Surveillance: What Is It? How Does It Relate to Routine Information Gathering and Use? Do We Need It?

Peter Nsubuga, U.S. Centers for Disease Control and Prevention

Abstract

It is a truism that "all politics is local." Those who have worked in District Health Offices know that limitations of staff and logistics means that "all health information is integrated at the district level and below," because the same few staff members gather and analyze data (and do everything else). Recognizing this reality allows planners to build on the potential benefits of integration (training, shared logistics, etc.) and to minimize potential pitfalls (health workers spending all their time on one system, etc.).

Surveillance systems are the part of the health information system that provides rapid information to support public health responses that must often be made on short notice. Because surveillance systems may generate information of political interest, there are opportunities to increase the amounts of resources that can be shared at the local level. Surveillance has many definitions all of which imply collection of information for rapid action. Information from the surveillance system is one source of data for the routine health information system. The type of action and when the action would need to be taken should determine the objectives and the method of collection of health information.

The U.S. Centers for Disease Control and Prevention (CDC) has worked with WHO (headquarters and African Regional Office [WHO-AFRO]) to define a strategy to improve infectious disease surveillance, epidemic preparedness and response (EPR) called the Integrated Disease Surveillance (IDS) strategy. The IDS strategy focuses on 19 priority infectious diseases and is implemented through the phases of assessments, prioritized action planning, implementation, monitoring and evaluation. To date 19 countries in the 46 country WHO-AFRO have initiated IDS and data from 10 countries' assessments will be presented.

In the IDS strategy improvements are based on a definition of the core activities of surveillance and EPR (i.e., detection, confirmation, registration, reporting, analyses, response, and feedback), support functions which include training, supervision, coordination, communication, and resource-provision, and the levels at which they occur (i.e., community, health facility, district, national, international). CDC, WHO-AFRO and partners have developed technical guidelines to help countries with implementation of IDS, based on the core activities and support functions of surveillance and EPR, focusing on the district level.

Challenges in the way forward include how the current health information systems can be used as a vehicle for improved surveillance and EPR and the utilization of disease specific programs against HIV/AIDS, TB, malaria and polio. Efforts are also underway to develop indicators that would measure the impact of improved surveillance and EPR.