Introduction
The April 2023 evaluation provides a comprehensive look at how the Philippines monitored COVID-19 and other respiratory viruses across national, regional, and local levels. Using mixed methods, the study assessed operations, interconnectivity, and performance, with a focus on sustainable, multisource surveillance for SARS-CoV-2, influenza-like illness (ILI), severe acute respiratory infection (SARI), and respiratory syncytial virus (RSV).
Scope of surveillance systems evaluated
Six systems were examined: COVID-19 case-based surveillance, COVID-19 traveler screening, SARS-CoV-2 genomic surveillance, ILI sentinel surveillance, SARI sentinel surveillance, and an RSV sentinel pilot. Sites spanned three regions—Cordillera Administrative Region, Eastern Visayas, and the National Capital Region—to reflect geographic and administrative diversity. The evaluation aimed to describe structure and processes, measure usefulness and acceptability, assess performance indicators such as timeliness and data completeness, and determine how well surveillance data described person, place, and time patterns of transmission.
Key findings
Surveillance landscape and information systems
In response to the pandemic, the DOH expanded surveillance and created new information systems. The shift included universal COVID-19 reporting, sentinel ILI/SARI networks, and the introduction of TKC to replace COVIDKaya, as well as the EDCS-IS suite to modernize notifiable disease reporting. Although these systems improved data collection and molecular testing capacity, they created fragmentation, with eight systems in concurrent use and limited interoperability between epidemiologic and laboratory data platforms. End-user feedback highlighted mismatches between system capabilities and frontline needs, leading to workarounds and duplicated workflows.
Laboratory capacity and genomic surveillance
Molecular testing expanded rapidly, with a rise in PhilHealth-accredited SARS-CoV-2 laboratories from 114 to 234 (2020–2022) and four national sequencing laboratories by 2023. The RITM and GECO-PH initiatives helped coordinate sequencing, contributing thousands of genomes to global databases. Yet, capacity gaps remained for multiplex testing and bioinformatics, underscoring a need to sustain laboratory throughput and data quality as routine surveillance becomes less resource-intensive.
Data quality and timeliness
Across the six systems, data completeness varied. Key variables like sex and residence were highly complete, but others—such as patient outcomes in SARI and non-SARS-CoV-2 test results in some systems—showed gaps. Timeliness favored COVID-19 case-based reporting (median 3 days from symptom onset to lab result), whereas sentinel systems reported longer delays. Fragmented systems and nonstandardized data flows hindered timely, population-level interpretation and cross-system comparisons.
Operational challenges
Workforce constraints, high workload, and reliance on short-term contracts strained sustainability. Staff faced heavy surveillance demands at risk of burnout, with limited capacity-building and unclear job descriptions. A broader governance and interoperability issue emerged: multiple systems with overlapping scopes increased administrative burden and raised data consistency concerns across national, regional, and local levels.
Recommendations for a right-sized, integrated approach
- Right-size universal COVID-19 surveillance: taper routine case reporting, while maintaining sentinel networks and targeted traveler screening.
- Integrate influenza, SARS-CoV-2, and RSV into a single, harmonized surveillance model: unify data tools, testing algorithms, and reporting formats to reduce duplication and improve interoperability.
- Strengthen sentinel surveillance and syndromic monitoring: focus resources on well-distributed sentinel sites, with regular data quality auditing and catchment-area assessments to ensure representativeness.
- Improve data systems and governance: standardize reporting tools (e.g., CIFs, summaries), clarify roles, and invest in interoperable platforms to minimize manual data transfers.
- Invest in capacity-building and workforce sustainability: provide ongoing training in data management and epidemiology, and address long-term staffing needs beyond pandemic-era contracts.
Looking ahead
Lessons from the Philippines’ experience echo globally: rapid digital expansion during a health crisis brings benefits in surveillance and surge capacity but challenges in interoperability and data quality. A phased transition toward an integrated respiratory virus surveillance framework aligns with WHO guidance and supports sustainable, data-driven decision-making as public health priorities evolve.
