The PHRplus Project is funded by U.S. Agency for International Development and implemented by: Abt Associates Inc. and partners, Development Associates, Inc.; Emory University Rollins School of Public Health; Philoxenia International Travel, Inc. Program for Appropriate Technology in Health; SAG Corp.; Social Sectors Development Strategies, Inc.; Training Resources Group; Tulane University School of Public Health and Tropical Medicine; University Research Co., LLC. URL: Improving surveillance data quality and use in Tanzania Kathryn Kohler Banke, Ph.D. Peter Mmbuji, M.D., M.Med. Global Health Council June 1, 2005

Overview Background – integrated disease surveillance and response (IDSR) Background – integrated disease surveillance and response (IDSR) PHRplus/National Institute for Medical Research (NIMR) project in Tanzania PHRplus/National Institute for Medical Research (NIMR) project in Tanzania Results Results Next steps Next steps Lessons learned Lessons learned

Integrated Disease Surveillance and Response (IDSR) WHO strategy for infectious disease surveillance in the African region (1998) WHO strategy for infectious disease surveillance in the African region (1998) Goal: Improved detection of and response to priority infectious diseases Goal: Improved detection of and response to priority infectious diseases

IDSR functions Identify cases Identify cases Report Report Analyze and interpret data Analyze and interpret data Investigate and confirm cases/outbreaks Investigate and confirm cases/outbreaks Respond Respond Provide feedback Provide feedback Evaluate and improve system Evaluate and improve system

Overview of USAID-funded IDSR strengthening project in Tanzania Partners: MOH, National IDSR Task Force, NIMR, PHRplus, CDC, CHANGE Project, WHO/AFRO Partners: MOH, National IDSR Task Force, NIMR, PHRplus, CDC, CHANGE Project, WHO/AFRO Objective: Improved prevention and control of 13 priority infectious diseases Objective: Improved prevention and control of 13 priority infectious diseases Implementation: Implementation: Develop, test, refine strategies most effective for improved system performance in 12 districts Develop, test, refine strategies most effective for improved system performance in 12 districts Focus on district and facility levels Focus on district and facility levels

IDSR priority diseases, Tanzania Epidemic-prone diseases Epidemic-prone diseases Cholera, bacillary dysentery, plague, measles, yellow fever, cerebrospinal meningitis, rabies Diseases targeted for eradication/elimination Diseases targeted for eradication/elimination Acute flaccid paralysis, neonatal tetanus Diseases of public health importance Diseases of public health importance Diarrhea <5 years, pneumonia <5 years, malaria, typhoid

Baseline situation: Monthly IDSR report accuracy Facility (n=85) District (n=12) Diarrhea13%0% Pneumonia15%8% Malaria25%16% Accuracy defined as number of cases in submitted report within +/- 5% of number of cases in data audit.

Baseline situation: Routine data analysis Facility (n=109) District (n=12) Any trend analysis, priority diseases 33%42% Trend analysis, malaria 28%16% Malaria: monthly cases & deaths <5 years 4%8%

The PHRplus/NIMR IDSR intervention in Tanzania (1) Situation analysis Situation analysis Epidemic preparedness planning Epidemic preparedness planning Disease outbreak management field manual Disease outbreak management field manual Training materials and methods Training materials and methods Training of trainers; district and facility level IDSR trainings Training of trainers; district and facility level IDSR trainings

The PHRplus/NIMR IDSR intervention in Tanzania (2) Data management, analysis, & interpretation tools Data management, analysis, & interpretation tools Follow-up visits and district quarterly meetings Follow-up visits and district quarterly meetings Monitoring and evaluation Monitoring and evaluation Operational research (costing; analysis and response) Operational research (costing; analysis and response)

The PHRplus/NIMR IDSR intervention in Tanzania (3) Laboratory job aids Laboratory job aids Community linkages Community linkages

Results: IDSR materials and job aids Tested, revised, finalized Tested, revised, finalized Endorsed by IDSR Task Force Endorsed by IDSR Task Force Ready for scale-up Ready for scale-up

Results: Improved capacity for sustainable training Trained staff at all levels: Trained staff at all levels: 51 District level trainers 51 District level trainers 96 District Health Management Team members 96 District Health Management Team members 32 Facility level trainers 32 Facility level trainers 787 Facility health workers in 591 facilities 787 Facility health workers in 591 facilities Strengthened horizontal and vertical linkages between National level, Zonal Training Centers, Regions, and Districts Strengthened horizontal and vertical linkages between National level, Zonal Training Centers, Regions, and Districts High demand for IDSR training in non- project districts High demand for IDSR training in non- project districts

Results: Improved reporting District TrainingFacility Training

Results: Improved reporting

Next steps Materials & methods in place, but funds lacking Materials & methods in place, but funds lacking Zonal Training Centers – expanding training using methods and materials Zonal Training Centers – expanding training using methods and materials Global Fund proposal Global Fund proposal Scale up IDSR plus other health system strengthening needs

Lessons learned Understand the system and define standards Understand the system and define standards Adapt materials to local context Adapt materials to local context Focus on facility and district levels Focus on facility and district levels Training necessary, but not sufficient Training necessary, but not sufficient Integration challenging Integration challenging

The PHRplus Project is funded by U.S. Agency for International Development and implemented by: Abt Associates Inc. and partners, Development Associates, Inc.; Emory University Rollins School of Public Health; Philoxenia International Travel, Inc. Program for Appropriate Technology in Health; SAG Corp.; Social Sectors Development Strategies, Inc.; Training Resources Group; Tulane University School of Public Health and Tropical Medicine; University Research Co., LLC. URL: Thank You Reports related to this presentation are available at

Dodoma Rural Babati Project districts

Results: Improved reporting