When communities are equipped with strong disease warning systems and people trained to use them, they are able to respond more quickly to threats, limiting the spread of disease. An initiative based primarily in Africa has verified nearly 73,000 threats in the last three years, half of which were flagged within 24 hours.
The program is called Strengthening Outbreak Notification and Response (SONAR). Led by The Task Force for Global Health, with support from the Global Fund, SONAR enables countries to be proactive in detecting, notifying and responding to emerging health threats and outbreaks.
“SONAR embeds highly skilled locally-based epidemiologists within the national and subnational structures to work alongside the Ministry of Health to improve data quality which informs decision-making at all levels,” said Dr. Malembe Ebama, Director of SONAR. “At the end of the project, SONAR will leave behind public health staff who are better prepared for the next epidemic, as well as systems that are functional, sustainable, replicable and owned by the country.”
SONAR builds critical preventative capacity, with a strong emphasis on national leadership, to ensure communities can withstand emerging and resurgent diseases. In an interconnected world, having this timely information is not only crucial but can be the decisive factor between disease containment and crisis.
“If someone in a community sees multiple people with unusual symptoms, they know what to do, they know who to call, and then that next person knows what to do, and the chain works from the most remote area to the national level,” said Dr. Ebama.
SONAR has significantly strengthened workforce capacity across regional, national, and subregional tiers. This success includes training 5,600 trainers and 44,000 community health workers, alongside specialized surveillance training.
“We are helping 14 countries strengthen their surveillance systems so they are better prepared for the next pandemic,” said Dr. Ebama. “We work with ministries of health and other partners to ensure their approaches are coordinated in every step of the chain.”
Strengthening Disease Response
In Mangochi, a lakeside district in southeastern Malawi, SONAR’s early warning system enabled a swift response to a measles outbreak. Rapid detection and confirmation allowed vaccination teams to act quickly, cutting the transmission chain and limiting the outbreak to 126 cases – an outcome that would likely have been far worse without early intervention.
The SONAR initiative applies the 7-1-7 approach to help countries identify and address delays in their surveillance and response systems. This means the team teaches countries to detect a health event within seven days, notify authorities within one day, and initiate an effective response within the next seven days. This method highlights possible gaps in laboratory confirmation, data reporting or coordination, and also drives countries to strengthen their systems in real time. This results in faster detection and outbreak response after a threat is detected – saving lives and resources and building trust in national systems.
“SONAR has worked intensively on capacity building of more than 70 regional, national and subnational consultants. These national consultants, who are within the country, are a great asset and will continue to strengthen the health system,” said Asalif Belayneh, SONAR’s Associate Director.
The partnership and capacity-building initiatives are yielding significant, real-time results in countries like Kenya, Madagascar and Sierra Leone.
The Kenya Ministry of Health says the legacy of SONAR’s partnership is not just a set of tools, but a fundamental shift in their public health culture and capabilities.
“We are building a system that can withstand shocks,” said Yusuf Ajack, the monitoring and evaluation and informatics focal person in the Division of Disease Surveillance and Response in Kenya. “The infrastructure and protocols developed for pandemic response are equally effective for managing seasonal health challenges, natural disasters, or future novel pathogens. This resilience directly translates to saved lives and a more stable society.”
Likewise, Madagascar has enhanced its early warning system through event-based surveillance, says Dr. Raseheno Harinirina, the country’s Director of Surveillance and Response.
This improvement is measured through WHO’s Joint External Evaluation tool, which measures a country’s public health system by assigning scores from one (no capacity) to five (sustainable capacity).
“Progress was reflected in higher scores in the surveillance technical area during the joint external evaluation in October,” said Dr. Harinirina.
In Sierra Leone, SONAR provided technical support to scale up the event-based surveillance (EBS) implementation and organized training for national and district-level staff. Officials at Sierra Leone’s National Public Health Agency credit the support and materials with improving outbreak detection, especially among community members.
A Lasting Legacy
The resilient foundation that SONAR has helped build will enable participating countries to expand the work and serve as a model for future global health security initiatives.
For example, Sierra Leone’s EBS structure is gradually being scaled up to multiple districts.
Similarly, the Kenya Ministry of Health is planning to consolidate all of their systems under the National Public Health Intelligence Information System – which SONAR helped develop – to avoid duplication of effort.
“The systems established by SONAR improve how countries collect, analyze and use surveillance data, making outbreak detection faster. Over time, these improvements and adopted practices translate into earlier response, fewer outbreaks and more efficient use of public health resources,” said Dr. Ebama.
Similar to how Task Force Co-Founder Dr. Bill Foege reflected on smallpox eradication years after the mission was complete, Dr. Ebama says she feels the same about this surveillance work.
“I believe one day we’ll look back at this post-pandemic era and the work happening now and realize that this was a turning point,” said Dr. Ebama.
