Public Health Surveillance Strengthening in the Kingdom of Swaziland

Abstract

ObjectiveTo enable coordination of Swaziland Ministry of Health units forpublic health surveillance (PHS).IntroductionIn the Kingdom of Swaziland, a baseline assessment found thatmultiple functional units within the Ministry of Health (MoH) performPHS activities. There is limited data sharing and coordination betweenunits; roles and responsibilities are unclear. The Epidemiology andDisease Control Unit (EDCU) is mandated to coordinate efforts andstrengthen PHS through implementing Integrated Disease Surveillanceand Response (IDSR) to fulfill requirements of International HealthRegulations (2005) (IHR[2005]), and the Global Health SecurityAgenda (GHSA).MethodsA baseline assessment that included key informant interviewsof unit representatives was conducted. Data flows were developed.Results were disseminated at a facilitated stakeholder workshop withunit representatives. A database was then built containing all distinctactivities found within the IDSR Technical Guidelines (2010), IHR[2005], GHSA Action Packages, the baseline assessment, a previousCDC IDSR assessment, and suggestions from the stakeholderworkshop. Activities were categorized by IDSR function (identify,report, analyze, investigate, prepare, respond, provide feedback,and evaluate) and designated as an ongoing “role” or a one-timeimplementation activity. A document containing all PHS roles waspresented at a facilitated consensus workshop; unit representativesdiscussed and designated a lead unit/agency for each role.One-time implementation activities were assigned a lead actor, targetcompletion date, and compiled into a 3-year IDSR Roadmap to guideimplementation.ResultsA Roles and Responsibilities Framework was developed thatpresents a consensus on lead units for all roles within an IDSR-basedPHS system that fulfills requirements of IHR [2005] and GHSA.This document enables coordination by EDCU. The IDSR Roadmapprovides time-bound activities with assigned actors to implementIDSR. EDCU is using these documents to guide coordination ofmultiple MOH units already performing PHS activities.ConclusionsCoordinating well-established programs that already collectepidemiological data increases efficiency and enables more completeepidemiologic analysis. Stakeholder engagement and clarity of rolesis critical for EDCU to coordinate PHS. Consolidating activitiesfor IDSR, IHR [2005], and GHSA in guiding documents enables astreamlined approach for public health surveillance strengthening.Future work aims to achieve data sharing through an electronicplatform and introduce data standards for interoperability among datasets.K