To promote the most effective uses of health

resources.
• The highest-priority public health events should be
under surveillance.
• Surveillance system should meet their objectives as
efficiently as possible.
• Effective and rapid response should be linked.
1. Public health importance & priority
2. System objectives
3. Description of the system
4. System capacity & attributes
5. Co-ordination
6. Response mechanism for action
1. Public health importance & priority
2. System objectives
3. Description of the system
4. System capacity & attributes
5. Co-ordination
6. Response mechanism for action
Describe the public health importance of the
condition:
• Total number of cases, incidence, prevalence
• Severity measuring (e.g., case fatality ratio)
• Mortality rate
• Medical costs
• Preventability
 major public
health burden epidemic
with feasible potential
intervention

international
importance

WHO/EMC
Diseases Priority Existing
surveillance
activities
Poliomyelitis

Leptospirosis

Bacterial meningitis

Yellow Fever

Malaria

Tuberculosis

surveillance gap
WHO/EMC
1. Public health importance & priority
2. System objectives
3. Description of the system
4. System capacity & attributes
5. Co-ordination
6. Response mechanism for action
What are the objectives of the system?
• detecting or monitoring outbreaks
• monitoring trends
• identifying contacts and administering
prophylaxis
• generating hypotheses about etiology
• enrolling case in a study
Does it:
 contribute to the prevention and control of
the condition?
 detect changes in trends?
 detect epidemics?
 estimate of morbidity and mortality?
 identify disease risk factors?
 permit assessment of control measures?
 lead to improved clinical practice?
1. Public health importance & priority
2. System objectives
3. Description of the system
4. System capacity & attributes
5. Co-ordination
6. Response mechanism for action
Is the system documented?
• Case definition
• Population under surveillance
• Type of system
• Data structure
• Indicators
• Feedback
Do we know precisely what is under
surveillance?
• Availability
• Sensitivity and specificity
• Multi-levels (confirmed, probable, suspect...)
• Consistency over time and place
In which population ?

• Entire population
• High risk groups
• Denominators available ?
Is the system design appropriately given its
objectives ?
 Active - Passive
 Sentinel - Exhausive
 Individual data - Aggregated data
 Who are responsible for the data ?
 Are standard formats used ?
 Data validation
 Data storage
 Data confidentiality
What do you measuring ?
• Clearly defined ?
– number of cases
– or departure from expected, or……..
• What kind of indicators ? (thresholds, cutoffs,
targets…)
• Does information make action ?
 Type
Paper (e.g., weekly bulletin)
Electronic communication
 Frequency (monthly, annually..)
 Adapted to target ?
Sources
intermediate level
Decision makers, etc.
1. Public health importance & priority
2. System objectives
3. Description of the system
4. System capacity & attributes
5. Co-ordination
6. Response mechanism for action
 Simplicity
 Flexibility
 Acceptability
 Sensitivity
 Predictive value positive
 Representativeness
 Timeliness
 Cost
Structure
• information needed
• number and type of sources
• training needs
• number of information users

Functionality
• data transmission
• system maintenance
• data analysis
• information dissemination
Can change be accommodated ?

• new event to follow-up

• new data about an event
• new sources of information
Willingness to participate in the system

• participation rate of sources

• refusal rates
• completeness of report forms
• timeliness of reporting
Proportion of cases reported among actual
cases
Affected by:
• % of cases seeking medical care
• % of these correctly diagnosed
• % of these reported
• public/physician awareness
Proportion of cases reported that actually
have the condition
• If action required, low predictive
value wastes resources.
• More specific definition can
improve.
• Good communication can improve.
Accuracy of the description of health events
under surveillance by the system in term of
time, place, and person.

(This information is not generally available, may

have to be measure via special study.)
Delay between steps in a surveillance system, for
example:
From onset of illness
to receipt of the report of cases
From time to diagnosis
to identifying trends of outbreaks
Identifying the resources that are used to
operate the system, for example:
• Personnel and financial resources expended in
collecting, processing, analyzing, and
dissemination of surveillance data.
• Cost of travel, training, supplies, equipment, and
services (mail, phone…..)
1. Public health importance & priority
2. System objectives
3. Description of the system
4. System capacity & attributes
5. Co-ordination
6. Response mechanism for action
 Level
detection - reporting - analysis - action
peripheral - intermediate - central
 Function
multiple task co-operation
 5. Co-ordination

Vector
Investigation Surveillance Reservoir Dead Sick

Prediction Exposed

Epidemiology Clinicians

Coordination

Education Laboratory Clinical

Health
personnel
Specimen
Special General transfer
Diagnostic
groups population
Media Authorities Decisions
Infrastructure
Regulations
 Repetition
heavy workload at intermediate/peripheral level
resulting in discouragement
 Competition
budget
human resource
1. Public health importance & priority
2. System objectives
3. Description of the system
4. System capacity & attributes
5. Co-ordination
6. Response mechanism for action
Control & Prevention
Preparedness
Rapid response
Feedback
Policy
New policy
Modification