Baseline Assessment of Public Health Surveillance in the Kingdom of Swaziland

ObjectiveTo assess essential support functions for Integrated DiseaseSurveillance and Response(IDSR) in the Kingdom of Swaziland andmake recommendations for a national IDSR Roadmap.IntroductionImplementation of the IDSR framework for fulfillment of theInternational Health Regulations (2005) ([IHR 2005]) has beenchallenging in Swaziland due to distribution of IDSR functions acrossunits within the Strategic Information Department (SID) and otherexternal departments within the Ministry of Health. We conducted aqualitative assessment and a Strength, Weaknesses, Opportunities andThreats (SWOT) analysis of current public health surveillance (PHS)support structures to inform implementation of IDSR.MethodsKey informant interviews, focus group discussions, and a deskreview were performed. Participants were personnel at essential units,departments and programs at the national level as well as at healthfacilities and clinics at regional and local levels. Transcripts werecoded into SWOT matrices using MAXQDA for each building blockof PHS: structures, workforce, resources, processes (detect, report,assess/analyze, respond, feedback), and informatics.ResultsSelected Strengths included existence of immediate notifiabledisease reporting through the Epidemic and Pandemic Response unit(EPR) and reporting of summary health facility data to the HealthManagement Information System (HMIS) unit and laboratorynetwork. Weaknesses included lack of clear roles and responsibilitiesfor IDSR among SID units, limited coordination between SID units,lack of data sharing, lack of Standard Operating Procedures (SOPs),uncoordinated case investigations and response, minimal analysisconducted for public health surveillance and limited feedback forreporters..Identified opportunities were political will for establishing ofroles and responsibilities and mechanisms for coordination anddata sharing. Threats were limited data access, limited funding forfeedback, lack of analysis for IDSR and paper-based reportingConclusionsCurrently there is limited use of surveillance data for decisionmaking due to lack of coordination. Findings were presented at adissemination meeting to representatives of relevant departments,and there was consensus on the need to clearly define the role andresponsibilities of different programs for IDSR. In March 2016, aconsensus meeting was held to designate roles and responsibilitiesfor IDSR, a direct result of this assessment. Additional resourcesand funding is needed to support these highly important initiatives toensure the safety and health security of the Swazi nation

Baseline Assessment of Public Health Surveillance in the Kingdom of Swaziland

ObjectiveTo assess essential support functions for Integrated DiseaseSurveillance and Response(IDSR) in the Kingdom of Swaziland andmake recommendations for a national IDSR Roadmap.IntroductionImplementation of the IDSR framework for fulfillment of theInternational Health Regulations (2005) ([IHR 2005]) has beenchallenging in Swaziland due to distribution of IDSR functions acrossunits within the Strategic Information Department (SID) and otherexternal departments within the Ministry of Health. We conducted aqualitative assessment and a Strength, Weaknesses, Opportunities andThreats (SWOT) analysis of current public health surveillance (PHS)support structures to inform implementation of IDSR.MethodsKey informant interviews, focus group discussions, and a deskreview were performed. Participants were personnel at essential units,departments and programs at the national level as well as at healthfacilities and clinics at regional and local levels. Transcripts werecoded into SWOT matrices using MAXQDA for each building blockof PHS: structures, workforce, resources, processes (detect, report,assess/analyze, respond, feedback), and informatics.ResultsSelected Strengths included existence of immediate notifiabledisease reporting through the Epidemic and Pandemic Response unit(EPR) and reporting of summary health facility data to the HealthManagement Information System (HMIS) unit and laboratorynetwork. Weaknesses included lack of clear roles and responsibilitiesfor IDSR among SID units, limited coordination between SID units,lack of data sharing, lack of Standard Operating Procedures (SOPs),uncoordinated case investigations and response, minimal analysisconducted for public health surveillance and limited feedback forreporters..Identified opportunities were political will for establishing ofroles and responsibilities and mechanisms for coordination anddata sharing. Threats were limited data access, limited funding forfeedback, lack of analysis for IDSR and paper-based reportingConclusionsCurrently there is limited use of surveillance data for decisionmaking due to lack of coordination. Findings were presented at adissemination meeting to representatives of relevant departments,and there was consensus on the need to clearly define the role andresponsibilities of different programs for IDSR. In March 2016, aconsensus meeting was held to designate roles and responsibilitiesfor IDSR, a direct result of this assessment. Additional resourcesand funding is needed to support these highly important initiatives toensure the safety and health security of the Swazi nation

Public Health Surveillance Strengthening in the Kingdom of Swaziland

ObjectiveTo enable coordination of Swaziland Ministry of Health units forpublic health surveillance (PHS).IntroductionIn the Kingdom of Swaziland, a baseline assessment found thatmultiple functional units within the Ministry of Health (MoH) performPHS activities. There is limited data sharing and coordination betweenunits; roles and responsibilities are unclear. The Epidemiology andDisease Control Unit (EDCU) is mandated to coordinate efforts andstrengthen PHS through implementing Integrated Disease Surveillanceand Response (IDSR) to fulfill requirements of International HealthRegulations (2005) (IHR[2005]), and the Global Health SecurityAgenda (GHSA).MethodsA baseline assessment that included key informant interviewsof unit representatives was conducted. Data flows were developed.Results were disseminated at a facilitated stakeholder workshop withunit representatives. A database was then built containing all distinctactivities found within the IDSR Technical Guidelines (2010), IHR[2005], GHSA Action Packages, the baseline assessment, a previousCDC IDSR assessment, and suggestions from the stakeholderworkshop. Activities were categorized by IDSR function (identify,report, analyze, investigate, prepare, respond, provide feedback,and evaluate) and designated as an ongoing “role” or a one-timeimplementation activity. A document containing all PHS roles waspresented at a facilitated consensus workshop; unit representativesdiscussed and designated a lead unit/agency for each role.One-time implementation activities were assigned a lead actor, targetcompletion date, and compiled into a 3-year IDSR Roadmap to guideimplementation.ResultsA Roles and Responsibilities Framework was developed thatpresents a consensus on lead units for all roles within an IDSR-basedPHS system that fulfills requirements of IHR [2005] and GHSA.This document enables coordination by EDCU. The IDSR Roadmapprovides time-bound activities with assigned actors to implementIDSR. EDCU is using these documents to guide coordination ofmultiple MOH units already performing PHS activities.ConclusionsCoordinating well-established programs that already collectepidemiological data increases efficiency and enables more completeepidemiologic analysis. Stakeholder engagement and clarity of rolesis critical for EDCU to coordinate PHS. Consolidating activitiesfor IDSR, IHR [2005], and GHSA in guiding documents enables astreamlined approach for public health surveillance strengthening.Future work aims to achieve data sharing through an electronicplatform and introduce data standards for interoperability among datasets.

Public Health Surveillance Strengthening in the Kingdom of Swaziland

ObjectiveTo enable coordination of Swaziland Ministry of Health units forpublic health surveillance (PHS).IntroductionIn the Kingdom of Swaziland, a baseline assessment found thatmultiple functional units within the Ministry of Health (MoH) performPHS activities. There is limited data sharing and coordination betweenunits; roles and responsibilities are unclear. The Epidemiology andDisease Control Unit (EDCU) is mandated to coordinate efforts andstrengthen PHS through implementing Integrated Disease Surveillanceand Response (IDSR) to fulfill requirements of International HealthRegulations (2005) (IHR[2005]), and the Global Health SecurityAgenda (GHSA).MethodsA baseline assessment that included key informant interviewsof unit representatives was conducted. Data flows were developed.Results were disseminated at a facilitated stakeholder workshop withunit representatives. A database was then built containing all distinctactivities found within the IDSR Technical Guidelines (2010), IHR[2005], GHSA Action Packages, the baseline assessment, a previousCDC IDSR assessment, and suggestions from the stakeholderworkshop. Activities were categorized by IDSR function (identify,report, analyze, investigate, prepare, respond, provide feedback,and evaluate) and designated as an ongoing “role” or a one-timeimplementation activity. A document containing all PHS roles waspresented at a facilitated consensus workshop; unit representativesdiscussed and designated a lead unit/agency for each role.One-time implementation activities were assigned a lead actor, targetcompletion date, and compiled into a 3-year IDSR Roadmap to guideimplementation.ResultsA Roles and Responsibilities Framework was developed thatpresents a consensus on lead units for all roles within an IDSR-basedPHS system that fulfills requirements of IHR [2005] and GHSA.This document enables coordination by EDCU. The IDSR Roadmapprovides time-bound activities with assigned actors to implementIDSR. EDCU is using these documents to guide coordination ofmultiple MOH units already performing PHS activities.ConclusionsCoordinating well-established programs that already collectepidemiological data increases efficiency and enables more completeepidemiologic analysis. Stakeholder engagement and clarity of rolesis critical for EDCU to coordinate PHS. Consolidating activitiesfor IDSR, IHR [2005], and GHSA in guiding documents enables astreamlined approach for public health surveillance strengthening.Future work aims to achieve data sharing through an electronicplatform and introduce data standards for interoperability among datasets.