From habits of attrition to modes of inclusion: enhancing the role of private practitioners in routine disease surveillance

Background: Private practitioners are the preferred first point of care in a majority of low and middle-income countries and in this position, best placed for the surveillance of diseases. However their contribution to routine surveillance data is marginal. This systematic review aims to explore evidence with regards to the role, contribution, and involvement of private practitioners in routine disease data notification. We examined the factors that determine the inclusion of, and the participation thereof of private practitioners in disease surveillance activities. Methods: Literature search was conducted using the PubMed, Web of Knowledge, WHOLIS, and WHO-IRIS databases to identify peer reviewed and gray full-text documents in English with no limits for year of publication or study design. Forty manuscripts were reviewed. Results: The current participation of private practitioners in disease surveillance efforts is appalling. The main barriers to their participation are inadequate knowledge leading to unsatisfactory attitudes and misperceptions that influence their practices. Complicated reporting mechanisms with unclear guidelines, along with unsatisfactory attitudes on behalf of the government and surveillance program managers also contribute to the underreporting of cases. Infrastructural barriers especially the availability of computers and skilled human resources are critical to improving private sector participation in routine disease surveillance. Conclusion: The issues identified are similar to those for underreporting within the Integrated infectious Disease Surveillance and Response systems (IDSR) which collects data mainly from public healthcare facilities. We recommend that surveillance program officers should provide periodic training, supportive supervision and offer regular feedback to the practitioners from both public as well as private sectors in order to improve case notification. Governments need to take leadership and foster collaborative partnerships between the public and private sectors and most importantly exercise regulatory authority where needed

Min-Max Fair Power Flow Tracing for Transmission System Usage Cost Allocation: A Large System Perspective

Power flow tracing has been suggested as an approach for evaluating 1) transmission system usage (TSU) cost and 2) loss (MW) cost for generator and load entities in the system. Recently, optimal power flow tracing methods have been proposed to "explicitly" model fairness constraints in the tracing framework. This paper, further, strengthens the tracing-compliant min-max fair cost allocation approach. The min-max model proposed in this paper is robust. It addresses concerns like scalability, numerical stability and termination in a finite number of steps while searching the optimal solution. We also propose a methodology to model DISCOMs and GENCOs as coalition within min-max framework. Case studies on an all India network of 1699 nodes and comparison with average participation and marginal participation methods bring out the better conflict resolution feature of the proposed approach. A method to model HVDC lines within the marginal participation scheme is also proposed. Quantitative and qualitative comparison of various TSU cost allocation methods on such a large system is another noteworthy contribution of the paper