Integrated Disease Surveillance and Response (IDS/R) in the African Region

Integrated Disease Surveillance and Response (IDS/R) in the African Region Mary Harvey and Patrick Swai SOTA June 12, 2002

AFRO

GOAL Improve the well-being of the 600 million people living in the 46 Member States of the WHO Regional Office for Africa through implementation of integrated disease surveillance for infectious diseases and improved preparedness for epidemic response

WHO/AFRO Priority Infectious Diseases • Diseases targeted for eradication/elimination • Epidemic Prone Diseases • Diseases of Public Health Importance

General Objective of IDS To provide evidence on which to base decisions and public health interventions for the control of communicable diseases

Specific Objectives of IDS 1. To strengthen the capacity of health workers to conduct surveillance activities. 2.To Integrate multiple surveillance systems for efficiency of staff, forms, resources. 3. Improve use of Information for decision making. 4. To improve the flow of surveillance information between and within levels of the health system 5. To strengthen laboratory capacity and involvement in confirmation 6. To increase involvement of clinicians

Steps for IDS Strategy implementation Implement Plan Plan Assess Sensitize

Major achievements • Completion of IDSR TG, tools / instruments • Strengthening of the Laboratory • Training • Indicators drafted and being field tested • Support from MOH, USAID, UNF ,CDC, WHO • National IDS coordinating committees • Progress observed on implementation of IDSR in Member States

Status of IDS Implementation Non AFRO country Not started Initial contact made Preparing assessment Assessment completed Plan of action completed Guidelines adaptation initiated Guidelines adapted

Challenges • Ownership and sustainability • Availability of resources • Commitment of stakeholders • Involvement of all levels

Expected Outcomes of IDS • Simplification of recording and reporting • Information is more accessible and timely • Action taken is more timely and appropriate • Resources are used more effectively

Developing experience and evidence in surveillance implementation in Tanzania Dr. Patrick Swai USAID/Tanzania

Milestones of IDS in Tanzania • 1998 National level assessment • 1998 Adoption of IDS strategy • 1999 Implementation plan developed • 2000 IDS Task Force created • 2001 National IDS guidelines for 13 priority diseases • 2001 Lab networking guidelines • 2002 Development of draft District analysis book • 2002 The coordinated implementation team initiated implementation in focus districts

Source of USAID funds for IDS implementation in Tanzania • Africa Bureau – Providing support to WHO, (including the 1998 assessment) • Tanzania Mission – operationalizing the IDS strategy and strengthening surveillance implementation • Bureau of Global Health – developing evidence of successful programming around surveillance; dissemination of tools, materials, and lessons learned to other countries

USAID-funded partners in local IDS implementation in Tanzania • National Institute for Medical Research (NIMR) • Partners for Health Reform plus (PHRplus) • Centers for Disease Control and Prevention -- NCID and EPO/DIH • CHANGE Project • HealthTech

Structure of the Tanzania Health System and Relevance for IDS Know what to report when to health care system for action; Participate in response and prevention Communities Identify cases, report, respond and participate in public health actions Facilities Hub of decision making, response/ action and resource mobilisation District Reg’l Support for lab, outbreak investigation, training Policy, direction, plan, country guidelines Nat’l WHO Strategy, guidelines, tools

How the implementation team contributes to IDS strengthening • WHO/AFRO – support to creating strategy, guidelines, and tools • IDSR guidelines provide a comprehensive technical definition of a functioning system. • Local implementation process is beyond the scope of regional guidelines • Local-level (country) implementation: operationalize the strategy and guidelines

Questions for country level implementation: • What obstacles do districts, facilities, and communities face in operationalizing the system? • What are the best strategies for overcoming these obstacles?

What are some of the obstacles that districts in Tanzania face? • Very limited diagnostic confirmation capacity • Lack of adequate communications between levels • Barriers to adequate transport of specimens • Low motivation and capacity for analysis (and use) of information for public health action • Poor coordination of available resources • Undefined roles and responsibilities for IDS • National level standards and policies missing Need a guiding “road map” for operationalizing IDSR

How we are breaking ground in implementation in Tanzania • Support the development of new ID surveillance and public health action technologies and tools for both epidemic and non-epidemic diseases • Conduct research into critical issues surrounding ID surveillance and response that will support its successful adoption by other countries • Coordinate with global and national institutions to provide training to develop the necessary skills needed for ID surveillance and response

How we are breaking ground in implementation in Tanzania • Disseminate lessons learned • Develop successful examples of ID surveillance and response that can be adopted by other districts in Tanzania and other countries to address the real obstacles at local levels

Implications for other countries for implementing IDSR • Provide a model for other countries • Answer questions with operations research • Development of best practices • Documentation and transfer of experiences and lessons learned • Dissemination of tools and materials for implementation

Thank you!