[Show abstract][Hide abstract] ABSTRACT: In an effort to contain the frequently devastating epidemics in sub-Saharan Africa, the World Health Organization (WHO) Regional Office for Africa launched the Integrated Disease Surveillance and Response (IDSR) strategy in an effort to strengthen surveillance and response. However, 36 sub-Saharan African countries have been described as experiencing a human resource crisis by the WHO. Given this human resource situation, the challenge remains for these countries to achieve, among others, the health-related Millennium Development Goals (MDGs). This paper describes the process through which the African Field Epidemiology Network (AFENET) was developed, as well as how AFENET has contributed to addressing the public health workforce crisis, and the development of human resource capacity to implement IDSR in Africa. AFENET was established between 2005 and 2006 as a network of Field Epidemiology Training Programs (FETPs) and Field Epidemiology and Laboratory Training Programs (FELTPs) in Africa. This resulted from an expressed need to develop a network that would advocate for the unique needs of African FETPs and FELTPs, provide service to its membership, and through which programs could develop joint projects to address the public health needs of their countries. A total of eight new programs have been developed in sub-Saharan Africa since 2006. Programs established after 2006 represent over 70% of current FETP and FELTP enrolment in Africa. In addition to growth in membership and programs, AFENET has recorded significant growth in external partnerships. Beginning with USAID, CDC and WHO in 2004-2006, a total of at least 26 partners have been added by 2011. Drawing from lessons learnt, AFENET is now a resource that can be relied upon to expand public health capacity in Africa in an efficient and practical manner. National, regional and global health actors can leverage it to meet health-related targets at all levels. The AFENET story is one that continues to be driven by a clearly recognized need within Africa to develop a network that would serve public health systems development, looking beyond the founders, and using the existing capacity of the founders and partners to help other countries build capacity for IDSR and the International Health Regulations (IHR, 2005).
Full-text · Article · Dec 2011 · Pan African Medical Journal
[Show abstract][Hide abstract] ABSTRACT: Uganda is currently implementing the International Health Regulations (IHR) within the context of Integrated Disease Surveillance and Response (IDSR). The IHR(2005) require countries to assess the ability of their national structures, capacities, and resources to meet the minimum requirements for surveillance and response. This report describes the results of the assessment undertaken in Uganda.
We conducted a descriptive cross-sectional assessment using the protocol developed by the World Health Organisation (WHO). The data collection tools were adapted locally and administered to a convenience sample of HR(2005) stakeholders, and frequency analyses were performed.
Ugandan national laws relevant to the IHR(2005) existed, but they did not adequately support the full implementation of the IHR(2005). Correspondingly, there was a designated IHR National Focal Point (NFP), but surveillance activities and operational communications were limited to the health sector. All the districts (13/13) had designated disease surveillance offices, most had IDSR technical guidelines (92%, or 12/13), and all (13/13) had case definitions for infectious and zoonotic diseases surveillance. Surveillance guidelines were available at 57% (35/61) of the health facilities, while case definitions were available at 66% (40/61) of the health facilities. The priority diseases list, surveillance guidelines, case definitions and reporting tools were based on the IDSR strategy and hence lacked information on the IHR(2005). The rapid response teams at national and district levels lacked food safety, chemical and radio-nuclear experts. Similarly, there were no guidelines on the outbreak response to food, chemical and radio-nuclear hazards. Comprehensive preparedness plans incorporating IHR(2005) were lacking at national and district levels. A national laboratory policy existed and the strategic plan was being drafted. However, there were critical gaps hampering the efficient functioning of the national laboratory network. Finally, the points of entry for IHR(2005) implementation had not been designated.
The assessment highlighted critical gaps to guide the IHR(2005) planning process. The IHR(2005) action plan should therefore be developed to foster national and international public health security.
Full-text · Article · Dec 2010 · BMC Public Health
[Show abstract][Hide abstract] ABSTRACT: The revised International Health Regulations 2005 (IHR) provides a legal framework for the global response to public health emergencies of international concern (PHEIC). With the coming into force of the IHR on June 15, 2007, under Annex 1a and Annex 2, all 194 Member States (including the United States) of the World Health Organization (WHO) have committed to develop core capacities for the early detection, investigation, and response to events with potential for international spread; report to WHO any potential PHEIC; develop a plan of action for implementing the IHR; and to assess, monitor, and evaluate progress towards achieving these capacities. WHO is required to support the assessment of the national surveillance and response capacities, the strengthening of the national systems, the monitoring of progress on the IHR implementation, and the evaluation of outcomes. This presentation will describe and demonstrate a prototype web-based data collection tool that has been developed for countries and WHO to provide a set of monitoring indicators and guidance tools for surveillance, response, laboratory, and points of entry respectively. The Tool will collect data on yearly scores along ordinal scales reflecting levels of maturation on each of 33 IHR indicators for monitoring 8 national core capacities (national legislation, policy coordination, surveillance, preparedness, response, risk communication, laboratory, and human resources) for surveillance and response along 5 categories of hazards (infectious disease, zoonosis, food safety, chemical, and radio-nuclear).
[Show abstract][Hide abstract] ABSTRACT: Accurate, reliable, and timely public health information is essential to improve global health and ensure health security in today's globalized, interconnected, increasingly complex, and rapidly changing world. One of the greatest threats arises from outbreaks of epidemic-prone diseases. Such outbreaks occur in increasing numbers, fuelled by rapid urbanization, environmental mismanagement, food production and trade, and antibiotic misuse. Shared vulnerability to these threats requires collective action, international cooperation, information sharing, and capacity to detect and contain threats at points of origin. World Health Organization's (WHO) Departments of Health Statistics and Informatics, the International Health Regulations (IHR) Coordination Program and CDC's National Center for Public Health Informatics (NCPHI) have proposed to establish WHO Collaborating Center for Public Health Informatics (WHO CC) combining their technical resources and mandates for leadership, shaping health agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries, and monitor the evolving global heath situation. The proposed WHO CC will focus on challenges hindering global information exchanges and overcoming siloed systems, tools, and services. Specifically, the Center will advance global informatics standards and interoperability; support distributed information exchange and sharing including strengthening the Global Health Observatory; contribute to shift from development of information system silos to distributed and synergistic development of a suite of globally shareable interoperable tools services; provide informatics support to the implementation of the IHR (2005); and advance the science and best informatics principles, strategies, and practices. Progress in informatics, recent legal frameworks, global health and eHealth initiatives, are providing unprecedented opportunities to strengthen, integrate, and interoperate health information systems and tools ensuring rapid access and sharing of information to respond effectively to routine and emergent health threats. WHO CC's proposed goals, structure, regulatory drivers, strategic framework, stakeholders in light of current global informatics challenges and opportunities will be described and discussed.
[Show abstract][Hide abstract] ABSTRACT: The 194 Member States (including the United States) of the World Health Organization (WHO) have signed the revised International Health Regulations 2005(IHR), a legal framework that aims to prevent and respond to acute public health threats with the potential for international spread. IHR strengthens WHO member states collective defences against the multiple and varied public health threats that today's globalized world is facing and which have the potential to rapidly spread through expanding travel and trade. With the coming into force of the IHR on June 15, 2007, Member States are required to notify WHO of all events which may constitute a public health emergency of international concern; assess core alert and response capacities for the early detection, investigation, and response to these events; develop a plan of action for implementing the IHR; and to monitor and evaluate progress towards achieving these capacities. WHO is required to support the assessment of the national surveillance and response capacities, the strengthening of the national systems, the monitoring of progress on the IHR implementation, and the evaluation of outcomes. Monitoring of IHR implementation helps identify needed changes, provides information to guide program improvement, informs strategic and program planning, helps establish a feedback process for decision-making, provides WHO with status of IHR implementation, and targets WHO and partner support to countries. Indicators ensure that monitoring and evaluation is a standards-based process and that the selected indicators are a tool to recognize valuable results among multiple, central outcomes. This presentation will describe and discuss WHO developed monitoring framework and indicators, data collection tools, and data analysis and dissemination approaches. The indicators cover 8 core capacities, across 5 categories of hazards and at capacities at points of entry.
[Show abstract][Hide abstract] ABSTRACT: The threat of a global influenza pandemic and the adoption of the World Health Organization (WHO) International Health Regulations (2005) highlight the value of well-coordinated, functional disease surveillance systems. The resulting demand for timely information challenges public health leaders to design, develop and implement efficient, flexible and comprehensive systems that integrate staff, resources, and information systems to conduct infectious disease surveillance and response. To understand what resources an integrated disease surveillance and response system would require, we analyzed surveillance requirements for 19 priority infectious diseases targeted for an integrated disease surveillance and response strategy in the WHO African region.
We conducted a systematic task analysis to identify and standardize surveillance objectives, surveillance case definitions, action thresholds, and recommendations for 19 priority infectious diseases. We grouped the findings according to surveillance and response functions and related them to community, health facility, district, national and international levels.
The outcome of our analysis is a matrix of generic skills and activities essential for an integrated system. We documented how planners used the matrix to assist in finding gaps in current systems, prioritizing plans of action, clarifying indicators for monitoring progress, and developing instructional goals for applied epidemiology and in-service training programs.
The matrix for Integrated Disease Surveillance and Response (IDSR) in the African region made clear the linkage between public health surveillance functions and participation across all levels of national health systems. The matrix framework is adaptable to requirements for new programs and strategies. This framework makes explicit the essential tasks and activities that are required for strengthening or expanding existing surveillance systems that will be able to adapt to current and emerging public health threats.
[Show abstract][Hide abstract] ABSTRACT: Because both public health surveillance and action are crucial, the authors initiated meetings at regional and national levels to assess and reform surveillance and action systems. These meetings emphasized improved epidemic preparedness, epidemic response, and highlighted standardized assessment and reform.
To standardize assessments, the authors designed a conceptual framework for surveillance and action that categorized the framework into eight core and four support activities, measured with indicators.
In application, country-level reformers measure both the presence and performance of the six core activities comprising public health surveillance (detection, registration, reporting, confirmation, analyses, and feedback) and acute (epidemic-type) and planned (management-type) responses composing the two core activities of public health action. Four support activities - communications, supervision, training, and resource provision - enable these eight core processes. National, multiple systems can then be concurrently assessed at each level for effectiveness, technical efficiency, and cost.
This approach permits a cost analysis, highlights areas amenable to integration, and provides focused intervention. The final public health model becomes a district-focused, action-oriented integration of core and support activities with enhanced effectiveness, technical efficiency, and cost savings. This reform approach leads to sustained capacity development by an empowerment strategy defined as facilitated, process-oriented action steps transforming staff and the system.
Full-text · Article · Feb 2002 · BMC Public Health