The document discusses integrated communicable disease surveillance and efforts towards integration in several countries in the Eastern Mediterranean region. It notes that integrated surveillance allows for more efficient data collection, analysis, and response across disease programs. Several countries are making progress on establishing integrated electronic platforms and national surveillance systems through partnerships with international organizations. Fully implementing integrated surveillance remains an ongoing challenge that requires resources, training, and political commitment over the long term.

1. 64th
Session of
the Regional Committee
for the Eastern Mediterranean
Islamabad, Pakistan
9–12 October 2017

2. Integrated Surveillance in the EMR
• Why are we discussing
Integrated Communicable
Disease Surveillance again?
• What is the importance to
Member States?
2
INFORMATION
FOR
ACTION

3. What is Integrated Disease
Surveillance?
“A “merging” of various surveillance systems, using a single infrastructure
or platform to gather information about diseases of interest, utilizing similar
structures, personnel and processes”

5. Surveillance System Requirements
• Similar core activities:
– Case detection/Reporting
– Investigation and confirmation
– Analysis and interpretation
– Action
• Similar support functions:
– Standards
– Epidemiology training
– Laboratory support
– Management: Communications, supervision,
financial resources
Adapted from personal commincation; A.
Wilson, Public Health England

6. Why do we need Integrated Disease
Surveillance? Information for Action
• Policy and Planning:
 Burden of disease: Morbidity+ Mortality+ Cost
 Priority setting and resource mobilization
• Monitoring and evaluation:
 Measure impact
 Program implications
 Health Indicators, SDGs
• Preparedness and Response:
 Early outbreak detection
 Important as part of post JEE

7. Joint External Evaluation
Common recommendations
• Develop and implement integrated communicable
disease surveillance and response guidelines
• Organize a unified secure electronic platform
notification system for all health hazards
• Provide advanced training for key multidisciplinary
surveillance team staff to develop analytical expertise
7

8. Integrated Communicable Disease Surveillance –
EMRO’s efforts to date
• Technical paper on integrated approach
to communicable disease surveillance,
2002 (EM/RC49/11)
• Consultative Meeting for Integrated
Disease Surveillance in EMR, 2012:
– Establish a committee in the Regional
Office for Integrated Communicable
Disease Surveillance
– Develop a regional framework to
implement integrated disease
surveillance

9. 9
Regional Alert, Surveillance and Detection Of Outbreak Network
(RASDOON)
Imagine having…
Best team
Best tools
Collection, analysis, reporting
Secured access
Anywhere, Anytime
To free your hands to…
Decide…Plan…and Lead

10. Specific Challenges with Communicable Disease
Surveillance Integration
• Political commitment:
– Limited governance structure
• Perceived competing program interests:
– Many vertical programs
– Using old systems to build upon for integration
• Limited coordination:
– donors and technical agencies need to align support,
driven by Member State development plans
• Reactive:
– most progress for communicable disease surveillance
integration occurs during crisis
• Information Technology:
– Minimal use of common platforms to accommodate
different needs
10

11. Integrated Communicable Diseases
Surveillance Structure - Needs
• Setting priorities for integration process
• Ensuring integration will not delay achieving diseases control goals
• Human resources; a permanent cadre of skilled staff, with a sustainable retention career
structure
• Common, joint, multidisciplinary training for surveillance and laboratory staff
• Adequate physical resources (can share resources and create synergy between programs)
• Unified development and implementation of standards, guidelines, and operating
procedures, to reduce duplication
• Networked laboratory integration, capacity, and quality
• Integrated information technology platform and professionals
11

12. Essential role of Health Laboratories for Integrated
Surveillance

13. Data Integration and System Interoperability
Antimicrobial
Resistance
Zoonotic
Diseases
Biosafety/Biose
curity
Immunization GHSA
Reporting
Link Public Health
and Law
Enforcement
Medical
Countermeasu
res
National
Laboratory
System
Disease
Surveillance
Systems
Emergency
Operations
Centers
National
Health
System Data
Warehouse

14. 14
Why do we need an Integrated
Electronic Platform?
• Standardization of data collection,
flow and exchange:
Better data quality and Faster availability
• Improved/faster analysis and
automated signal generation:
Rapid response
• Faster automated report
generation:
Easier, faster feedback

15. Ideal Attributes for Integrated
Surveillance Software Platforms
• Ability to create complex
indicators
• Collect information using
mobile and browser
• Aggregate data in different
combinations
• Store, export, import data
• Create on-demand, flexible
reports and dashboards
• Specifically designed for M&E
without customization
• Open source and ability to share
templates
• Used successfully by large
organizations
• Large community of developers to
prevent vendor lock-in
• Ability to be configured without
developers
• Frequent updates to mitigate
obsolescence
DHIS2 meets these criteria and is funded for development by WHO/GF

16. EMR countries are starting to use
Integrated Platforms
• Disease Early Warning Systems
– Afghanistan
– Pakistan
– Sudan
– Somalia
– Iraq
– Syria
– Yemen
– Others…
• National Electronic Disease Surveillance System
(Egypt)
• Health Electronic Surveillance Network (HESN/
KSA) and UAE electronic surveillance system
• Integrated Tablet/Mobile System (Jordan)
16

17. Feedback – How can regional office support?
• All suggestions welcome
17

18. THANK YOU
To reduce illness and deaths in our region from Communicable diseases and to
lead in their control and prevention

19. Integrated Disease Surveillance and Response (IDSR)
• 42 countries (89%) have
adapted IDSR Technical
Guidelines;
• 35 countries (74%)
adapted the training
modules
• 33 countries (70%)
conducted training of
trainers and started the
training at district level
• 16 countries submit data
weekly
Africa CDC EBS Meeting19
• Group 1: Countries adapted IDSR guidelines and training modules, and
conducted training of trainers and started district training
• Group 2: Countries adapted IDSR and training modules and conducted
training of trainers
• Group 3: Countries adapted IDSR guidelines and training modules
• Group 4: Countries only adapted IDSR guidelines
• Group 5: Countries adapted IDSR guidelines and conducted district
training without training of trainers performed
• Group 6: Countries have not started adaptation of the IDSR guidelines
• Group 7: No information provided for the status of implementation of
IDSR

20. Revision of IDSR as an opportunity to integrate all
• Scaling up of IDSR implementation in the context of the current
environment
• Taking into consideration
– lessons learnt from the recent outbreaks
– new initiatives and approaches in global health security
– New IHR monitoring and evaluation framework
– Emergency Response Framework
• A need for contemporary guidance
to Member States
Africa CDC EBS Meeting
20

21. Case: Pakistan’s Progress towards
Integrated Surveillance
• After JEE, the Ministry of
National Heath Service,
Regulation, & Coordination
developed a costed 5 year
roadmap to upgrade areas
identified in the JEE.
• Integrated Communicable
Disease Surveillance is one of
the main cross-cutting JEE
indicators within the roadmap;
seen as a priority to progress
Pakistan.
21

22. Case: Pakistan’s Progress towards
Integrated Surveillance
• Pakistan’s National Institute of
Health:
– Working with Public Health England
to help establish a National
Integrated Disease Surveillance &
Response workgroup
– Working with US Centers for Disease
Control and Prevention to help
establish a National Public Health
Institute and upgrade the Field
Epidemiology Training Program
• WHO Country office: Chair of the
donor group for Global Health
Security Agenda
22
Donors are aligning towards a
single goal directed mission
based on JEE results that the
GoP used to make a 5-year
roadmap

23. Case: NEDSS in Egypt
• 2002: Disease surveillance system launched
with Egyptian Ministry of Health and
Population, WHO, USG (NAMRU3/USAID/CDC)
and others i.e. World Bank, US DoDGEIS
23

24. Case: NEDSS in Egypt
• Continual improvements on the system
– Additional sites fever hospitals  Univ., private
– N “Egyptian” to “Electronic” DSS
– Conjoining notification system to registration system
• Planned integration of vertical programs e.g.
environmental health
• High level visibility and support: integrated
dashboard monitored by Under Secretary Dr. Amr
Kandeel
24

25. Summary Points
• Lessons learned
– Partnerships are fundamental for success, this is hard
work.
– Multi-diseases surveillance and response frameworks are
necessary, need to adapt them to new technologies.
– Competently trained staff to operate surveillance and
response systems are critical.
– A lot funding is needed; major public health interventions
can help.
– Networking is necessary for effective surveillance and
response and efficient training.
– Political will is necessary to achieve and maintain success.
• There is plenty of work remaining to be done.