Assessmnet of the Performance of the Integrated Disease Surveillance and Response System in Zambia

Abstract

Well-functioning disease surveillance and response systems are vital for the effective implementation of disease control and prevention programmes. In 2000, Zambia adopted the World Health Organisation for Africa Regions’ (WHO-AFRO) Integrated Disease Surveillance and Response strategy (IDSR) to monitor, control and prevent priority notifiable infectious diseases in the country. Through the strategy, all activities pertaining to disease surveillance are coordinated and streamlined to take advantage of similar surveillance functions, skills, resources and targeted populations. The purpose of the study was to assess the Integrated Disease Surveillance and Response system in Zambia using secondary quantitative (surveillance) and primary qualitative data. The study used a convergent parallel mixed methods design. Aggregated national monthly surveillance counts on Measles and Typhoid Fever covering a period of 86 months (April 2008 and May 2015) and provincial weekly surveillance reports covering a period of 256 weeks (from week 1 of 2011 to week 48 of 2015) were collected from the Monitoring and Evaluation (M&E) and Epidemiological units respectively at Ministry of Health (MoH) headquarters. The study conducted key informant interviews with selected health personnel at; MoH headquarters, Lusaka Provincial Health Office (LPHO), Lusaka and Chongwe District Health Management Team Offices and selected health facilities in the two districts. Descriptive, times series (exponential smoothing) and epidemiological (age specific attack and case fatality rates) statistics were utilized in the analysis of quantitative data. Thematic analysis approach was used to analyze qualitative data. A total of 45,732 and 3,820 admitted cases of Measles and Typhoid Fever respectively were reported to MoH headquarters between April 2008 and May 2015. The age group of 1 year and below was the most affected with the highest attack rate of 777 per 100,000 recorded in 2010, and 41 per 100,000 recorded in 2013 for Measles and Typhoid Fever respectively. The Key qualitative findings include: lack of adequate and consistent training of health staff on IDSR, challenges in recording and tallying of cases at health facilities, lack of adequate data analysis especially at health facilities, inadequate demographic variables reported in the weekly and monthly reports, inadequate supply of the IDSR technical guidelines to the health facilities, poor availability of transportation at district and health facility level, unsatisfactory feedback, poor performance by health facilities and districts in the timeliness and completeness of reporting, existence of parallel reporting structures for weekly and monthly reports etc. IDSR implementation in Zambia is fairly extensive although gaps still exist. The support component of the IDSR is not optimally being implemented as a result the other components of the system such as the core functions and quality attributes are being negatively affected. This in-turn is leading to poor quality surveillance data being generated, transmitted, analyzed and used in disease control and prevention programs and decision making.