Ministry Of Health Field Epidemiological Training Program (FETP) Final Presentation Moses K. Beyan, Dso Somalia Drive Health District Montserrado County-liberia November 2-3, 2015

Expanded Surveillance Summary Report EPI Introduction Somalia drive district Sixty six (66) HFs→Government-6, Private-60 Four (4) zones (1100B1, 1200, 1300 & 1400) An estimated population of 275,622 Highlights Expanded Surveillance Summary Report EPI Week 31-42, 2015 Surveillance Quality Problem Analysis

Summary Reporting quality Disease reports Expanded Surveillance Report for Somalia Drive District EPI weeks 31- 42 Summary Reporting quality Disease reports

Summary Total Number of IMRD = 312 susp EVD-126, susp. Measles-53,Neonatal Tetanus 4,Acute Water Diarrhea-33,Non-Bloody Dysentry-58,Susp. Meningitis-3, Human/Dog bite-8, Maternal Death-1 & Neonatal Death-18 Suspected EVD Cases 126: All live cases Specimen were collected & sent to lab, few negative results received by DHT Continuous follow-up on remaining results.

Reporting Quality High priority Facilities Reporting on Timeliness & Completeness EPIwk.31-42, 2015 FACILITY WK. 30 31 Wk. 32 33 Wk.34 Wk.35 Wk. 36 Wk. 37 Wk. 38 WK. 39 WK. 40 WK. 41 WK.42 % CUM. Timeliness % CUM. Completeness James N. Davis Hospital T L 69% 100% Gardnerville Comm. Clinic NR R. H. Ferguson Clinic Sis. Barbra H. Center 62% MSF Hospital 77% New Georgia Health Center 92% Chocolate City Health Center Barnesville Health Center LEGEND: On Time T Late L No report (NR) %CUM. Timeliness % CUM. Completeness

Comments on Reporting Quality 50% achieved National Target of ≥ 80% for Timeliness 75% exceeded National Target of 80% for completeness Gardnersville Clinic & Barbra Ann HC least performed among high priority Facilities under performance due to lack of motivation or wrong perception One facility remained silent despite formal communication served from county. PUBLIC HEALTH ACTION DHT continues to engage under-performed HFs in order to improve on their reporting.

Summary of Key Notifiable Diseases & Events, Epi Week 31-42 CASES DEATHS CUMULATIVE CASE FATALITY RATE AFP 0% Suspected EVD 126 Suspected Measles 53 NNT 4 AWD 33 Non-bloody Dysentery 58 Lassa Fever Yellow fever Other VHF Suspected Meningitis 3 Suspected Cholera Human/ Dog Bites 8 Maternal Death 1 Neonatal Death 18

Comments Increase cases of dysentery that peaked at wk 35 probably because to constant flooding of communities due to the raining season increase suspected measles cases at week36 findings revealed parents refusal to get children vaccinated especially part of Iron Factory community There was no death from all suspected and/or reported cases PUBLIC HEALTH ACTION Vigorous outreach vaccination against measles by HF & ZSO Non-bloody dysentery, treated & discharged no sample collected

Surveillance Quality Problem Late Surveillance Reporting in the Somalia Drive District The District continues to struggle with timely reporting since its formation. From the backdrop that surveillance is an information for action, any factor that hinders the timely transmission of its finding/information to next level requires key consideration for resolution. The surveillance team along with one OIC gathered at District office to discuss the problem, causes and way forward

Problem Analysis Team Members Moses K. Beyan, DSO Somalia Drive District John P. Kromah, ZSO Zone 1100B1 Alexander G. Toe, ZSO Zone 1300 Nathaniel Ballah, ZSO Zone 1200 Mally Biah, OIC Barnesville HC

FISHBONE DIAGRAM ADMINISTRATION POLICIES PROBLEM Legend: N: Not in my control P: Partially in my control T: Totally in my control ADMINISTRATION POLICIES Lack of motivational package (N) Weak National Policies (N) Inadequate Logistics Communication & gas (N) No fear of discipline for non-compliance (N) Inadequate Training of HFs’ Staff (P) Lack of Data Officer (N) CRITICAL CAUSE Wrong Perception about Surveillance reporting among Health Facility Staff PROBLEM LATE SURVEILLANCE REPORTING IN THE SOMALIA DRIVE DISTRICT Under staff of DHT (N) Bad Road Condition (N) Wrong perception about surveillance reporting among HF Staff (T) Poor traffic system on the Somalia Drive (N) High Workload (N) High Staff Attrition (N) ENVIRONMENT PERSONNEL

Improvement Recommendations DHT to initiates an awareness campaign intended to change/erase the wrong perception about surveillance cultivated by some facility staff County Health Team provide motivational package to health facility staff involve with surveillance-scratch card and/or financial reward Surveillance team focus on surveillance activities in the district- supervision, report collection, etc Regular refresher Training for all health facility staff in all aspect of surveillance; especially for case definition/detection and reporting That National Government reinforces policy if there be any for surveillance reporting.

I am grateful to all for the support and training Acknowledgement I am grateful to all for the support and training MCHT MOH Mentors Training Leads CDC Partners

THANK YOU.