Improving surveillance data quality and use in Tanzania

1. Improving surveillance data quality and use in Tanzania Kathryn Kohler Banke, Ph.D. Peter Mmbuji, M.D., M.Med. Global Health Council June 1, 2005

2. Overview • Background – integrated disease surveillance and response (IDSR) • PHRplus/National Institute for Medical Research (NIMR) project in Tanzania • Results • Next steps • Lessons learned

3. Integrated Disease Surveillance and Response (IDSR) • WHO strategy for infectious disease surveillance in the African region (1998) • Goal: Improved detection of and response to priority infectious diseases

4. IDSR functions • Identify cases • Report • Analyze and interpret data • Investigate and confirm cases/outbreaks • Respond • Provide feedback • Evaluate and improve system

5. Overview of USAID-funded IDSR strengthening project in Tanzania • Partners: MOH, National IDSR Task Force, NIMR, PHRplus, CDC, CHANGE Project, WHO/AFRO • Objective: Improved prevention and control of 13 priority infectious diseases • Implementation: 2002-2005 • Develop, test, refine strategies most effective for improved system performance in 12 districts • Focus on district and facility levels

6. IDSR priority diseases, Tanzania • Epidemic-prone diseases • Cholera, bacillary dysentery, plague, measles, yellow fever, cerebrospinal meningitis, rabies • Diseases targeted for eradication/elimination • Acute flaccid paralysis, neonatal tetanus • Diseases of public health importance • Diarrhea <5 years, pneumonia <5 years, malaria, typhoid

7. Baseline situation: Monthly IDSR report accuracy Accuracy defined as number of cases in submitted report within +/- 5% of number of cases in data audit.

8. Baseline situation: Routine data analysis

9. The PHRplus/NIMRIDSR intervention in Tanzania (1) • Situation analysis • Epidemic preparedness planning • Disease outbreak management field manual • Training materials and methods • Training of trainers; district and facility level IDSR trainings

10. The PHRplus/NIMRIDSR intervention in Tanzania (2) • Data management, analysis, & interpretation tools • Follow-up visits and district quarterly meetings • Monitoring and evaluation • Operational research (costing; analysis and response)

11. The PHRplus/NIMRIDSR intervention in Tanzania (3) • Laboratory job aids • Community linkages

12. Results: IDSR materials and job aids • Tested, revised, finalized • Endorsed by IDSR Task Force • Ready for scale-up

13. Results: Improved capacity for sustainable training • Trained staff at all levels: • 51 District level trainers • 96 District Health Management Team members • 32 Facility level trainers • 787 Facility health workers in 591 facilities • Strengthened horizontal and vertical linkages between National level, Zonal Training Centers, Regions, and Districts • High demand for IDSR training in non-project districts

14. Results: Improved reporting District Training Facility Training

15. Results: Improved reporting

16. Results: Improved reporting

17. Next steps • Materials & methods in place, but funds lacking • Zonal Training Centers – expanding training using methods and materials • Global Fund proposal • Scale up IDSR plus other health system strengthening needs

18. Lessons learned • Understand the system and define standards • Adapt materials to local context • Focus on facility and district levels • Training necessary, but not sufficient • Integration challenging

19. Thank You Reports related to this presentation are available at www.phrplus.org

21. Babati Dodoma Rural Project districts

22. Results: Improved reporting

23. Results: Improved reporting

24. Results: Improved reporting

25. Results: Improved reporting