to describe how to plan for a collaborative surveillance system. Qualitative thematic analysis was conducted to delineate stakeholders’ recommendations using the health systems’ building blocks. Results Stakeholder engagement, prioritization of needs, and power to negotiate were key drivers to a successful collaborative surveillance system. Weak governance, policies, lack of accountability, and different priorities, coupled with weak collaborations, workforce, and health information systems, were challenges faced in having effective collaborative surveillance systems. Data availability, use, and negotiation power were key drivers for the prioritization of collaborative surveillance. Including collaborative surveillance in primary health services and increasing government budget allocation for surveillance were recommended. Conclusions Strengthening collaborative surveillance systems in LMICs using a people-centered approach increases transparency and accountability and empowers national institutions, communities, and stakeholders to engage in sustainable activities that potentially strengthen health systems. EGASP implementations in Zimbabwe and Malawi serve as models for other countries planning to implement or improve collaborative surveillance systems in their context.

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