Community Health Surveillance

A.
Community Health Surveillance

Public health surveillance is the ongoing systematic collection, analysis, and interpretation of data,
closely integrated with the timely dissemination of these data to those responsible for preventing and
controlling disease and injury (Thacker and Berkelman 1988).
Public health surveillance is a tool to estimate the health status and behavior of the populations served by
ministries of health, ministries of finance, and donors.
Because surveillance can directly measure what is going on in the population, it is useful both for
measuring the need for interventions and for directly measuring the effects of interventions. The purpose
of surveillance is to empower decision makers to lead and manage more effectively by providing timely,
useful evidence.
B. Forms of surveillance
Active surveillance: a system employing staff members to regularly contact heath care providers or the
population to seek information about health conditions. Active surveillance provides the most accurate
and timely information, but it is also expensive.
Passive surveillance: a system by which a health jurisdiction receives reports submitted from hospitals,
clinics, public health units, or other sources. Passive surveillance is a relatively inexpensive strategy to
cover large areas, and it provides critical information for monitoring a community's health.
Forms of passive and active surveillance
 Routine health information system: a passive system in which regular reports about diseases
and programs are completed by public health staff members, hospitals, and clinics.
 Health information and management system: a passive system by which routine reports about
financial, logistic, and other processes involved in the administration of the public health and
clinical systems can be used for surveillance.
 Categorical surveillance: an active or passive system that focuses on one or more diseases or
behaviors of interest to an intervention program.
 Integrated surveillance: a combination of active and passive systems using a single
infrastructure that gathers information about multiple diseases or behaviors of interest to several
intervention programs (for example, a health facility–based system may gather information on
multiple infectious diseases and injuries).
 Syndromic surveillance: an active or passive system that uses case definitions that are based
entirely on clinical features without any clinical or laboratory diagnosis (for example, collecting
the number of cases of diarrhea rather than cases of cholera, or "rash illness" rather than measles).
 Behavioral risk factor surveillance system (BRFSS): an active system of repeated surveys that
measure behaviors that are known to cause disease or injury (for example, tobacco or alcohol use,
unprotected sex, or lack of physical exercise).
C. Objectives of Surveillance Systems

provides the scientific and factual database essential to informed decision making and appropriate public
health action.
The key objective of surveillance is to provide information to guide interventions
The public health objectives and actions needed to make successful interventions determine the design
and implementation of surveillance systems. For example, if the objective is to prevent the spread of
epidemics of acute infectious diseases, such as SARS, managers need to intervene quickly to stop the
spread of disease. Therefore, they need a surveillance system that provides rapid early warning
information from clinics and laboratories. In contrast, chronic diseases and health-related behaviors
change slowly.
D. Principles and uses of surveillance
The fundamental principle of public health surveillance is that the surveillance should be designed and
implemented to provide valid (true) information to decision makers in a timely manner at the lowest
possible cost.
The utility of surveillance data can be viewed as immediate, annual, and archival, on the basis of the
public health actions that can be taken ( Thacker and Stroup 1998b).
E. Establishing and Maintaining a Surveillance System

As with every health system, competent, motivated health workers need to be found or trained and
provided with career paths and supervision.
After a manager decides to create a surveillance system, there are six steps to establishing the system
F. Analysis and Dissemination of Surveillance Data

Surveillance information is analyzed by time, place, and person. Knowledgeable technical personnel
should review data regularly to ensure their validity and to identify information of use to top managers.
Simple tables and graphs are most useful for summarizing and presenting data. Timely dissemination of
data to those who make policy and implement intervention programs is critical to the usefulness of
surveillance data.
One international standard computer program used in many countries’ information systems is Epi Info, an
epidemiology surveillance and biostatistics program widely used around the world for the analysis of
surveillance data
G. Surveillance as a Component of National Public Health Systems

WHO and the World Bank cite public health surveillance as an essential function of a public health
system (World Bank 2001)
When linked to policy and program units, surveillance information improves the efficiency and
effectiveness of health services by targeting interventions and documenting their effect on the population.
Surveillance as a Tool to Improve Public Health
Managers need focused, timely, scientifically sound information that provides evidence to make decisions
on interventions for improving the health of the population in their jurisdiction. Simply collecting data
and presenting them are not enough.
H. Using Surveillance Information for Evidence-based Decisions

A major gap in promoting effective surveillance lies between the production of data and the ability to
convert those data into usable information and then initiate the appropriate public health action.
Surveillance and response can be described in terms of a data generation hemisphere and a data use
hemisphere (USAID 2005).
The data generation hemisphere is the traditional view of surveillance, whereas the data use hemisphere is
the public health response that begins with interpretation of the data from the surveillance system
I. Selected Surveillance Strategies
Surveillance systems need to be designed and implemented to meet top management's needs for focused,
reliable, timely evidence gathered efficiently and presented effectively.
i. Sentinel Surveillance
In a sentinel surveillance system, a prearranged sample of reporting sources agrees to report all cases of
defined conditions, which might indicate trends in the entire target population (Birkhead and Maylahn
2000)
ii. Periodic Population-based Surveys

Population-based surveys can be used for surveillance if they are repeated on a regular basis (Thacker and
Berkelman 1988). Examples of population-based surveys in surveillance include the BRFSS in the United
States, HIV-prevalence surveys, household surveys, and the demographic and health surveys that many
developing countries conduct every five years
iii. Laboratory-based Surveillance

Laboratory-based surveillance systems require resources, facilities, and training. A central public health
reference laboratory is essential for quality assurance and quality control and support.
Such a laboratory-based system might begin with systematic referral of a sample of strains isolated at a
sample of sentinel clinics, plus those strains that are part of outbreaks.
iv. Integrated Disease Surveillance and Response

The Integrated Disease Surveillance and Response (IDSR) strategy, first developed in Africa, links
epidemiologic and laboratory data in communicable disease surveillance systems at all levels of the
health system, with emphasis on integrating surveillance with response (WHO 1993, 1998)
Key steps in implementing the IDSR strategy include sensitizing key health authorities and stakeholders;
conducting situational analysis; preparing a strategic IDSR plan; identifying and training a motivated,
competent workforce; developing national IDSR technical guidelines; implementing the plan; and
monitoring and evaluating implementation to improve performance (WHO 2000b).
J. Surveillance for Specific Conditions
Environmental Public Health Surveillance

Surveillance for environmental public health practice requires the collection, analysis, and dissemination
of data on hazards, exposures, and health outcomes (figure 53.4; Thacker and others 1996).
Injury surveillance
WHO (Holder, Peden, and Krug 2001) and the Pan American Health Organization (Concha-Eastman and
Villveces 2001) have developed guidelines for establishing injury surveillance systems in developing
countries.
Critical points should be addressed when planning an injury surveillance system in a developing country.
First, data sources need to be clarified. In some developing countries, routine data on injuries are not
always captured in health information systems. It is therefore necessary to consider other sources of data
Chronic Disease Surveillance Systems

Development and evaluation of policies for health improvement require a reliable assessment of the
burden of disease and injury, an inventory of the disposition of resources for health, assessment of the
policy environment, and information on the cost effectiveness of interventions and strategies
References
https://www.ncbi.nlm.nih.gov/books/NBK11770/ Chapter 53, Public Health Surveillance: A Tool for
Targeting and Monitoring Interventions by Thacker and Stroup 1998b, 65
http://www.worldbank.org/ Disease control priorities in Developing countries, 2 nd edition by Jamison DT,
Breman JG, 2006

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A.

Community Health Surveillance

Forms of passive and active surveillance

C. Objectives of Surveillance Systems

E. Establishing and Maintaining a Surveillance System

F. Analysis and Dissemination of Surveillance Data

G. Surveillance as a Component of National Public Health Systems

H. Using Surveillance Information for Evidence-based Decisions

ii. Periodic Population-based Surveys

iii. Laboratory-based Surveillance

iv. Integrated Disease Surveillance and Response

J. Surveillance for Specific Conditions

Environmental Public Health Surveillance

Chronic Disease Surveillance Systems

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