Strengthening health surveillance systems to detect public health threats early
The theme for World Field Epidemiology Day 2022 (on 7 September) is Empowering Field Epidemiologists for Stronger Health Systems. As we wrote in an earlier blog, to celebrate, we are sharing weekly stories from Pacific field epidemiologists on the frontlines in our programs for each of the Day’s six sub-themes.
Today we are pleased to share with you the work of Symphorian Sumun. Symphorian is a Field Epidemiology Training in Papua New Guinea (FETPNG) graduate, Advanced FETPNG fellow and FETPNG junior faculty in Papua New Guinea.
Here, Symphorian shares about some operational research he conducted to evaluate public health surveillance in PNG, speaking to the second sub-theme for World Field Epidemiology Day 2022: Strengthening surveillance systems to detect public health threats early.
Symphorian out in the field
I had been selected to participate at the FETPNG Training Program in 2015, as part of the 2nd Cohort, whilst I was in the role of the Provincial HIV/Aids Response Coordinator in West Sepik Province. That FETP training program was facilitated and mentored by mostly the expatriate faculty members from the CDC, WHO and University of Newcastle.
I had completed my Intermediate FETP successfully, and moved on with my career as the HIV/Aids Response Coordinator, then to the District Health Manager in 2017, and then now to the role of the Deputy Director Public Health Programs on the 17th of November 2021, with the West Sepik Provincial Health Authority in Vanimo, West Sepik Province Papua New Guinea. This had taken me five years to shift from the three different Public Health Managerial roles in the organisation since graduating from the Intermediate Field Epidemiology Training Program back in 2015. I am now undertaking the Advance Field Epidemiology Training Program in Papua New Guinea (aFETPNG) to date.
As part of my studies in aFETPNG, I conducted an evaluation of the use of the ODK surveillance reporting platform in West Sepik from 2020 – April 2022. I hope to publish my full results (so you will have to wait for the whole story til then!) but am pleased to now share with you some of the important findings from this evaluation that illustrate the value of strengthening surveillance so that we can better detect public health threats early.
Symphorian with FETPNG fellow graduate, Pauline Mukura
An introduction
Periodic data collection of field data, analysis and interpretation of data are key to good health care services. This data is used by decision makers to recognise preventative measures, provide timely support to the affected and to help measure the effects of their interventions. Looking at the current trend of emerging and re-emerging of diseases that are now putting pressure on the existing health care systems globally, it is also a growing concern on the effectiveness of the surveillance systems that are in place.
The means of data collection and analysis have undergone several changes in the last few years. Paper based modes of information gathering are slowly being replaced with the use of emerging technologies for better, faster and more error-free processes. Improved surveillance attributes are the primary focus on establishing mechanisms that can address them appropriately. One of those information technologies that was designed for the developing regions that can utilise the current Mobile Phone Communication Industry is with the use of the Android Platforms, and that is the Open Data Kit (ODK). It is a free, open-source suite of tools that allows data collection using Android mobile devices and data submission to an online server, even without an Internet connection or mobile carrier service at the time of data collection.
Currently the Syndromic Surveillance and Public Health Event Based Surveillance (PHEBS) reporting in Papua New Guinea are done through the use of the ODK application that was installed in the Android Phones and issued to the reporting health facilities to submit every week on a set timing after filling out the forms directly from the Android phones.
To that effect, the Vanimo Green District of West Sepik Province, had made an effort to strengthening the surveillance reporting in the district by purchasing Android Phones installed with ODK Application and issued them to all its key health facilities in the district in 2020.
A brief training was conducted on the use and filling in forms on the ODK and the use of Android phones. It was anticipated that having the Android Phone issued with the ODK Application installed, it should be able to;
· improve the timeliness of weekly surveillance reporting from the district,
· identify and attend to the Urgently Notifiable conditions and
· contribute to the overall provincial surveillance reporting for West Sepik Province.
Symphorian facilitating group work session with fellow FETPNG graduates
An overview of the evaluation process
In my full evaluation, I describe the surveillance system, including its objectives, case definitions for 12 syndromes/events, data sources and collection methods (see below graphic I created to illustrate data flow), resources required to operate the system and stakeholders involved in its implementation.
Through a desktop review of datasets, review of surveillance reports, self-administered questionnaires with key surveillance stakeholders and an in-person interview with a key stakeholder, I assessed the data quality (accuracy and completeness), acceptability and timeliness.
Key findings
I share here results relating to strengthening health surveillance systems to detect public health threats early. This is a key purpose of the system, with the first three objectives of the system being:
To identify any urgently notifiable conditions so that early interventions can take place to address the event/outbreak
To detect locally any unusual health events and take actions
To keep health facilities on alert in early detection of any Syndrome and health events should it happens in the community
A key finding of an evaluation of the attribute of timeliness was that of all the surveillance reports submitted in 2021, 40% were submitted on time, with two-thirds of delayed reports sent within 24 hours of the deadline.
West Sepik Province has a total of 38 Reporting Health Facilities and most of these health facilities are based at the remote locations in the districts which are constrained by communication accessibility and transport. Timely reporting is usually an issue that had been experienced well over decades now for these facilities. At one stage, a High Frequency Radio network was installed and operational in those remote health facilities where effective communication between health facilities and the Provincial and District Headquarters were maintained, however that communication system is no longer operational thus contributing to the poor timeliness of routine reporting as well as the surveillance reporting that we are now experiencing. Current reporting is done through paper based systems, and that takes a while or even weeks reaching the district or the provincial level if there are available third level airlines operating in the area or other means of sending the reports in.
For the digital reporting submitted by phone using ODK at District level, key informants shared that there was often no data credit supplied for the phone, often no power available to charge the phone to submit reports, and the phone was often being used by other officers for other purposes and unavailable to submit reports on time. Importantly, the majority of interviewees shared that they are not receiving any feedback from surveillance reports that they send, so they cannot tell whether their ODK submissions had improved timeliness of detection and response and data accuracy within the surveillance reporting system.
Symphorian (second from left) with field epidemiology colleagues
Recommendations
Recommendations from key informants to strengthen the system to enable more timely detection of public health events included the provision of communication enabling features such as data/credit for the data transmission, available electricity to charge the phones, restricting phones for surveillance reporting purpose only and feedbacks to be given to them. The stakeholders have also indicated that, despite those issues, it is strongly stressed that the ODK Platform used in Surveillance reporting can be rolled out and used by addressing all these identified issues and facilitating good monitoring and coordination from the national down to the provincial and further down to the district and health facility levels.
Disease outbreaks and occurrences of unusual events at the community or health facility level can only be reported if our surveillance systems are up and running with good mechanisms in place to routinely access and improve if there are weaknesses of issues identified earlier. COVID-19, as well as previous emergencies that PNG has faced such as measles and polio, have demonstrated the importance of having well-functioning surveillance systems that can support early detection of public health threats. It is vital that we continue to strengthen existing surveillance systems, and address identified gaps. In my evaluation I provide some practical ideas for investment that would have tangible impact on the ability of the system to effectively detect public health events and, subsequently, protect our communities from the devastating consequences of outbreaks.
Thank you Symphorian!
If you missed our first World Field Epidemiology Day sub-theme blog featuring John Landime sharing about his experience fighting outbreaks and health emergencies, including COVID-19, on the frontlines, you can catch up here.
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