CPI-WHE-WHO/AFRO

Overview of IDSR

What is Public Health Surveillance?

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• Is the ongoing systematic identification, collection, collation, analysis, and interpretation of disease occurrence and public health event data to take timely and robust action
• It includes the:
• timely dissemination of resulting information for effective and appropriate action
• Is essential for planning, implementation, and evaluation of public health practice

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Public Health Surveillance Approaches - 1

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Passive surveillance:

• A system by which, a health institution receives routine reports submitted from health facilities:
• Such as hospitals, clinics, public health units, or community or other sources
• There is no active search for cases
• It includes surveillance of diseases/events using routine Indicator-based surveillance, Health management and information system (HMIS)

Public Health Surveillance Approaches -2

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Active Surveillance:

• An ongoing search for cases in the community or health facilities
• Involves regular contact with reporting sources by:
• Telephone calls to health care workers at a facility or laboratory
• Physically moving to the reporting sites
• Conducting records review of data

Examples: 1. Active search for measles and polio cases

2. Finding additional cases during outbreaks

Public Health Surveillance Approaches -3

Title of the Presentation

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• To ensure robust early warning and prompt response, the IDSR data collection and analysis system relies on two main channels of information or alert generation:
1. Indicator-Based Surveillance (IBS)
2. Event-Based Surveillance (EBS)

Types of Public Health Surveillance

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• Indicator based surveillance (IBS): is the systematic (regular) collection, monitoring, analysis and interpretation of structured data, such as indicators produced by a number of well-identified, mostly health-based formal sources
• Event-based surveillance (EBS): is the organized collection, monitoring, assessment and interpretation of mainly unstructured ad hoc information regarding health events or risk, which may represent an acute risk to health

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Indicator based surveillance (IBS) and the common types used

Common types of IBS -1

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Facility-based surveillance:

• All reporting units (e.g. health facilities) are required to report on a weekly, monthly, quarterly or annual basis to the next level based on the categories of the diseases, conditions and events
• Required to report immediately, any epidemic prone disease to the next level

Common types of IBS -2

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Laboratory-based surveillance:

• Surveillance conducted at laboratories for detecting events or trends that may not be seen as a problem at other locations or that originates from laboratory testing mainly done routinely

Common types of IBS -3

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Disease-specific (vertical) surveillance:

• Involves activities aimed at targeted health data for a specific disease for vertical surveillance
• Examples: Tuberculosis, Malaria and HIV surveillance systems

Common types of IBS -4

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Case based surveillance:

• For diseases that are targeted for elimination or eradication or during confirmed outbreaks, every individual case identified is reported immediately, using a case based form to the next level

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Common types of IBS -5

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• Syndromic surveillance:
• An active or passive system that uses Standard Case Definitions based entirely on clinical features without any laboratory diagnosis

Common types of IBS -6

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Sentinel surveillance:

• A given number of designated health facilities or reporting sites for early warning and reporting of priority events;
• such as pandemic, epidemic events or other public health events
• They are usually representative of an area or are in an area of likely risk for a disease or condition of concern

Common types of IBS -7

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Community-Based Surveillance (CBS):

• A surveillance system that collects community-based health information and the entire community population is under surveillance, and not simply a segment of the community
• Note: CBS incorporates both Indicator-based and Event-based surveillance methods

Event-Based Surveillance�Versus Indicator-based surveillance

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• Unlike indicator-based surveillance, event-based surveillance is:
• Not based on the routine monitoring of indicators and automated thresholds for action
• But Based on the screening of all available information to detect any event happening in the community such as:
• Unusual disease
• Deaths in humans or animals,
• Unusual clustering of cases, events/conditions  

IBS and EBS as back bone to IDSR Strategy

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IBS and EBS as back bone to IDSR Strategy

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Levels of Applications and Reporting of EBS and IBS in the context of IDSR

IDSR Early warning alert system: Indicator Based Surveillance and Event Based Surveillance

What is IDSR? -1

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• IDSR is a strategy adopted by WHO AFRO member states in September 1998 for;
• Improving public health surveillance and response for priority diseases, conditions and events at community, health facility, district and national level in African countries

Key principles of IDSR

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• Integration:
• Refers to harmonizing different methods, software, data collection forms, standards and case definitions in order to prevent inconsistent information and maximize efforts among all disease prevention and control programmes and stakeholders
• Coordination:
• Refers to working or acting together effectively for the rational and efficient use of available but limited resources such as the Health Management Information System (HMIS) and various disease programs

Advantages of IDSR Strategy

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1. Promotes rational and efficient use of resources by integrating and streamlining common surveillance activities and functions
2. Makes surveillance and laboratory data more usable
3. Help public health managers and decision-makers improve detection and response of priority diseases/conditions/events

Specific objectives of IDSR-1

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1. Strengthen the capacity of countries to conduct effective surveillance activities
2. Integrate multiple surveillance systems so that tools, personnel and resources are used more efficiently
3. Improve the triangulation and use of information to detect changes in trend in order to conduct a rapid response to suspected and confirmed outbreaks; monitor the impact of interventions

Specific objectives of IDSR - 2

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4. Improve the flow of surveillance information between and within levels of the health system and other health systems

5. Build strong laboratory systems and networks at district and national levels

6. Trigger epidemiological investigations of reported public health problems and the implementation of effective public health interventions

IDSR Core Functions and Health Systems levels

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Implementation Levels

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1. Community

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• Health facility

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• District

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• National level

IDSR is a Comprehensive, evidence-based strategy for strengthening national public health surveillance and response systems

IDSR is Primarily used to conduct surveillance, outbreak investigation and response for common priority diseases and events

CPI-WHE-WHO/AFRO

International Health Regulations (2005)

• In 2005, the resolutions WHA58.3 adopted IHR (2005)
• IHR (2005) entered into force on 15 June 2007 in accordance with Article 59, replacing IHR (1969)
• IHR (2005) is legally binding for WHO 194 Member States
• Includes all 47 WHO Member States in the African region

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Purpose and Scope of IHR (2005)

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To prevent, protect against, control and provide public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic

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Implementing IHR through IDSR

Decision instrument (Annex C, Booklet 1)

State parties that answer “Yes” to the question whether the event meets any two of the four criteria above shall notify WHO according to article 6 of the IHR

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Principles of a new IHR Monitoring and Evaluation Framework (IHR MEF)

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Roles and Responsibilities of various actors in IDSR

Title of the Presentation

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Turn to Annex G, of the Malawi3rd Edition IDSR TG for the roles of the following in IDSR:

1. Community health worker
2. Health Facility staff and Point of Entry
3. Surveillance Officer at district level
4. District Health Management Team
5. Political Leaders at district level
6. Ministry of Health
7. WHO and other partners

Other IDSR Linkages

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IDSR in the context of One Health-1

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• One Health approach addresses public health events arising at the intersection of:
• human, animal (domestic and wildlife), and environmental interface
• Humans and animals share the same eco-system
• One Health approach is intrinsic to and strongly reinforced by WHO’s IHR and the IDSR strategy

IDSR in the context of One Health-2

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• Animal and human health workers as well as other relevant partners should be engaged at various levels to be information sources for IDSR:
• To facilitate information sharing and joint rapid response activities

IDSR and Disaster Risk Management (DRM)

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• DRM is a systematic process of using administrative and organizational directives, operational skills and capacities to implement strategies, policies and improved coping capacities in order to lessen the adverse impact of hazards and the possibility of disaster
• IDSR is a tool for DRM:
• Provides early warning information, for risk assessment and risk reduction
• Assists in identification of hazards, assessment and monitoring of disaster risks

IDSR and Cross-Border Surveillance

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• Countries in collaboration with WHO to establish:
• Cross-border surveillance and response framework with neighbouring countries
• Procedures for information sharing within the framework of IDSR
• Procedures for notification of detected outbreaks to neighbouring cross border areas and districts
• Develop and organize simulation exercises with cross border district teams
• Organize regular cross border meetings
• Malawi has established cross-border framework with its neighbouring countries Zambia, Mozambique and Tanzania
• Note: Strong Political Leadership required

IDSR and Points of Entry (PoE)

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• IHR 2005 calls for strengthening of national capacity for surveillance and control, including PoE:
• i.e. Ports, Airports and Ground crossings
• Border health activities should be sustainable and aligned with other surveillance activities under IDSR
• All designated PoEs must have capacities for Surveillance and Effective Public Health Response System in line with existing IDSR guidelines

Electronic IDSR (eIDSR)

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• eIDSR is the application of electronic tools to the principles of IDSR to facilitate prevention, prediction, detection, reporting and response. OHSP and DHIS2 in Malawi
• It is based on standardized interoperable and interconnected information systems administered within the national context
• It is core in achievement of IHR (2005) requirements by countries
• Reduce manual data entry that is prone to errors

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• THANK YOU