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To promote the most effective uses of health

resources.The highest-priority public health events should beunder surveillance.Surveillance system should meet their objectives asefficiently as possible.Effective and rapid response should be linked.

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1. Public health importance & priority

2. System objectives

3. Description of the system

4. System capacity & attributes

5. Co-ordination

6. Response mechanism for action

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1. Public health importance & priority

2. System objectives

3. Description of the system

4. System capacity & attributes

5. Co-ordination

6. Response mechanism for action

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Describe the public health importance of thecondition:

Total number of cases, incidence, prevalence

Severity measuring (e.g., case fatality ratio)Mortality rateMedical costsPreventability

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major publichealth burdenwith feasibleintervention

epidemicpotential

internationalimportance

WHO/ EMCWHO/ EMC

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Diseases Priority

Poliomyelitis

Leptospirosis

Bacterial meningitis

Yellow Fever

Malaria

Tuberculosis

Existingsurveillance

activities

surveillance gap

WHO/ EMCWHO/ EMC

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1. Public health importance & priority

2. System objectives

3. Description of the system

4. System capacity & attributes

5. Co-ordination

6. Response mechanism for action

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What are the objectives of the system?

detecting or monitoring outbreaks

monitoring trendsidentifying contacts and administeringprophylaxisgenerating hypotheses about etiologyenrolling case in a study

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Does it:` contribute to the prevention and control of

the condition?` detect changes in trends?` detect epidemics?` estimate of morbidity and mortality?` identify disease risk factors?` permit assessment of control measures?` lead to improved clinical practice?

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1. Public health importance & priority

2. System objectives

3. Description of the system

4. System capacity & attributes

5. Co-ordination

6. Response mechanism for action

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Is the system documented?Case definition

Population under surveillanceType of systemData structureIndicators

Feedback

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Do we know precisely what is under surveillance?

Availability

Sensitivity and specificityMulti-levels (confirmed, probable, suspect...)Consistency over time and place

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In which population ?

Entire population

High risk groups

Denominators available ?

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` Who are responsible for the data ?` Are standard formats used ?` Data validation` Data storage` Data confidentiality

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What do you measuring ?

Clearly defined ?

± number of cases ± or departure from expected, or««..What kind of indicators ? (thresholds, cutoffs,targets«)Does information make action ?

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` TypePaper (e.g., weekly bulletin)

Electronic communication` Frequency (monthly, annually..)` Adapted to target ?

Sources

intermediate levelDecision makers, etc.

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1. Public health importance & priority

2. System objectives

3. Description of the system

4. System capacity & attributes

5. Co-ordination

6. Response mechanism for action

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` Simplicity` Flexibility` Acceptability` Sensitivity` Predictive value positive` Representativeness` Timeliness`

Cost

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Structureinformation needednumber and type of sourcestraining needsnumber of information users

Functionalitydata transmissionsystem maintenancedata analysisinformation dissemination

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Can change be accommodated ?

new event to follow-up

new data about an event

new sources of information

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Willingness to participate in the system

participation rate of sourcesrefusal ratescompleteness of report formstimeliness of reporting

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Proportion of cases reported among actualcases

Affected by:% of cases seeking medical care% of these correctly diagnosed% of these reported

public/physician awareness

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Proportion of cases reported that actuallyhave the condition

If action required, low predictivevalue wastes resources.More specific definition canimprove.Good communication can improve.

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Accuracy of the description of health eventsunder surveillance by the system in term of time, place, and person.

(This information is not generally available, mayhave to be measure via special study.)

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Delay between steps in a surveillance system , for example:

From onset of illnessto receipt of the report of cases

From time to diagnosisto identifying trends of outbreaks

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1. Public health importance & priority

2. System objectives

3. Description of the system

4. System capacity & attributes

5. Co-ordination

6. Response mechanism for action

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` Level

detection - reporting - analysis - actionperipheral - intermediate - central

` Functionmultiple task co-operation

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Coordination

Epidemiology

Education

Clinicians

Laboratory

Media AuthoritiesDiagnostic

Clinical

Specimentransfer

Dead Sick

Exposed

Surveillancenvestigation

Prediction

Healthpersonnel

Specialgroups

Generalpopulation

Decisionsnfrastructure

RegulationsVaccinations etc

Vector Reservoir

5. Co -ordination

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` Repetitionheavy workload at intermediate/peripheral level

resulting in discouragement` Competition

budgethuman resource

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1. Public health importance & priority

2. System objectives

3. Description of the system

4. System capacity & attributes

5. Co-ordination

6. Response mechanism for action

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Control & Prevention

PreparednessRapid response

FeedbackPolicy

New policyModification

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