Development of a climate-sensitive disease forecasting tool in the Horn of Africa: A multi-stakeholder exploration of priorities in Ethiopia, Kenya, Somalia, and Uganda

Extreme climate events impose significant impacts across the Horn of Africa. One way to monitor these is by using novel digital tools to forecast extreme events and climate-sensitive disease outbreaks. However, limited information exists on stakeholder use of such tools. This qualitative study identified key multidisciplinary stakeholders in Ethiopia, Kenya, Somalia, and Uganda, and conducted a needs assessment and gap analysis. Focal persons of multi-lateral agencies, government institutions and ministries, non-governmental organisations, and academic institutions, at regional, national, and sub-national levels, were engaged in Key Informant Interviews (KIIs; N = 63) and Focus Group Discussions (FGDs; N = 7, total participants = 57). Malaria (54.0%), Rift Valley Fever (RVF; 44.4%), cholera (39.7%), dengue fever (27.0%), and anthrax (14.3%) were the most frequently reported climate-sensitive disease priorities amongst KII participants. Country-level variations existed in the use of climate or environmental data to support disease decision-making (Kenya: 95.2% of KII participants, Uganda: 75.0%, Somalia: 64.3%, Ethiopia: 58.3%), electronic reporting systems (Kenya: 42.9%, Ethiopia: 41.7%, Somalia: 14.3%, Uganda: 12.5%), and modelled outputs (Kenya: 57.1%, Uganda: 25.0%, Somalia: 7.1%). FGD participants described barriers to sustainable digitalised systems including cost-effectiveness, lack of technological expertise or support, and poor Internet access, which may be addressed by engaging key national stakeholders, training provision, and financial resources. Overall, digital tool preferences for analysing, displaying or reporting data included provision of data summaries and visual aids, a dashboard format, and functions to download data for further analysis. This study provides critical insights into the needs of disease control stakeholders who would benefit from, and are the likely primary users of, digital tools to tackle the increasing threat of climate-sensitive diseases. It underscores the importance of applying context-specific approaches to supporting local capacity, which will inform the development of a sustainable Climate Sensitive Disease Forecasting Tool (CLIMSEDIS).