Challenges of implementing the integrated disease surveillance and response strategy in Zambia: a health worker perspective

Abstract

BackgroundDespite advances in medical technology and public health practice at the global level over the past millennia, infectious diseases are still the leading causes of death in most resource limited countries. Stronger infectious disease surveillance and response systems in developed countries facilitated the near elimination of infectious disease related deaths in those countries. Today, low-income countries are following this path by strengthening disease surveillance and response strategies that would help reverse the trend in infectious disease associated morbidity and mortality cases. In 2000, Zambia adopted the World Health Organisation Regional Office for Africa’s (WHO-AFRO) Integrated Disease Surveillance and Response Strategy (IDSR) to monitor, prevent and control priority notifiable infectious diseases in the country. Through this strategy, activities pertaining to disease surveillance are coordinated and streamlined to take advantage of similar surveillance functions, skills, resources and targeted populations. The purpose of the study was to investigate and report on the existing challenges in the implementation of the IDSR strategy in a resource limited country from a health worker perspective.MethodsA qualitative study approach was used to achieve the study aim. Data was collected through key informant interviews with selected persons at the Lusaka Province Health Office (LPHO); Lusaka and Chongwe District Health Management Team Offices; and four selected health facilities in the two districts (two from each). Thematic analysis approach was used to analyse the qualitative data.ResultsThe major successes included operationalised response and epidemic preparedness at all levels (National to district); full-time staff and budget dedicated to disease surveillance at all levels and adoption of the 2010 World Health Organisations’ Integrated Disease Surveillance and Response Strategy technical guidelines to the Zambian context. Several challenges hampered effective implementation. These include inadequate trained human resources, poor infrastructure and coordination challenges.ConclusionThe implementation of IDSR strategy in Zambia has recorded some successes. However, several gaps hinder effective implementation. It is imperative that these gaps are addressed for Zambia to have a robust surveillance system that could inform policy in a comprehensive and timely manner.

Assessment of surveillance core and support functions regarding neglected tropical diseases in Kenya

“…However, indicators at lower surveillance levels hardly met the IDSR performance targets due to surveillance activities implementation challenges relating to unavailability of PC-NTD case de nition guidelines and case registers, limited reporting and data analysis, minimal supervision of surveillance activities at lower levels and limited training on surveillance, which together contributed to the sub-optimal performance of PC-NTDs surveillance activities at the sub-national level. These challenges are comparable to ndings from studies conducted in other countries in the African region [41,[52][53][54][55][56].…”

“…Core Functions E cient case detection is dependent on the availability of case de nition guidelines and well-trained health personnel on utilising the available case de nitions [57]. Availability of surveillance guidelines at the health facility level is the cornerstone of a strengthened surveillance system especially regarding disease noti cation [54]. In the current study, low utilisation of PC-NTDs case de nitions was commonly reported by health facility workers due to unavailability of such guidelines.…”

“…Inadequate registration of PC-NTDs cases according to respondents in the current study was due to lack of speci c case registers and increased workload. Similarly, in Zambia, inconsistent case registration resulted from health workers lacking ample time to accurately register cases due to high patient demand and lack of designated data entry clerks [54]. In the present study, peripheral levels lacked the capacity to collect and handle PC-NTD specimens.…”

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“…Along with this, poor coordination and lack of properly trained staff can also affect the disease surveillance processes. 5…”

The Impact and Control of Emerging and Re-Emerging Viral Diseases in the Environment: An African Perspective

“…Effective surveillance in Africa is, however, a challenge due to the remoteness of some communities, especially in rural settings without access to good road infrastructure. For example, a study conducted in Zambia revealed that the lack of transportation facilities was among the leading contributing factors challenging the implementation of an integrated disease surveillance and response strategy in the country (Mandyata et al 2017). Similarly, a review of the challenges faced by 18 African countries in implementing adequate surveillance schemes identified the lack of transportation as a significant compounding factor (Phalkey et al 2013).…”