Transcript No Slide Title

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
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
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
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
Communities
Facilities
District
Reg’l
Nat’l
Know what to report when to health
care system for action;
Participate in response and prevention
Identify cases, report, respond and
participate in public health actions
Hub of decision making, response/
action and resource mobilisation
Support for lab, outbreak investigation, training
Policy, direction, plan, country guidelines
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
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 operationalizing
available
Need
a guiding
“road map” for
IDSR
resources
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
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!
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
Communities
Facilities
District
Reg’l
Nat’l
Know what to report when to health
care system for action;
Participate in response and prevention
Identify cases, report, respond and
participate in public health actions
Hub of decision making, response/
action and resource mobilisation
Support for lab, outbreak investigation, training
Policy, direction, plan, country guidelines
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
Need
a guidinglevel
“roadstandards
map” for operationalizing
• National
and policies IDSR
missing
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
Epidemic Preparedness
and Response
• Yellow Fever epidemics in Cote
d'Ivoire, Ghana, Guinea and Liberia
in 2000-2001
• 5 Countries accounted for 75% of
the 61,988 Meningitis cases and
67% of the 6,172 deaths:Burkina,
Niger, Benin, Mali, Ethiopia, and
Chad
• Cholera in South Africa, Malawi,
Madagascar, Zambia
• Ebola: Gabon, RDC, Uganda
Meningitis Epidemics in Africa
• Meningitis epidemics
historically caused by
serogroup A meningococci
• Other serogroups (B, C, W135)
often associated with sporadic
disease in Africa
• However, W135 outbreak in
Saudi Arabia in 2000 created
alert (264 cases)
Meningitis Epidemic
Preparedness and Response
• 1. Epidemic Management
committee
• 2. Laboratory-based
surveillance and alert system
• 3. Strengthen Laboratory
• 4. Vaccination with A/C
vaccine
• 5. Case management
• 6. Social mobilisation
Definition of Alert and Epidemic Thresholds for
Meningococcal Meningitis in Highly Endemic
Countries in Africa [a]
Alert threshold
Epidemic
threshold
Population
Over 30,000
Population
Under 30,000
5 cases / 100,000
inhabitants / week
2 cases in the same week
If (1) No epidemic for at
least three years and
vaccination coverage is
under 80%, or
(2)
Alert
threshold
crossed early in the dry
season [b]
10
cases
/
100,000
inhabitants / week
Other situations
15
cases
/
100,000
inhabitants / week
Or
An increase in the number
of cases in relation to
previous
non-epidemic
years
5 cases in the same week
Or
Doubling of the number of
cases in a three-week
period[c]
Or
Other situations should be
studied on a case-by-case
basis [b, d]
Meningitis Epidemic,
Burkina Faso 2002
(Jan 1 to May 5, 2002)
• 12,284 cases and 1,411 deaths
identified
• Overall case fatality ratio (CFR)
11.5%
• Overall disease incidence rate:
99 cases/100,000 population
• 33 health districts in (22 in
epidemic, 12 in alert) at peak
of the epidemic (week 14)
Challenges Presented
• W135 meningococci as the
predominate cause
• First W135 epidemic of this
magnitude
• W135-containing
meningitis vaccine not
currently available for large
use in Africa (low quantity,
high cost)
Issues Regarding Serogroup W-135
Epidemiological questions
• Causes for emergence of W-135
disease?
–Changes in carriage
–Changes in immunity
–Other changes in host (risk
factors)
–Other changes in pathogen
–Changes in environment
–Implication of previous
vaccination (A/C)campaigns
Issues Regarding Serogroup W-135
Implications for Public Health Response in the
Future
• Maintain/improve meningitis laboratorybased surveillance 2002-2003
• W-135 containing polysaccharide vaccine
for future epidemics
–Monovalent (W135) Vs Quadrivalent
(A/C/Y/W135)
• Development and introduction of W-135containing conjugate vaccine
• Case management
• Economics
• Lessons learnt
Support Impacts Success
IDS requires:
• Commitment
• Resources
– human
– budgetary
• Transport
• Communications
• Training
• Supervision
• Laboratories