Bibliography on HIV/AIDS in Ethiopia and Ethiopians in the Diaspora: The 2004 Update

No Abstract Available Ethiop.J.Health Dev. Vol.19(1) 2005: 65-8

Assessment of the infectious diseases surveillance system of the Republic of Armenia: an example of surveillance in the Republics of the former Soviet Union

BACKGROUND: Before 1991, the infectious diseases surveillance systems (IDSS) of the former Soviet Union (FSU) were centrally planned in Moscow. The dissolution of the FSU resulted in economic stresses on public health infrastructure. At the request of seven FSU Ministries of Health, we performed assessments of the IDSS designed to guide reform. The assessment of the Armenian infectious diseases surveillance system (AIDSS) is presented here as a prototype. DISCUSSION: We performed qualitative assessments using the Centers for Disease Control and Prevention (CDC) guidelines for evaluating surveillance systems. Until 1996, the AIDSS collected aggregate and case-based data on 64 infectious diseases. It collected information on diseases of low pathogenicity (e.g., pediculosis) and those with no public health intervention (e.g., infectious mononucleosis). The specificity was poor because of the lack of case definitions. Most cases were investigated using a lengthy, non-disease-specific case-report form Armenian public health officials analyzed data descriptively and reported data upward from the local to national level, with little feedback. Information was not shared across vertical programs. Reform should focus on enhancing usefulness, efficiency, and effectiveness by reducing the quantity of data collected and revising reporting procedures and information types; improving the quality, analyses, and use of data at different levels; reducing system operations costs; and improving communications to reporting sources. These recommendations are generalizable to other FSU republics. SUMMARY: The AIDSS was complex and sensitive, yet costly and inefficient. The flexibility, representativeness, and timeliness were good because of a comprehensive health-care system and compulsory reporting. Some data were questionable and some had no utility

Conceptual framework of public health surveillance and action and its application in health sector reform

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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

Community Based Organizations in HIV/AIDS Prevention, Patient. Care and Control in Ethiopia

The main objective of this review is to provide a preliminary evaluation of the suitability of community-based organizations (CBOs) to contribute to HIV/AIDS prevention, care/support and control programs in Ethiopia. In order to put CBOs and programs in the context of HIV transmission and spread, the role of the Multisectoral HIV/AIDS Strategy (2000-2004) and other government policies and programs in promoting an environment conducive for these organizations and initiatives are highlighted. The Ethiopian literature and recent news releases on CBOs were reviewed and findings examined in the context of recent government policies, community initiatives and prevailing infrastructure in health programs, socioeconomic and cultural constraints. Findings show that the Multisectoral HIV/AIDS Strategy, the current Health Policy, and plans to strengthen the weredas and kebeles facilitate the development of CBOs and programs and infrastructure through the HIV/AIDS Council, the Ministry of Health and various other governmental organizations. CBOs studied are at different stages of planning and implementing preventive and care/support programs but little is known about their progress, operations and effectiveness due to the recency of most programs and lack of monitoring and evaluation mechanisms. Although most CBOs are either still in the formative stage or in process of carrying out HIV/AIDS prevention programs on a limited scale, their self initiative, their knowledge of and acceptance by the community and their relative cost-effectiveness render them suitable as owners, advocates and participants in programs. Several organizations and health agents are operating in integrated primary health and HIV/AIDS prevention programs that have a multi-disease, multi-organizational and poverty-reduction focus and use appropriate and promising behavioral change communication methods that may contribute significantly to overcoming social stigma and reduce HIV exposure risk. The various CBOs can be partners in HIV/AIDS prevention, patient care/support and control programs. They may facilitate efforts to curb the spread of HIV through the expansion of awareness creation and prevention initiatives and also provide patient care and support. The kebele may act as forum for community initiatives and as a link between the community and outside institutions if they can overcome bureaucratic intransigence and create an enabling environment. Towards that objective, CBOs need both internal strengthening of programs and outside support for their sustainability, and persisting stigma and discrimination against living with HIV/AIDS persons need to be reduced. Among new strategies, integrated home-based care programs involving people living with HIV/AIDS (PLWHA), families and neighbors, and poverty alleviation with an integrated HIV/AIDS component promise to create an enabling environment and promote project ownership by communities, which facilitate program design, management and effectiveness. Recommendations are made for further research towards identifying, promoting, strengthening and upscaling CBOs and programs to the regional and national levels. [Ethiopian J. Health Dev. Vol.17 Special Issue 2003: 3-31

Bibliography on HIV/AIDS in Ethiopia and Ethiopians in the Diaspora

A bibliography on HIV/AIDS in Ethiopia and Ethiopians in the Diaspora covers all aspects of the epidemic and prevention and control efforts as well as patient care and support between 1984 and the end of 2002 [Ethiopian J. Health Dev. Vol.17 Special Issue 2003: 33-85

Structure and performance of infectious disease surveillance and response, United Republic of Tanzania, 1998

OBJECTIVE: To assess the structure and performance of and support for five infectious disease surveillance systems in the United Republic of Tanzania: Health Management Information System (HMIS); Infectious Disease Week Ending; Tuberculosis/Leprosy; Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome; and Acute Flaccid Paralysis/Poliomyelitis. METHODS: The systems were assessed by analysing the core activities of surveillance and response and support functions (provision of training, supervision, and resources). Data were collected using questionnaires that involved both interviews and observations at regional, district, and health facility levels in three of the 20 regions in the United Republic of Tanzania. FINDINGS: An HMIS was found at 26 of 32 health facilities (81%) surveyed and at all 14 regional and district medical offices. The four other surveillance systems were found at <20% of health facilities and <75% of medical offices. Standardized case definitions were used for only 3 of 21 infectious diseases. Nineteen (73%) health facilities with HMIS had adequate supplies of forms; 9 (35%) reported on time; and 11 (42%) received supervision or feedback. Four (29%) medical offices with HMIS had population denominators to use for data analyses; 12 (86%) were involved in outbreak investigations; and 11 (79%) had conducted community prevention activities. CONCLUSION: While HMIS could serve as the backbone for IDSR in the United Republic of Tanzania, this will require supervision, standardized case definitions, and improvements in the quality of reporting, analysis, and feedback

Assessment of the infectious diseases surveillance system of the Republic of Armenia: an example of surveillance in the Republics of the former Soviet Union

Abstract Background Before 1991, the infectious diseases surveillance systems (IDSS) of the former Soviet Union (FSU) were centrally planned in Moscow. The dissolution of the FSU resulted in economic stresses on public health infrastructure. At the request of seven FSU Ministries of Health, we performed assessments of the IDSS designed to guide reform. The assessment of the Armenian infectious diseases surveillance system (AIDSS) is presented here as a prototype. Discussion We performed qualitative assessments using the Centers for Disease Control and Prevention (CDC) guidelines for evaluating surveillance systems. Until 1996, the AIDSS collected aggregate and case-based data on 64 infectious diseases. It collected information on diseases of low pathogenicity (e.g., pediculosis) and those with no public health intervention (e.g., infectious mononucleosis). The specificity was poor because of the lack of case definitions. Most cases were investigated using a lengthy, non-disease-specific case-report form Armenian public health officials analyzed data descriptively and reported data upward from the local to national level, with little feedback. Information was not shared across vertical programs. Reform should focus on enhancing usefulness, efficiency, and effectiveness by reducing the quantity of data collected and revising reporting procedures and information types; improving the quality, analyses, and use of data at different levels; reducing system operations costs; and improving communications to reporting sources. These recommendations are generalizable to other FSU republics. Summary The AIDSS was complex and sensitive, yet costly and inefficient. The flexibility, representativeness, and timeliness were good because of a comprehensive health-care system and compulsory reporting. Some data were questionable and some had no utility.</p

Conceptual framework of public health surveillance and action and its application in health sector reform

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusions</p> <p>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.</p