From the field side of the binoculars: a different view on global public health surveillance

Abstract

It is generally assumed by the donor community that the targeted funding of global, regional or cross-border surveillance programmes is an efficient way to support resource-poor countries in developing their own national public health surveillance infrastructure, to encourage national authorities to share outbreak intelligence, and ultimately to ensure compliance of World Health Organization (WHO) Member States with the revised (2005) International Health Regulations. At country level, a number of factors and constraints appear to contradict this view. Global or regional surveillance initiatives, including syndromic surveillance and rumour surveillance projects, have been conceived in neglect of fragile health systems, from which they extract scarce human resources. In contradiction with a rightful stance promoting 'integrated surveillance' by WHO, the nurturing of donor-driven, poorly coordinated and redundant surveillance networks generally adds further fragmentation to national health priorities set up by developing countries. In their current categorical format, ignoring the overwhelming deficits in governance and health care capacity, global surveillance strategies seem bound to benefit mainly the most industrially developed nations through the provision of early warning information or scientific data. In lower-income countries, a focus of resources on strengthening the health system first would ultimately be a more efficient way to achieve proper detection and response to outbreaks at national or sub-national level. As documented in several pilot initiatives at sub-national level (India, South Africa, Tuvalu and Cambodia), the empowerment of frontline health workers and communities is a key element for an efficient surveillance system. Such simple measures centred on human resources and community values appear to be more beneficial than massive and conditional monetary inputs.

Governing epidemics in an age of complexity: Narratives, politics and pathways to sustainability

“…In the case of avian influenza, for example, such routine responses and institutionalised practices are encoded in the standard, global surveillance, early warning and rapid response repertoires of the main agencies (Scoones and Forster 2008;see figure 3). Huge amounts of public cash have been invested in these, bringing financial and economic pressures to maintain certain styles of response and their associated funding streams (Calain 2007).…”

Quality of Plague Surveillance System in Pasuruan Regency Year 2014 Based on Surveillance Attributes

“…Menurut Calain (2007), masih kurangnya penerapan surveilans oleh pelaksana bidang kesehatan di negara berkembang dikarenakan oleh adanya pengulangan dan overlapping program surveilans lain yang tidak terkoordinasi, tidak bisa membedakan antara pengumpulan data untuk perencanaan/manajemen atau untuk respon cepat KLB, beban kerja yang tinggi,dan kurangnya insentif. Interpretasi yang kurang maksimal dikarenakan pelaksana surveilans pes di Dinas Kesehatan Kabupaten Pasuruan juga merangkap berbagai tugas lain selain surveilans pes sehingga beban kerja tinggi.…”

A saúde no Brasil em 2030: desenvolvimento, Estado e políticas de saúde - Vol. 1

“…Os países em desenvolvimento são cada vez mais críticos e desconfiados em relação à estruturação da cooperação internacional ou da ajuda externa para as doenças epidêmicas em termos de segurança nacional, pela percepção de que essas iniciativas beneficiam, fundamentalmente, os países ricos (Calain, 2007;Aldis, 2008). Essa desconfiança foi amplificada e ganhou visibilidade nas controvérsias e tensões ocorridas no episódio das amostras de vírus da gripe A/H5N1 (da Indonésia) (Fidler, 2008) e nas críticas à revisão do Regulamento Internacional da Saúde (Calain, 2007).…”

“…Essa desconfiança foi amplificada e ganhou visibilidade nas controvérsias e tensões ocorridas no episódio das amostras de vírus da gripe A/H5N1 (da Indonésia) (Fidler, 2008) e nas críticas à revisão do Regulamento Internacional da Saúde (Calain, 2007). Ao mesmo tempo se intensifica o debate em torno da arquitetura da "governança global em saúde" (Dogson et al, 2001).…”