SCENARIO

Outbreaks in Indonesia can be detected quickly and then approriate

handling is done due to an adequate epidemiological surveillance
system. Epidemiological surveillance is one of the programs
conducted by the Health Offices in all district of Indonesia. Each type
of disease that exists, both communicable disease and non-
communicable disease has its own surveillance and evaluation
system.

TERM CLARIFICATION

1. Surveillance
The process of observation continuosly and systematically of
the spread of a disease and condition that can increase the risk
of transmission by doing data collecting, analytic interpretation,
etc.
sur (over) and veiller (to watch) – is the “close and continuous
observation of one or more person for the purpose of direction,
supervision, or control.”
2. District
Province area
3. Outbreaks
Appreance of cases of disease, in excess of what would
normally be expected in a defined community geographical are
or season.
4. Epidemiological surveillance
Systematic collection, analysis, and dissemination of health
data for the planning implementation and evaluation of public
health program.
 SETTING THE PROBLEM

1. Difference between survey and surveillance

2. The definition of epidemiological surveilance
3. Types of epidemiologcal surveillance
4. Characteristic of surveillance system
5. The function and purpose of surveillance and the evaluation
system
6. Communicable and non-communicable disease
7. Other scope of epidemiological surveillance
8. Strategy of epidemiological surveillance
9. Surveillance and system of communicable and non-
communicable disease
10. Criteria develop for selecting and prioritizing health
problem for surveillance
11. Components of epidemiological surveillance based on
WHO
12. How to conduct epidemiological surveillance
13. Criteria of a good surveillance
14. The conseptual framework for the evaluation of
epidemiological surveillance (draw diagram)
15. Criteria of evaluating surveillance system
16. Limitations on surveillance system

ANALYZING THE PROBLEM

1. Difference between survey and surveillance

Survey : at a certain time; structured and systematic gathering
of information from a sample of population of interest in a
certain period of time.
 Surveillance : continously; the process of observation
continuosly and systematically of the spread of a disease and
condition that can increase the risk of transmission by doing
data collecting, analytic interpretation, etc. ; sur (over) and
veiller (to watch) – is the “close and continuous observation of
one or more person for the purpose of direction, supervision,
or control.”

2. The definition of epidemiological surveilance

Systematic collection, analysis, and dissemination of health
data for the planning implementation and evaluation of public
health program. A research about health problem that occur in
human population that is done continuosly and systematically.
Systematic on going, collection, dissemination of data ... so the
action can be taken. The continued watchfullness over the
distribution and trends of incidence of a disease through the
systematic collection, consolidation, and evaluation of
morbidity and mortality reports and other relevant data.

3. Types of epidemiological surveillance

- Passive : the health care provider initiating the report to the
state or local official.
- Active : local or state health initiate the collection of the
information.
- Sentinel : The report of health event by health professional
who are selected to represent a geographic area or a specific
reporting group.
- Syndromic : focus on one or more symptom rather than a
physic diagnose or laboratory confirmed disease.
- Partisipatory : depends on the partisipation
- Predictive :
 - Event based : depends on the incidence.
- Indicator based : depends on the
- How is a hospital to be chosen as sentinel.

4. Characteristic of surveillance system

- clear objectives
- minimal relevant data collection for approriate action
- adress a defined target population
- have specified sources of data : including health facility
records, whether its public or private, lab results, case
reports, surveys. And system assessment reports
- incorporate a well identified information with feedback and
info dissemination mechanism in place

5. The function and purpose of surveillance and the evaluation

system
Purpose : early detection and prevention of an outbreak, a tool
of monitoring and evaluating disease prevention and control, to
provide information for priority setting, policy making, planning
implementing allocating health resource, monitoring tendency
of the endemic disease and predicting its impact in the future,
identifying the need for research and further investigation.
Function : collecting data for outbreak early detection,
monitoring health events, collect data from all of the people in
that area, approriate handling.
Evaluation system : to evaluate of the ongoing program, to
know the efficacy of a program, to find an area of improvement
of a program.

6. Communicable and non-communicable disease

 Communicable : infectious disease, can passess from one
person to another caused by bacteria, virus, fungi, etc.
- HIV
- TBC
Non-communicable : chronic disease, are disease of long
duration and generally have slow progression.
- Cardiovascular disease
- Cancer
- Chronic respiratory disease
- Diabetes

7. Other scope of epidemiological surveillance

- Of communicable
- Of non-communicable
- Of environmental and behavioral health
- Of health problems
- Of health dimension (on disaster and social problems)

8. Strategy of epidemiological surveillance

- Advocation : increasing the advocation to make a better
policy
- Developing human resource

9. Surveillance and system of communicable and non-

communicable disease
Communicable : source of data from regular health service or
hospital
Non-communicable : from the sentinel
10. Criteria develop for selecting and prioritizing health
problem for surveillance
- Public health importants of the problem which include
incidence, prevalence, severity, sequel, disabilities, mortality
caused by the problem, socioeconomic impact,
communicablity, potential for an outbreak, public perseption
and concern, international requirements
- The ability to prevent, control, or treat the health problems
includes preventability and control measures and treament
- Capacity of health system to implement control measures
which includes speed of response, economic, avalability of
resources, and what surveillance of this event is required.

11. Components of epidemiological surveillance based on

WHO
- Collection (explain the purposes) : conducted at the local
state federal or international level by public agencies as well
as by private industries
- Analysis : same with collection
- Dissemination : specific public health activities
- Response : same with dissemination

12. How to conduct epidemiological surveillance

- Collecting data : collected in the hospital or puskesmas,
comes from individual person, healthcare providers, facilities
and records and environmental condition, administrative
action, financial transaction, legal action, laws and
regulation. Methods : environmental monitoring, survey,
notification , registries, re-analyzing of second use of the
data
- Processing data
 - Analyzing data
- Interpretation of the data
- Dissemination information

- Case identification
- Recording, reporting, data processing
- Analysis and data interpretation
- Epidemiological study
- Dissemination of health data to units in need
- Making recommendation for further action
- Feedback

13. Criteria of a good surveillance and evaluation surveillance

system
- Acceptability : data accurate, consistent, complete, ontime
- Flexibility : adjust to changes of information
- Predictive value positive : proportion of predicting correctly
towards a disease is higher
- Quality
- Representativeness : provide an accurate picture of
temporal trend of the disease
- Sensitivity : accurately respond to values of changes, to
allow identification of individual person with disease to
facilitate treatment quantitative or other approriate control
measures
- Simplicity : easy to understand
- Stability : consistent
- Timeliness : to implement effective control measure
- Validity : valid
 - Adequately resourced : cost of training, travel, supplies, and
equipment and services.

14. The conseptual framework for the evaluation of

epidemiological surveillance (draw diagram)

15. Limitations on surveillance system

- Under reporting ; lack of knowledge of reporting
requirement, negative attitude towards reporting,
missconception that result from lack of knowledge or
negative attitude
- Lack of representativeness of reported cases
- Lack of timeliness (late)
- Improvements ; improving awareness of practitioners,
incentives, simpifly reporting, frequent feedback, widerning
the net, shifting the burden.