Finding the fragments: community-based epidemic surveillance in Sudan.

Sudan faces inter-sectional health risks posed by escalating violent conflict, natural hazards and epidemics. Epidemics are frequent and overlapping, particularly resurgent seasonal outbreaks of diseases such as malaria, cholera. To improve response, the Sudanese Ministry of Health manages multiple disease surveillance systems, however, these systems are fragmented, under resourced, and disconnected from epidemic response efforts. Inversely, civic and informal community-led systems have often organically led outbreak responses, despite having limited access to data and resources from formal outbreak detection and response systems. Leveraging a communal sense of moral obligation, such informal epidemic responses can play an important role in reaching affected populations. While effective, localised, and organised-they cannot currently access national surveillance data, or formal outbreak prevention and response technical and financial resources. This paper calls for urgent and coordinated recognition and support of community-led outbreak responses, to strengthen, diversify, and scale up epidemic surveillance for both national epidemic preparedness and regional health security.

Building power-ful health systems: the impacts of electrification on health outcomes in LMICs.

Critical disparities threaten health care in developing countries and hinder progress towards global development commitments. Almost a billion people and thousands of public services are not yet connected to electricity - a majority in sub-Saharan Africa. In economically fragile settings, clinics and health services struggle to gain and maintain their access to the most basic energy infrastructure. Less than 30% of health facilities in LMICs report access to reliable energy sources, truncating health outcomes and endangering patients in critical conditions. While 'universal health coverage' and 'sustainable energy for all' are two distinct SDGs with their respective targets, this review challenges their disconnect and inspects their interdependence in LMICs. To evaluate the impact of electrification on healthcare facilities in LMICs, this systematic review analysed relevant publications up to March 2021, using MEDLINE, Embase, Scopus, CENTRAL, clinicaltrials.gov and CINAHL. Outcomes captured were in accordance with the WHO HHFA modules. A total of 5083 studies were identified, 12 fulfilled the inclusion criteria of this review - most were from Africa, with the exception of two studies from India and one from Fiji. Electrification was associated with improvements in the quality of antenatal care services, vaccination rates, emergency capabilities and primary health services; with many facilities reporting high-quality, reliable and continuous oxygen supplies, refrigeration and enhanced medical supply chains. Renewable energy sources were considered in six of the included studies, most highlighting their suitability for rural health facilities. Notably, solar-powered oxygen delivery systems reduced childhood mortality and length of hospital stay. Unavailable and unreliable electricity is a bottleneck to health service delivery in LMICs. Electrification was associated with increased service availability, readiness and quality of care - especially for women, children and those under critical care. This study indicates that stable and clean electrification allows new heights in achieving SDG 3 and SDG7 in LMICs.