Rapid evaluation of the disease surveillance system in the Rhino Camp Refugee Settlement, Uganda: a case for early warning systems in emergency settings, 2016

Abstract

Introduction : in July 2016, the Rhino Camp Refugee Settlement in Arua District received an influx of 11,800 immigrants fleeing armed conflicts from South Sudan, resulting in a >50% increase in the already large refugee population in the Settlement. Meanwhile, cholera outbreaks were ongoing in neighboring districts. We conducted a rapid review of the disease surveillance system to assess the capacity for timely detection and response to disease outbreaks, and to recommend measures to strengthen disease surveillance and response. Methods : we collected data through face-to-face interviews of health workers using a structured questionnaire, onsite observations and key informant interviews. We visited all the four health facilities and evaluated their disease surveillance system. Results : two parallel disease surveillance structures exist with different case definitions, action thresholds and reporting timelines and channels: One was managed by UNHCR; the other is the National Health Management Information System (HMIS). 80% of health workers had no prior training on the Integrated Disease Surveillance and Response (IDSR). The UNHCR system was more active in 4 of 5 facilities; however the case definitions had deficiencies and it emphasized only weekly alert thresholds rather than immediate reporting according to the national disease surveillance standards. 1 suspect cholera case was managed but never reported to HMIS. 4 of 5 facilities submitted late weekly HMIS reports. 1 of 5 facilities had evidence for active case detection and referrals at community level. All facilities lacked case-based forms for immediate reporting. Conclusion : this refugee settlement area had inadequate capacity on disease surveillance for early detection and response to outbreaks. The parallel reporting system compromised timeliness and quality of reporting. On our recommendation, the District and UNCHR trained staff on disease surveillance and provided guidelines and case based forms. Harmonization of surveillance systems in all emergency settings in Uganda is underway.