Background In 2000 Uganda adopted the Integrated Disease Surveillance and Response (IDSR) strategy, which aims to create a co-ordinated approach to the collection, analysis, interpretation, use and dissemination of surveillance data for guiding decision making on public health actions.Methods We used a monitoring framework recommended by World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC)-Atlanta to evaluate performance of the IDSR core indicators at the national level from 2001 to 2007. To determine the performance of IDSR at district and health facility levels over a 5-year period, we compared the evaluation results of a 2004 surveillance survey with findings from a baseline assessment in 2000. We also examined national-level funding for IDSR implementation during 2000–07.Results Our findings show improvements in the performance of IDSR, including: (1) improved reporting at the district level (49% in 2001; 85% in 2007); (2) an increase and then decrease in timeliness of reporting from districts to central level; and (3) an increase in analysed data at the local level (from 10% to 47% analysing at least one target disease, P < 0.01). The case fatality rate (CFR) for two target priority diseases (cholera and meningococcal meningitis) decreased during IDSR implementation (cholera: from 7% to 2%; meningitis: from 16% to 4%), most likely due to improved outbreak response. A comparison before and after implementation showed increased funding for IDSR from government and development partners. However, funding support decreased ten-fold from the government budget of 2000/01 through to 2007/08. Per capita input for disease surveillance activities increased from US$0.0046 in 1996–99 to US$0.0215 in 2000–07.Conclusion Implementation of IDSR was associated with improved surveillance and response efforts. However, decreased budgetary support from the government may be eroding these gains. Renewed efforts from government and other stakeholders are necessary to sustain and expand progress achieved through implementation of IDSR.
BackgroundUganda is a low income country that continues to experience disease outbreaks caused by emerging and re-emerging diseases such as cholera, meningococcal meningitis, typhoid and viral haemorrhagic fevers. The Integrated Disease Surveillance and Response (IDSR) strategy was adopted by WHO-AFRO in 1998 as a comprehensive strategy to improve disease surveillance and response in WHO Member States in Africa and was adopted in Uganda in 2000. To address persistent inconsistencies and inadequacies in the core and support functions of IDSR, Uganda initiated an IDSR revitalisation programme in 2012. The objective of this evaluation was to assess IDSR core and support functions after implementation of the revitalised IDSR programme.MethodsThe evaluation was a cross-sectional survey that employed mixed quantitative and qualitative methods. We assessed IDSR performance indicators, knowledge acquisition, knowledge retention and level of confidence in performing IDSR tasks among health workers who underwent IDSR training. Qualitative data was collected to guide the interpretation of quantitative findings and to establish a range of views related to IDSR implementation.ResultsBetween 2012 and 2016, there was an improvement in completeness of monthly reporting (69 to 100%) and weekly reporting (56 to 78%) and an improvement in timeliness of monthly reporting (59 to 93%) and weekly reporting (40 to 68%) at the national level. The annualised non-polio AFP rate increased from 2.8 in 2012 to 3.7 cases per 100,000 population < 15 years in 2016. The case fatality rate for cholera decreased from 3.2% in 2012 to 2.1% in 2016. All districts received IDSR feedback from the national level. Key IDSR programme challenges included inadequate numbers of trained staff, inadequate funding, irregular supervision and high turnover of trained staff. Recommendations to improve IDSR performance included: improving funding, incorporating IDSR training into pre-service curricula for health workers and strengthening support supervision.ConclusionThe revitalised IDSR programme in Uganda was associated with improvements in performance. However in 2016, the programme still faced significant challenges and some performance indicators were still below the target. It is important that the documented gains are consolidated and challenges are continuously identified and addressed as they emerge.
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