Disease surveillance is one of the areas where digital health is increasingly being applied, particularly in low-income countries. In Burkina Faso (BF), the liberalization of the telecommunications sector since 1996 has provided an opportunity for the adoption of Information and Communication Technologies (ICT) in the health sector. In 2004, the Ministry of Health and Public Hygiene (MSHP) adopted an e-health policy aimed at covering 95% of health facilities with ICT solutions by 2020. This article paid particular attention to the innovations emerging in the disease surveillance and response system (SIMR) in the face of the state's inadequate integration of ICTs into the healthcare system. More specifically, we will focus on innovations taking place in health and social promotion centers (CSPS). The study was conducted in Dandé health district in the south-western part of BF. Based on qualitative methods, data were collected through semi-structured interviews with head nurses (ICP) (n=11), Expanded Program on Immunization (EPI) managers (n=10), CISSE members (n=2) and Community-Based Health Workers (CBHWs) (n=15), as well as through observations of ICTs uses. Content qualitative analysis was performed by using concepts of tinkering and bricolage to discussing our results. With the advent of the wireless telephone, the government has tried to build a digital infrastructure, equipping the CSPSs with MoovAfrica (ex-Telmob) telephone chips and a prepaid "fleet" communication system of 5000 FCFA/month for the collection and transfer of epidemiological data called The Telegram Official Weekly Letter (TLOH). The results showed that the use of this "TLOH fleet" digital device encounters difficulties linked to the MoovAfrica telephone network signal, which is not fluid, specifically in rural localities. Other difficulties lie in the fact that the standard model of telephone acquired by the CSPSs does not have the functionalities to enable them to adapt to the challenges of call saturation on the CISSE fleet number. As the fleet is designed for telephone calls only, it is impossible, for example, for health workers to send SMS messages or use the Internet or WhatsApp. To overcome such challenges, the majority of ICPs use their personal phones to send SMS or call CISSE's personal number(s). As these personal numbers are not registered in the fleet system, ICPs are obliged to bear the cost of calls and SMS messages. In the age of digital convergence, health workers' strategies for adapting to the new environment involve the use of smartphones and personal megadata. WhatsApp has thus become a palliative to the problem of queuing and the telephone network. Since data is sent every Monday morning until 10 a.m., ICPs prefer to use their own megadata to transfer TLOH via WhatsApp from Sunday evening onwards. Our results also show that, in addition to TLOHs, patient follow-up sheets and investigation sheets are now dematerialized via this WhatsApp application. Several WhatsApp groups (TLOH DS DANDE, INFO_CISSE DS DANDE, for example) and the CISSE manager's personal WhatsApp account are used as channels for sending data in the form of manuscript photos, Excel or Word files. All in all, our results show the extent to which state efforts are negligible in the implementation of the "e-health" policy, and thus call the attention of health authorities to the need to build a reliable public digital infrastructure that takes into account the environmental challenges of rural localities.

Digital health m-Health/e-Health Epidemic disease surveillance