Enhancing disease surveillance reporting using public transport in Dodoma District, Central Tanzania

Abstract

An efficient disease surveillance system is a prerequisite for an effective disease control programme. It is only when correct and timely reports about disease outbreaks reaches the responsible persons that prompt actions can be taken. Tanzania is in the process of strengthening its infectious disease surveillance system using an integrated approach. However, several constraints hamper the smooth implementation of the new strategy (Miller et al., 2003). Under the current Integrated Disease Surveillance and Response (IDSR) strategy, health facilities in Tanzania are required to immediately notify the district when they suspect an outbreak, and to provide week-ending reports for 7 outbreak-prone diseases, and monthlyreports for 13 priority diseases (Mboera, 2004). Vital epidemiological information available at most health facilities in Tanzania are not often readily available for decision making at the district and national levels. This is due to lack of adequate information exchange facilities and systems that allow for a rapid access of information available at one level or both levels. Epidemiological reporting between facility and district levels of health delivery system has remained poor due to lack of effective and efficient means of communication (Miller et al., 2003; Kajeguka & Mboera, 2003). In a recent study in 12 districts of Tanzania, the overall timeliness reporting from facility to district level was found to be 8% (0-19%) for weekly reports and 24% (3-56%) for montly reports (Gueye et al., 2005). Some routine paper reports are currently being picked up during supervision and outreach visits, but these visits are quite irregular. Some reports are sent by radio call and hard copies delivered in person. In this paper, we report the use of a participatory process in solving weekly epidemiological surveillance reporting problem in Dodoma Rural district in Tanzania. Dodoma Rural District (6o, 30’ to 8o0’S, 35o, 30’ to 37o 0’E) is located in the central plateaus in Tanzania at an elevation of about 800-1200m above sea level. The district consists of a number of mountain chains, between which are low-lying flat areas. A number of depressions are associated with these lower areas, which are generally waterlogged during the rainy season and have a tendency of salinity because of their limited outflow. The district has a dry Savannah type of climate characterised by a long dry season lasting between April and November. The average annual rainfall is 500800mm, which is normally a short single wet season lasting between December and March. The district is made up of 8 divisions, 48 wards, and 128 villages covering an area of 14,004 km. The district population is 495,176 made up of 96,686 households. The district is served by 81 health facilities (1 hospital, 6 health centres and 74 dispensaries). The nearest and furthest health facilities are 37 km and 145 km from the district capital, respectively (Mboera et al., 2005). The participatory process approach involved researchers from the National Institute for Medical Research, district council health management team (CHMT) and the in-charges of all facilities in the district. The CHMT and health workers were trained to carry out problem-solving participatory approach in the area of communication. Following the discussions, strategies were developed and documented. Eighty-one health facilities were involved in the discussion in four different sessions. During the discussion several means of communication were suggested by the participants. These included: public bus transport, radio calls, passenger train, mobile phones and bicycles. The use of public buses was given the highest priority.