• Analyze data by time

• Analyze data by place

• Analyze data by person

• Construct a table for person analysis

• Calculate the percentage of cases within specific age groups

• Calculate attack rates

• Calculate case fatality rate

3. Compare Analysis Results with Thresholds for Public Health Action

• Alert Threshold: This is the crucial number of cases (or any relevant indicator such as proportion, or rate) that signals the need to initiate an investigation at the onset of a potential epidemic and to prepare for an appropriate response.

• Action (Epidemic) Threshold: This represents the essential number or concentration of susceptible individuals needed for an epidemic to occur, triggering a determined public health action.

4. Draw Conclusions from the Findings to Generate Information Through:

• Regularly compile and present data using graphs, maps, and tables. Engage in meetings with district health teams or relevant stakeholders to carefully review analysis results and thoroughly discuss the findings.

• Systematically examine the findings in accordance with the district’s analysis plan, if such a plan exists and has been prepared.

• Ensure to integrate your analysis with other relevant data sources, such as information from animal health or environmental monitoring, to support a more accurate and comprehensive interpretation of the findings.

• Evaluate the quality and reliability of the data when interpreting the results to ensure accuracy and validity of conclusions.

• At a minimum, review the findings to:

  • Assess the current situation based on the data.

  • Compare current data with previous trends and expected patterns.

  • Consider possible explanations for any observed increase in cases or unusual trends.

  • Analyze potential changes in reporting of cases that may affect data interpretation.

  • Examine any changes in reporting procedures that could influence the data.

  • Review any changes in case definitions being used for reporting to ensure consistency and accuracy.

• Summarize the analysis and effectively use it to improve public health action strategies and interventions.

• Prepare a comprehensive report and share the findings and recommendations with all relevant stakeholders, including the affected communities, to ensure transparency and collaborative action.

INVESTIGATION AND CONFIRMATION OF SUSPECTED CASES, OUTBREAKS/EVENTS:

Purposes:

• Verify the existence of an outbreak or confirm a significant public health event and assess the immediate risk to the population.

• Identify and ensure treatment for additional cases that might not have been previously reported or recognized through routine surveillance.

• Collect essential information and laboratory specimens to definitively confirm the diagnosis. Accurately identify the source of infection or the underlying cause of the outbreak to implement targeted interventions.

• Aid in thoroughly describing the epidemiological situation in terms of time, geographic place, and affected person characteristics to understand the scope and dynamics of the event.

• Explain the modes of disease transmission and identify the population groups at higher risk of infection. Select and implement appropriate response activities aimed at controlling the current outbreak or managing the public health event effectively.

• Strengthen existing prevention activities to effectively avoid future reoccurrence of similar outbreaks and enhance long-term public health security.

Steps of outbreak investigation

1. Prepare to conduct an investigation: Mobilize Public health emergency rapid response team (PHERRT)

   • Clearly define specific tasks for each member of the PHERRT, outlining their expected contributions.

   • Establish clear lines of supervision and communication pathways within the team and with external entities.

   • Determine the geographical scope and specific locations where the investigation will be concentrated.

   • Secure all necessary official authorizations and permissions to conduct the investigation effectively.

   • Finalize and prepare standardized forms and methodologies for consistent and comprehensive data collection and specimen handling.

   • Organize transportation arrangements and other logistical needs to ensure team mobility and operational efficiency.

   • Assemble and pack all essential supplies required for collecting laboratory specimens and conducting field investigations.

2. Verify and confirm the outbreak/event

   • Review patient clinical histories and relevant epidemiological data to understand the event’s nature.

   • Collect appropriate laboratory specimens for diagnostic confirmation and pathogen identification.

   • Obtain laboratory results to definitively confirm the diagnosis and characterize the causative agent.

3. Define and search for additional cases

   • Develop a clear and operational case definition to ensure consistent case identification.

   • Isolate and provide appropriate treatment to confirmed cases to prevent further transmission and manage illness.

   • Actively search for additional cases by reviewing health facility records and investigating reported cases and deaths.

   • Extend case finding to the community, actively searching for suspected cases and deaths, including contact tracing to identify chains of transmission.

4. Develop a line list and record information about the additional cases

   • Create a detailed line list to systematically record and track key information for each identified case.

5. Analyze data about the outbreak; Interpret analysis results

   • Interpret the time analysis results to understand the temporal pattern of the outbreak.

   • Interpret the person analysis results to identify high-risk populations and demographic factors.

   • Interpret the place analysis results to determine geographical distribution and potential environmental links.

   • Analyze collected data to formulate preliminary hypotheses about the outbreak’s origins and transmission.

   • Test and refine the initial hypotheses through further analytic studies and data review.

6. Report writing and dissemination of findings.

   • Prepare a comprehensive report documenting the investigation process, findings, and recommendations.

   • Disseminate the report to relevant stakeholders and public health authorities for informed decision-making and action.

7. Implement prevention and control measures.

   • Put into action targeted prevention and control strategies based on the investigation’s findings to contain and mitigate the outbreak.

8. Conduct an assessment to determine if the event is a potential public health emergency of international concern (PHEIC).

   • Evaluate the severity, scale, and potential international implications of the event to determine if it meets PHEIC criteria.

9. Maintain and intensify surveillance.

   • Continue and enhance surveillance activities to monitor the outbreak’s progression and detect any resurgence or new cases.

10. Conducting regular risk assessment after the outbreak has been confirmed.

    • Regularly perform risk assessments to adapt response strategies, evaluate ongoing risks, and plan for post-outbreak management and prevention.

RESPONDING TO OUTBREAKS AND OTHER PUBLIC HEALTH EVENTS

Preparation: Preparations for public health events involve the following;

1. Establish a permanent PHEOC (command and control Centre) for overseeing public health emergency preparedness and response activities.

   • The Public Health Emergency Operations Center (PHEOC) must develop essential elements to be fully functional to support preparation and response to emergencies.

     • Develop detailed plans and standard operating procedures for all critical operations within the PHEOC.

     • Implement robust telecommunication technology and infrastructure to ensure timely and reliable communication.

     • Establish an information management system to support data-driven and informed decision-making processes (e.g., using HMIS/DHIS2 platforms).

     • Ensure the availability of trained human resources capable of effectively staffing and managing the PHEOC during emergencies.

2. Establish a district or regional public health emergency management committee (PHEMC)

   • Form a Public Health Emergency Management Committee (PHEMC) at the district or regional level.

     • Clearly identify and appoint members of the PHEMC, defining roles and responsibilities.

     • Define the specific functions and operational procedures of the PHEMC in emergency response.

     • Schedule and conduct regular PHEMC meetings to ensure preparedness and coordination.

3. Establish public health emergency management committee at all level

   • Ensure a Public Health Emergency Management Committee is established and functional at every relevant administrative level to facilitate coordinated response.

These includes;

Coordination/management subcommittees.

Roles: Coordinate all aspects of the operations response, planning and management including;

• Selecting participating organizations and clearly assigning specific responsibilities to each partner involved in the response.

• Designing, implementing, and rigorously evaluating control interventions to ensure effectiveness and adapt strategies as needed in collaboration with partners.

• Facilitating coordination of technical Emergency Preparedness and Response (EPR) subcommittees and ensuring overall liaison with all involved partners.

• Ensuring daily communication and information sharing through situation reports that provide updates on the evolution and current status of the outbreak.

• Managing information dissemination to the public and news media to keep the community informed and manage public perception.

• Providing operational support, encompassing mobilization of resources, logistics, and administrative support necessary for field operations.

• Being responsible for staff wellbeing and security, ensuring the safety and support of all personnel involved in the response efforts.

Finance and administration.

• Track expenditure meticulously, manage payments efficiently, and provide essential administrative services to support financial operations.

• Ensure appropriate cash flow management, including tracking material and human resources, carefully looking at costs, budget preparation, monitoring, and maintenance of all administrative records related to finances.

Logistics committee.

• Provide budgetary support and secure funding specifically for epidemic preparedness and response activities.

• Manage the procurement process for all necessary equipment and supplies required for outbreak response.

• Maintain adequate stocks of essential supplies and equipment, ensuring readiness for rapid deployment in emergencies.

• Arrange for transport and establish reliable communication systems to support logistical operations.

• Liaise with other agencies and partners for logistical support, ensuring seamless resource mobilization and delivery.

• Provide accountability for all resources utilized during epidemic preparedness and response activities, ensuring transparent and responsible resource management.

Planning committee.

• Evaluate the overall situation through comprehensive information gathering and analysis to understand the evolving context of the emergency.

• Conduct thorough assessment of the various options for dealing with the situation, including resource implications and feasibility.

• Keep meticulous track of all resources utilized and needed throughout the response to inform planning and resource allocation.

Case management and infection prevention and control committee

• Ensure the development and availability of clear guidelines and Standard Operating Procedures (SOPs) for effective case management and rigorous infection prevention and control protocols across all healthcare facilities.

• Enhance the capacity of isolation facilities to appropriately manage cases and implement robust infection prevention and control measures to minimize transmission.

• Conduct thorough risk assessments specifically targeting healthcare workers to identify and mitigate occupational hazards.

• Confirm that appropriate and high-quality medical care is consistently provided to all patients, adhering to established clinical protocols.

• Organize and offer ambulance services to facilitate the safe and efficient collection and transportation of suspected cases from the community, strictly following the defined referral system.

• Systematically collect data from all treatment facilities involved in the response (if applicable) and promptly submit this data to the surveillance subcommittee for comprehensive oversight.

• Ensure proper and thorough disinfection of homes and environments where suspected, probable, or confirmed cases, as well as deaths from infectious diseases, have occurred to minimize environmental contamination.

• Conduct safe and dignified burial of deceased individuals from isolation facilities and communities, adhering to cultural sensitivities and public health guidelines to prevent further spread.

• Organize and implement training and refresher training programs for healthcare workers specifically in isolation facilities and other health facilities within the affected district to maintain high standards of care and safety.

Surveillance and laboratory

• Ensure that all relevant surveillance guidelines and tools are readily available and effectively utilized in all health facilities to standardize surveillance practices.

• Enforce the consistent application of the outbreak case definition to ensure uniform case identification and reporting.

• Conduct active case finding initiatives, thorough case investigations, and rigorous contact tracing and follow-up activities to identify and manage all potential cases.

• Implement verification processes for suspected cases, alerts, and rumors circulating within communities to promptly assess and respond to potential threats.

• Ensure the proper and systematic filing of case investigation forms, contact tracing records, and follow-up documentation for efficient data management and future reference.

• Implement protocols for proper collection, secure packaging, safe transportation, and accurate testing of specimens obtained from suspect, probable cases, and deceased individuals to ensure reliable laboratory diagnoses.

• Communicate laboratory test results promptly and effectively to clinical services to facilitate timely patient management and public health actions.

• Conduct comprehensive data management activities and provide regular epidemiological analysis and reports to inform decision-making and track outbreak dynamics.

• Organize specialized training for health personnel in advanced disease surveillance techniques to enhance workforce capacity and surveillance quality.

• Establish and maintain close collaboration with burial teams, infection control specialists, and social mobilization groups to ensure a coordinated and comprehensive response effort.

Risk communication and social mobilization

• Ensure the development and distribution of accessible risk communication materials and plans to effectively inform the public about the health risks and preventive measures.

• Conduct rapid assessments to understand community knowledge, attitudes, practices, and behaviors regarding prevailing public health risks and events to tailor communication strategies.

• Organize comprehensive sensitization and mobilization campaigns targeting communities to promote awareness, understanding, and engagement in prevention efforts.

• Serve as the primary point of contact for information to be released to the press and broader public, ensuring consistent and accurate messaging.

• Liaise closely with different subcommittees, local leadership, and Non-Governmental Organizations (NGOs) involved in activities aimed at mobilizing communities to maximize reach and impact.

Psychosocial support committee

• Provide essential psychological and social support services to suspected, probable, and confirmed cases, as well as affected families and communities to address mental health and social well-being needs.

• Provide wellness care and psychological support specifically to the response team members to manage stress and ensure their mental health during demanding operations.

• Prepare bereaved families and communities for culturally sensitive and dignified burials, offering support during grief and bereavement.

• Prepare communities for the reintegration of convalescent cases and patients who have fully recovered, promoting social inclusion and reducing stigma.

Water sanitation and hygiene- WASH committee

• Conduct detailed environmental health risk assessments specifically focused on the outbreak context to identify and mitigate environmental transmission pathways.

• Ensure consistent provision of clean and safe water to affected communities and healthcare facilities to prevent waterborne transmission and support basic hygiene.

• Implement improved water management strategies at both household and community levels to optimize water usage and minimize contamination risks.

• Plan and execute comprehensive sanitation improvement campaigns to enhance environmental sanitation and reduce disease vectors.

• Plan and promote improved hygiene practices, emphasizing hand-washing, food hygiene, and overall sanitation practices within communities to promote behavioral change and prevent transmission.

Vaccination campaign committee/EPI team

• Identify specific high-risk groups within the population during the outbreak who should be prioritized and targeted for vaccination to maximize impact and protection.

• Accurately compute the targeted population size to ensure sufficient vaccine supply and logistical planning for the vaccination campaign.

• Conduct meticulous micro-planning for all aspects of vaccination logistics, including cold chain management, vaccine delivery and distribution, human resource allocation, community mobilization needs, and waste handling procedures for a smooth and efficient campaign.

• Conduct the vaccination campaign in accordance with established protocols and implement post-vaccination campaign validation exercises to assess coverage and effectiveness.

Establish public health emergency rapid response team (PHERRT) Roles of PHERRT includes;

• Investigate rumors and formally reported outbreaks, rigorously verify diagnoses, and thoroughly assess other public health emergencies, including conducting laboratory testing to confirm etiologies.

• Collect additional samples from new patients and, when necessary, from old cases to gain comprehensive epidemiological and diagnostic information (samples can include human, animal, food, and water sources depending on the nature of the event).

• Conduct thorough follow-up activities by visiting and interviewing exposed individuals and affected communities to gather detailed histories, establish a robust case definition, and work collaboratively with the community to identify additional cases.

• Assist in establishing and implementing effective mechanisms for the implementation of Infection Preventive Control Measures in healthcare and community settings to minimize transmission.

• Assist in generating a comprehensive line list of cases, and perform descriptive epidemiological analysis of data (Person, Place and Time) to generate initial hypotheses about the outbreak’s dynamics, which is crucial for planning for further analytical studies.

• Propose appropriate and evidence-based strategies and control measures, including risk communications activities, tailored to the specific context and needs of the outbreak.

• Establish an appropriate and coordinated risk communication system, ensuring consistent messaging and utilizing a trained spokesperson to effectively communicate with the public and media.

• Coordinate rapid response actions, working in close collaboration with national and local authorities, international partners, and other relevant agencies to ensure a unified and effective response.

• Initiate the swift implementation of the proposed control measures, including capacity building activities to strengthen local response capabilities and ensure sustainability.

• Conduct ongoing monitoring and rigorous evaluation of the effectiveness of implemented control measures through continuous epidemiological analysis of the control efforts and adapting strategies as needed.

• Conduct Risk Assessments to rigorously determine if the outbreak qualifies as a potential Public Health Emergency of International Concern (PHEIC), based on established criteria.

• Prepare detailed investigation reports that are comprehensive and structured to effectively share findings and recommendations with the PHEMC for informed decision-making.

• Contribute actively to ongoing preparedness assessments and the final evaluation of each outbreak response to identify lessons learned and areas for improvement.

• Schedule and conduct daily meetings during active outbreaks to ensure real-time coordination and information sharing, and meet quarterly during periods without outbreaks to maintain preparedness and review protocols.

• Participate regularly in simulation exercises to test preparedness plans, enhance team coordination, and identify gaps in response capabilities.

4. Risk mapping for outbreaks and other public health events.

• Risk assessment and mapping techniques should be used as a valuable tool to enhance preparedness. This approach helps to pinpoint at-risk geographical areas or specific populations, prioritize preparedness activities based on risk levels, and effectively engage key policy makers and operational partners in targeted interventions.

5. Resource mapping to identify the available resources in every geographical area to ensure prompt mobilization and distribution of such resources including materials, human and funds in an outbreak situation

6. Prepare an emergency preparedness and response plan to strengthen the ability of the national to subnational levels to respond promptly when an outbreak/event is detected. This plan should; Response to outbreaks/events

• Declaring an outbreak and activating the response structures: Once an epidemic threshold is reached at the district level, the head of DHMT should promptly notify the region and the Ministry of Health (MOH). MOH will then assess whether the event constitutes a potential Public Health Event of International Concern.

• Mobilize PHERRT for immediate action which includes: Convene the district public health management team for outbreak/event. Once confirmed, DHMT will collaborate with the district authority to convene PHEMC to assess and implement the response strategy.

• Select and implement appropriate public health response activities. These includes;

  • Strengthen case management and infection prevent and control measures (IPC).

  • Build the capacity for response staff through targeted training and support.

  • Enhance surveillance activities during the response to track the outbreak’s progression.

  • Enhance surveillance collaboration with neighboring border districts to prevent cross-border spread.

  • Engage community participation actively during the response to ensure community ownership and support.

  • Inform and educate the community comprehensively about the outbreak, risks, and preventive measures.

  • Conduct a mass vaccination campaign if indicated and deemed necessary by public health assessment.

  • Improve access to clean and safe water to ensure basic sanitation and hygiene.

  • Ensure safe disposal of infectious waste to prevent environmental contamination and further transmission.

  • Improve food handling practices to minimize foodborne transmission risks.

  • Reduce exposure to infectious or environmental hazards through targeted interventions and public health advisories.

  • Ensure safe and dignified burial and handling of deceased bodies in accordance with cultural norms and public health guidelines.

  • Ensure appropriate and adequate logistics and supplies are in place to support all response activities effectively.

7. Provide regular situation reports on the outbreak and events

8. Document the response including minutes of meeting, activity, process, epidemic report, evaluation reports and other relevant document

9. Treatment of cases during an outbreak with appropriate medicine and procedures. These may include;

• Antibiotics, when applicable for bacterial infections.

• Rehydration with fluids administered orally or intravenously to manage dehydration.

• Assessment of pain and implementation of pain management strategies to alleviate suffering.

• Ensure appropriate infection control measures are strictly followed to prevent secondary infections and nosocomial transmission.

• Observation of vital signs and specific clinical observations to monitor patient condition and treatment response.

• Other routine nursing care as needed to support patient recovery and comfort.

The Different Levels Where Surveillance Activities Are Performed

1. Community: Surveillance at the community level is typically performed by basic community-level service providers. These include Village Health Teams (VHTs), village leaders (religious, political, traditional), school teachers, agricultural extension workers, veterinarians, chemical and drug sellers, and traditional healers who are often the first point of contact in healthcare seeking.

2. Health facility: For the purpose of surveillance, all health institutions (public and private health service providers) that offer outpatient care and/or in-patient facilities are defined as a “health facility” and are crucial for case detection and reporting.

3. Health Sub-district (HSD): The HSD is recognized as the basic level for the effective delivery of the Uganda National Minimum Health Care Package. It is mandated with comprehensive planning, organization, budgeting, supervision, and overall management of health services at both this level and lower-level health centers. The HSD carries an essential oversight function of health care services within its jurisdiction, often with a referral facility at the level of a general hospital or Health Centre (HC) IV. For surveillance purposes, the HSD receives, consolidates, and reviews reports from all lower-level health facilities within its catchment area and submits aggregated reports to the district level.

4. District: The District health services have the primary responsibility of planning and directing the implementation, supervision, and continuous monitoring of integrated health service delivery, particularly in the context of the “One Health” approach.

5. Regional Level: This level consists of regional referral hospitals (RRH), which are designed to provide specialized referral services, offer support supervision to lower districts, and coordinate response to public health threats to the districts within their respective regions.

6. National level: The national health system, at the apex, consists of the Ministry of Health and other national-level institutions. These encompass national referral hospitals, national reference laboratories, and national medical stores. It is at this level that national health policies, guidelines, and standard operating procedures are developed and resources are allocated. In relation to surveillance, this level reports on priority diseases and actively uses the IHR decision instrument for international health security.

Roles and Responsibilities of Various Actors in IDSR

Community-Based Surveillance Focal Person (Community Health Worker)

1. Employ simplified case definitions designed for community use to effectively identify priority diseases, health conditions, or potential hazards within the community.

2. Conduct regular household visits systematically to monitor community health status and detect potential health events.

3. Establish and maintain regular communication with key informants within the community to gather timely health-related information and insights.

4. Actively attend local ceremonies and community events to observe and follow up on any unusual occurrences, such as unexpected absences of individuals who were expected to be present.

5. Document priority diseases, health conditions, or unusual health events using standardized reporting forms and tools (like tally sheets), ensuring timely reporting within 24 hours of detection.

6. Participate in verbal autopsies by conducting structured interviews using questionnaires provided by health facility supervisors to gather information on deaths occurring in the community.

7. Promptly notify the nearest health facility and other relevant sectors about any unexpected or unusual cases of disease or deaths affecting humans or animals for immediate verification and investigation, adhering to International Health Regulations (IHR) and IDSR strategy timelines (within 24 hours).

8. Engage local leaders actively to gather insights on disease events and understand prevailing health trends within the community, fostering community ownership of surveillance.

9. Sensitize the community on the importance of reporting and seeking healthcare for priority diseases, health conditions, and any unusual health events to enhance community participation in surveillance.

10. Support health workers during case or outbreak investigations by assisting with contact tracing efforts and community-level data collection.

11. Mobilize local authorities and community members to garner support for and participation in public health response activities, ensuring broad community involvement.

12. Participate in risk mapping exercises to identify potential hazards and engage in training activities, including simulation exercises to enhance preparedness.

13. Participate in containment and response activities in close coordination with the district level, ensuring a unified and effective response.

14. Engage in various response activities, which may include home-based care provision, promoting social or behavior change related to traditional practices, and managing logistics for distribution of drugs, vaccines, or other essential supplies; providing trusted health education during crises is also a valuable contribution.

15. Provide feedback to community members regarding reported cases, actions taken, and progress of prevention activities to maintain community trust and engagement.

16. Verify if planned public health interventions are implemented as intended and ensure active community involvement in these interventions to maximize effectiveness and community ownership.

17. Participate in meetings organized by sub-district, district, and higher-level authorities to share community-level insights and contribute to broader surveillance and response planning.

Health Facility Staff and Point of Entry

1. Identify cases of priority diseases using the standard case definitions to ensure consistent and accurate case identification.

2. Document case-based information and report immediately notifiable diseases, conditions, and events to the next administrative level for prompt action and response.

3. Liaise effectively with the district level to receive guidance on how to conduct immediate laboratory investigations for suspected cases, ensuring timely diagnostic confirmation.

4. Manage case treatment and ensure appropriate referral of cases when necessary to higher levels of care based on established protocols.

5. Actively prepare for and participate in outbreak investigation and response activities, including active case treatment and management within the health facility.

6. Report summary data and case-based data (weekly reports) to the next level in a timely manner to maintain regular data flow and inform higher-level surveillance.

7. Conduct simple data analysis (using graphs, tables, charts) at the point of data collection to monitor trends and patterns at the facility level.

8. Communicate diagnoses for outbreak-prone diseases to the appropriate authorities at the district and community levels for coordinated response actions.

9. Convene the district rapid response team when necessary to coordinate immediate response actions within the health district.

10. Identify resources needed for response (human resources, financial resources, essential commodities, communication tools like phone cards) and assess timeline for their deployment to ensure resource availability for effective response.

District Surveillance Officer at District Level:

• Investigate and verify potential outbreaks, ensuring prompt confirmation and initiation of control measures, collect diagnostic samples appropriately, and advise on suitable treatment and prevention protocols based on evidence.

• Prepare and thoroughly analyze weekly surveillance reports and submit them to higher authorities in a timely manner for regional and national level overview and action.

• Ensure that all surveillance sites within the district consistently maintain surveillance reports and ledgers/logbooks appropriately, promoting standardized data recording and management.

• Maintain a current and comprehensive list of all reporting sites within the district to ensure complete reporting coverage and monitoring.

• Establish and maintain a robust database of all trained and registered healthcare workers who are designated to serve as surveillance focal persons at the reporting sites, as well as other Community-Based Surveillance Focal Persons (CBS FPs) for efficient communication and network management.

• Ensure there is an adequate and consistent supply of essential data collection and reporting tools available at all surveillance reporting sites to facilitate smooth and uninterrupted surveillance operations.

• Ensure that the IDSR standard case definitions for all priority diseases are well understood and consistently used by healthcare workers at each site, and provide on-the-spot training and clarification if needed to enhance diagnostic accuracy and reporting consistency.

• Monitor key performance indicators (such as data timeliness and completeness) of the IDSR system as stipulated in the IDSR guidelines to evaluate system performance and identify areas needing improvement.

• Periodically update graphs, tables, charts, etc., to visualize surveillance data and compare current data with previous months, quarters, weeks, or years (important for trend analysis and making informed recommendations for response actions).

• Provide in-person feedback to surveillance reporting sites on a weekly or monthly basis regarding the quality and completeness of their reporting and the proper implementation of the IDSR system to enhance data quality and site performance.

• Closely follow up (often through phone calls) with the reporting sites to ensure they report data on time and address any reporting delays or issues promptly.

• Conduct regular supportive supervision visits to various surveillance sites, including health facilities, border entries, and communities, and build their capacity to effectively analyze and interpret their surveillance data to guide local decisions and actions.

• Sign and date the inpatient and outpatient record books, registries, or line-lists to formally document the visit and provide written recommendations for data quality improvement.

• Support healthcare facilities to verify alerts originating from the community and ensure appropriate follow-up and verification of community-reported events.

• Arrange and lead the investigation of verified cases or outbreaks, ensuring thorough investigation and documentation of findings.

• Maintain an updated line list of suspected cases under investigation for effective case tracking and management.

• Assist healthcare facilities in the safe collection, proper packaging, secure storage, and timely transport of laboratory specimens for confirmatory testing to ensure accurate and timely laboratory diagnoses.

• Receive laboratory results from the Province/Region and promptly communicate them to the concerned healthcare facility for immediate clinical and public health actions.

• Conduct/coordinate on-the-job trainings for the surveillance sites to continuously build capacity and address knowledge gaps for surveillance staff, especially with new staff.

• Review the quality of surveillance data from time to time by conducting data quality audits and develop appropriate measures to improve data quality in the district, ensuring data accuracy and reliability.

• Maintain a rumor logbook to systematically record events reported for the surveillance site, including rumors and alerts, for tracking and follow-up.

• Ensure cross-border (district-district) coordination and collaboration on surveillance issues and provide notification of any outbreaks in the neighboring district, promoting regional cooperation for disease control.

The District Health Management Team:

• Coordination via District Medical Officer: Engage with the District Executive, District Commissioner, and Regional Medical Officer on overall surveillance activities and planning.

• Support for District Surveillance Officer: Assist the local Surveillance Officer in carrying out planned tasks.

• Integrate Surveillance into District Health Plans: Incorporate surveillance actions into the broader District Health Plan.

• Resource Mobilization: Collaborate with district authorities to secure funding for local surveillance efforts.

• Ensure Prompt Fund Disbursement: Facilitate the quick release of allocated funds for surveillance work.

• Monitor IDSR Performance: Track the effectiveness of IDSR and the results from data analysis and monitoring tools.

• Risk Mapping Participation: Engage in district risk mapping and contribute to action plan development based on findings.

• Outbreak Response Support: Aid the EPR committee in setting up rapid response teams during outbreaks and ensure they are operational (refer to section 5).

• Reporting Initial Investigation Findings: Communicate the results of initial investigations to the Province/Region authorities.

• Community Assessment & Risk Mapping: Take part in community assessments and risk mapping initiatives.

• EPR Committee Establishment and Functionality: Assist in setting up and ensuring the operational effectiveness of EPR committees.

• Community Health Education Programs: Design, deliver training for, and implement community health education initiatives.

• Response Training Support: Participate in and support response training for healthcare facilities and community members.

• Collaborative Public Health Responses: Work with the Province/Region to choose and implement suitable public health response measures.

• Timely Information and Education Planning: Plan and execute community information and education activities promptly.

• Documentation of Response Activities: Keep records of all response actions taken.

• Daily Situation Reports During Outbreaks: Provide daily reports on the district’s situation when outbreaks occur.

Other Political Leaders at the District Level:

• Key Role of Political Leaders: Political leaders (e.g., Village, Ward, District Officers) are crucial in promoting behavioral changes for effective disease surveillance.

• Roles:

  • Emergency Declaration Support: Back the declaration of public health emergencies.

  • Local Resource Inventory: Create an inventory of local resources (human, financial, logistics) for rapid response to prevent disease spread.

  • Hygiene and Sanitation Promotion: Promote adherence to hygiene and sanitation principles, including environmental cleanliness, latrine availability and use, safe water access, and personal hygiene practices like handwashing.

  • Reporting Illness Clusters: Report any clusters of illness or deaths to the nearest health facility.

  • Bylaw Implementation: Enforce bylaws to strengthen hygiene and sanitation practices.

  • Community Sensitization: Actively engage in sensitizing community members on promoting, maintaining, and sustaining good health.

  • Community-Based Health Program Facilitation: Support community-led planning, implementation, and evaluation of health programs at the Ward level (including IDSR).

  • Outbreak Follow-up: Conduct outbreak follow-up in coordination with healthcare providers and extension workers at the Ward level.

  • Administrative Support for Healthcare Providers: Offer administrative backup to healthcare providers at Ward and Village levels.

  • Legislative Enforcement Support: Support the enforcement of relevant laws to prevent and control infectious disease outbreaks.

  • Supervision of Hygiene and Sanitation Practices: Supervise subordinates to ensure adherence to hygiene and sanitation principles.

  • Regular Public Health Committee Meetings: Ensure regular meetings of the Public Health Care Committee (or Health Committee), especially during outbreaks.

  • Disease Pattern Discussion: Discuss disease trends and their implications for action in regular meetings with the District Medical Officer.

  • Committee Establishment and Facilitation: Ensure the establishment and smooth operation of various committees to carry out necessary activities.

  • Resource Mobilization for Disaster Response: Seek resources from diverse sources for disaster response, including epidemics.

  • Health Advocacy: Conduct advocacy on health issues through various district campaigns.

Regional or Provincial Health Management Team:

• Regional/National Coordination: Engage with Regional/Provisional Commissioners and national health authorities (Chief Medical Officer/Director General of Health) on surveillance activities and planning.

• Support for Regional and District Surveillance Officers: Assist Regional and District Surveillance Officers in executing planned surveillance tasks.

• Integration of Surveillance into Regional/District Health Plans: Incorporate surveillance actions into regional/provincial and district health plans.

• Resource Mobilization and Timely Fund Release: Secure funding and ensure the prompt disbursement of funds for surveillance and response activities.

• District IDSR Performance Monitoring: Track the effectiveness of IDSR in districts and their data analysis.

• Support for District Risk Mapping and Assessments: Assist districts with risk mapping, action plan development, and community assessments.

• District Emergency Preparedness and Response Support: Support districts in emergency preparedness, response training, and overall public health response efforts.

Ministry of Health/National Level:

• Establish Emergency Operation Center: Create a Public Health Emergency Operation Center and incident management framework.

• Spokesperson and Risk Communication Plans: Designate a spokesperson and develop risk communication strategies.

• IDSR Standards and Emergency Response Guidelines: Establish standards, policies, and guidelines for IDSR, and update emergency preparedness and response plans.

• National Capacity Assessment and Improvement: Evaluate and enhance national-level capacity, including surge capacity for emergencies.

• Resource Mobilization and Coordination for IDSR: Mobilize and coordinate resources from domestic and international sources to support IDSR activities.

• IDSR Supervision, Monitoring, and Evaluation: Oversee, monitor, and evaluate IDSR activities comprehensively.

• Epidemiological Bulletin Production and Dissemination: Develop and distribute epidemiological bulletins.

• Epidemic Investigation Support: Support the investigation of suspected epidemic outbreaks.

• National Data Management and Analysis Support: Offer data management and analytical support at the national level.

WHO and Other Partners: (UN Agencies, CDC, USAID, PATH MSF, REDCROSS, UNICEF)

• Guideline Development: Assist in the creation of norms and the formulation of guiding principles.

• Technical and Material Aid: Offer specialized support, knowledge, and tangible resources to improve surveillance, lab capabilities, and health data networks.

• Fundraising for Activities: Back the process of securing financial resources for surveillance and outbreak response efforts.

• IDSR Oversight and Assessment: Help with the direction, monitoring, and evaluation processes of IDSR implementation.

• Administrative Support: Provide organizational assistance, for instance, in drafting funding applications.

• Capacity Enhancement: Bolster skills through training programs and the provision of necessary equipment.

• Emergency Response Support: During public health crises, deploy specialized personnel, rapid response teams, mobile labs, essential supplies, and immunizations.

Roles of a Nurse in IDSR

Nurses are essential for IDSR programs because they play key roles in healthcare delivery. Their broad patient interactions and diverse duties within healthcare settings make their involvement critical. Nurses often act as frontline healthcare providers, delivering care, patient education, and support. Their engagement in IDSR ensures early detection, rapid response, and effective management of disease outbreaks, ultimately improving community health outcomes.

Roles

1. Assessment and Reporting: Evaluate and report on priority disease cases, escalating information from local to higher authorities.

2. Coordination of Activities: Streamline IDSR coordination among various participants, including community members and technical staff at institutions such as the CDC. This ensures smooth operation and communication.

3. Planning and Preparation: Develop strategies and prepare for effective control of disease outbreaks within communities. This involves proactive measures and resource allocation.

4. Assistance in Monitoring and Evaluation: Actively participate in monitoring and assessing the effectiveness of disease outbreak programs. This ensures programs are on track and achieving goals.

5. Assessment, Analysis, and Reporting: Analyze and interpret data, then create clear reports on priority disease outbreaks, applying epidemiological knowledge.

6. Engagement in Immunization Programs: Participate in community immunization efforts to protect against vaccine-preventable diseases. Public health bodies advocate for early childhood vaccination against preventable diseases, a role nurses actively support.

Advantages of IDSR:

• Cost-Effectiveness: Efficient use of existing health personnel and standard reporting formats for routine health data makes it economical.

• Computerization Enablement: Facilitates the digitization of readily available data at a central point, improving data accessibility and management.

• Capacity Building: Offers training and skill development opportunities for health personnel, enhancing workforce capabilities.

• Community Engagement: Encourages community involvement in identifying and responding to disease outbreaks, fostering local ownership and participation.

• Resource Efficiency: Streamlines effective resource application and allocation to areas of greatest need.

• Rapid Public Health Response: Enables swift reactions to public health events, minimizing potential impact and spread.

Challenges in IDSR Implementation:

• Financial Sustainability: Lack of consistent funding sources can hinder long-term IDSR activities and program stability.

• Stakeholder Coordination: Poor collaboration among diverse stakeholders can impede unified and effective action.

• Training and Staff Turnover: Insufficient training combined with high turnover of frontline health staff weakens system capacity.

• Feedback Mechanism Issues: Unreliable feedback from higher to lower levels disrupts communication and responsiveness.

• Supervision and Support Gaps: Inadequate oversight and assistance from higher levels diminishes field-level effectiveness.

• Laboratory and Job Aid Deficiencies: Weak laboratory resources and limited availability of job aids (like case definitions and reporting forms) hamper accurate and timely data collection.

• Communication and Transport Limitations: Poor communication channels and transport systems, especially at local levels, slow down response times.

• Data Management and Analysis Capacity: Insufficient skills in data management and analysis at various levels limit effective data use.

• Resistance to Integrated Approaches: Opposition to shifting from traditional disease surveillance methods to a more integrated IDSR approach can slow progress.

• Community Engagement and Ownership Deficit: Lack of community participation and ownership of the IDSR system can undermine its local effectiveness.

• Animal and Human Health System Linkages: Weak connections between animal and human health surveillance systems hinder a “One Health” approach.

• Political Commitment and Leadership Shortcomings: Insufficient political will and leadership can impede sustained IDSR implementation and resource allocation.

• Fragmented Health Information Systems: Disjointed health information systems can hinder data sharing and comprehensive analysis.

• Limited Digital Technology Use: Underutilization of digital technologies and innovations to improve IDSR efficiency and reach.

• Adapting to Evolving Epidemiology: Challenges in modifying IDSR strategies to address changing disease patterns and new health threats.

• Outbreak Detection and Response Capacity: Limited ability for prompt outbreak identification, investigation, and effective response actions.