Assessing the local context for implementing a climate based early warning system for dengue fever outbreaks in Ecuador

Resumen

Dengue fever is hyper-endemic in Ecuador and has persistently challenged its public health system. Previously, El Niño Southern Oscillation (ENSO) and its impact on local temperature and precipitation in coastal Ecuador was linked to dengue outbreaks. A framework for early epidemics prediction based on long-lead ENSO and local climate forecasts was developed and tested for El Oro province. It could provide timely information to policy makers, but it is not being systematically utilized. In this study we assess barriers and pathways for a climate-driven dengue EWS implementation in Ecuador. Initially, 30 stakeholders from the climate and health sector were approached, and 11 semi-structured interviews were conducted and analyzed using the Consolidated Framework for Implementation Research to identify needs and priorities. Although all topics were covered during each interview, the structure and sequence of the questions varied according to the stakeholder background. In the exploratory phase specific codes were assigned to data fragments, and themes that reached the highest level of saturation were analyzed. Our results point to a limited compatibility between the current outbreak management and a climate-driven dengue EWS. To enhance compatibility, all participants indicated that EWS implementation should be led by the Ministry of Health or another established inter-institutional management structure invested with authority and knowledge about the needs and aims. This would ensure the participation of stakeholders with diverse backgrounds, and build trust in the EWS. Promoting data sharing, working on city or province level and improving local infrastructure to prevent flooding could also guarantee its effectiveness.