Since 2002, the Global Fund has invested more than US$60 billion to fight the deadliest infectious diseases on earth: HIV, tuberculosis (TB), and malaria. To protect those programs during the COVID-19 pandemic, the Global Fund created the COVID-19 Response Mechanism (C19RM) in 2020 to fight COVID-19, adapt lifesaving HIV, TB and malaria programs, and reinforce fragile systems for health. As the pandemic evolved, C19RM investments adapted to respond to countries’ needs and promote efficient use of investments, shifting from the acute emergency response to COVID-19 to strengthening systems for health and preparing for future pandemics.

Global Fund C19RM funds were provided to prime recipient World Vision in Papua New Guinea. The C19RM funds were designed to support emergency COVID programming and strengthen the health system in Papua New Guinea. The Meeting Targets and Maintaining Epidemic Control (EpiC) project was funded by the U.S. Agency for International Development (USAID) to provide technical assistance (TA) to support the C19RM activities and ensure this work progressed effectively. EpiC supported two major activities: a diagnostics network optimization (DNO) study and strengthening COVID-19 surveillance systems.

Diagnostics network optimization study

The DNO was a large-scale study conducted across 18 of the 22 provinces in Papua New Guinea to better understand the existing diagnostic network for COVID-19, TB, and HIV viral load monitoring and early infant diagnosis. This study has been critical to COVID-19 programming as it has identified the national diagnostic capacity for COVID-19 and led to development of operational plans and scenarios that could optimize the network and improve access, utilization rates, and efficiencies. It has also highlighted infrastructure and capacity gaps while measuring utilization rates that informed what opportunities existed to support the current COVID-19 response and also prepare for future pandemics.

Through the DNO study, an improved understanding of the diagnostic network that supports COVID-19, as well as HIV and TB, was established. Operational plans that have been developed will therefore benefit all three disease programs and will ensure that there are efficiencies and optimizations across diagnostic services for HIV, TB, and COVID-19, which use the existing GeneXpert network in Papua New Guinea.

COVID-19 surveillance system strengthening

EpiC’s surveillance system strengthening efforts supported the national COVID-19 response by improving surveillance, data management, and data use. C19RM funds were used to conduct a rapid assessment of existing COVID-19 surveillance systems and identify gaps and opportunities for improvement. The assessment highlighted the need for a more robust and open-source data system that could address the current surveillance needs, while preparing the country to handle future data management priorities for disease surveillance. Through this investment, EpiC was able to improve the existing COVID-19 system before making recommendations to migrate to a longer-term and open-source solution in District Health Information Software 2 (DHIS2). EpiC supported the National COVID-19 Control Centre (NCC) and the National Department of Health (NDoH) to develop the Outbreak Information Management System (OIMS) based on DHIS2 that will serve as the national disease surveillance data management platform. EpiC supported the migration of existing COVID-19 records to the new platform for improved data management and use.

Efforts to improve COVID-19 surveillance have led to the introduction of DHIS2 into Papua New Guinea. With its introduction, efforts are underway to leverage the platform to support case-based surveillance from other programs, like HIV, to improve centralized data management, and improve data access and data use.

Sustaining health system improvements

While the C19RM funds were initially designed for the emergency pandemic period, the investments will have lasting impacts on the health system. EpiC will hand over the DNO operational plans to the 18 Provincial Health Authorities to help them implement the recommendations for optimizing the diagnostic network for COVID-19, TB and HIV. EpiC will also transfer the DNO data and geospatial mapping to the NDoH to support the planning and monitoring of the diagnostic network. EpiC will migrate the DHIS2-based OIMS to the NDoH for ongoing management and configuration. The OIMS will serve as the national disease surveillance data management platform for COVID-19 and other respiratory diseases.

The investment by Global Fund, with support from EpiC Papua New Guinea, was instrumental in supporting emergency COVID-19 response, as well as sustaining improvements to the overall health system in the country. Through its partnership with the Global Fund, EpiC has been able to mitigate the impact of COVID on other disease programs and stabilize the health system during the periods of pandemic response and recovery.

Featured image: EpiC DNO Project Monitoring and Evaluation Officer Murphy Tauno diligently records data from the TB presumptive register book into the Health Facility Register form during the DNO data collection exercise in East New Britain Province, Papua New Guinea. Photo by Douglas Diave, FHI 360.