evaluasi surveillance
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8/6/2019 Evaluasi Surveillance
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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