1. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 1 Strengthening PH Surveillance & Control Dr Robert Hartley Stevens WHO Country Office, Turkey WHO European Region

2. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 2 International Policy Context

3. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 3 The UN Family UNOWHOFAOUNESCOILO Specialised Agencies Implementing bodies UNICEF UNDP UNHCR Etc. Self-Governing Agencies IMF WB WTO Etc.

4. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 4 Health For All Secure and Supportive Society Nutrition Education Income Health Services Public Health Housing Individuals fulfill their health potential

5. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 5 The Health For All approach Improve Health and Reduce Health Inequalities through: Multi-Sectoral Working Evidence Based Practice Partnership and Participation Health Systems Development

6. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 6 The Health Gap in WHO Euro 55y 57y 59y 61y 63y 65y 67y 69y 71y 73y 75y Disability Adjusted Life Years (DALYs) Commonwealth of Independent States Republic of Turkey EU 10 joining May 2004 EU 15 before May 2004

7. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 7 Health versus Wealth Deaths / 100,000 live births GDP per cap PPP USD 000s Maternal Mortality Rate versus Gross Domestic Product 42 / 52 Euro states, 2002, HFA Database 2005 Turkey Reported Turkey Actual

8. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 8 Health Spending as a National Priority Health Expenditure as a % of GDP versus log GDP 42 / 52 Euro states, 2002, HFA Database 2005 Health Exp as a % of GDP GDP per cap PPP USD 000s Turkey

9. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 9 Health Systems Development Turkey is spending an above average %GDP on health But MMR is still average to high because of organisational factors

10. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 10 Old Int Health Reg 1969 Limited scope (Cholera, Yellow fever, Plague) Only official reports and information considered Notification by MS only after confirmation WHO involved only after official notification Border controls

11. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 11 New IHR 2005 All PH Emergencies of International Concern Containment in-country WHO acts on all information sources Adapted responses according to risks WHO / ECDC / GOARN support from the start

12. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 12 EC CD Legislation List of 46 diseases brought progressively under surveillance Contribution to Community networks Comparable and compatible data Early warning and response

13. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 13 EC CD Legislation Legal Framework ECDC Norms + Systems = NPoA WHO Guidelines SoPs P erformance Audit

14. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 14 Technical Issues: Surveillance

15. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 15 Public Health Emergency of International Concern (PHEIC) Any two of: –Serious public health impact of the event –Event is unusual or unexpected –Significant risk of international spread –Significant risk of international travel or trade restrictions ‘an extraordinary event which constitutes a public health risk to other States through the international spread of disease and potentially require a coordinated international response’

16. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 16 Examples of PHEICs Sudden increase in IMD in pilgrims returning from the Haj Cholera with high risk of international spread Cases of a novel strain of influenza Natural disasters with potential impact on other countries Serious chemical contamination of rivers crossing international boundaries Serious chemical or radioactive air pollution following an industrial accident

17. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 17 CD Surveillance and Control Event detection, warning and early response Estimating burden and trend in disease Changes in severity, clinical picture Monitoring disease control incl. VPI Generating research hypotheses

18. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 18 Event Detection Baseline Alert threshold Action threshold

19. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 19 Signals and Noise Typo Year-on-year trend Noise Seasonality Outbreak Reporting Variation

20. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 20 Turkey Meningitis Source: MoH routine notifications 1996 to 2006 Includes all causes of probable cases of meningitis 30-fold variation due to reporting bias

21. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 21 Turkey Meningitis EU 25 average Source: MoH routine notifications 1996 to 2006 Rapid decrease in baseline

22. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 22 Turkey Meningitis EU Median 2005 Source: MoH routine notifications 1996 to 2006 Reports are 1/5 of EU average, lower than any of EU 25

23. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 23 Surveillance System Strengthening

24. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 24 Main Achievements to Date  EPIET-like 3 week epidemiology course (30 Fellows)  4 / 5 x 1-week modules in more specialized public health topics (30 Fellows)  Adult education  Preparatory of study protocols  Data analysis of study results  Health Mapping  6 / 6 x 2-week ToTs (180 CD Department staff).  30 / 81 Provinces x 2-day Basic Training (3000 GPs)  Strategic management training to a national planning group (20 core Working Group members)  Laboratory management training  2-week ToT (40) 3-day (450 microbiologists)  SoPs for PH microbiology  Launching a pilot laboratory sentinel surveillance network

25. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 25 Strategic 5 year plan Yearly action plans Monitoring progress Evaluating outcomes and impact Assessing risks; prioritising public health threats; assessing existing systems IHR: Planning and Management Cycle

26. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 26 Primary Health MoH NRL PHDs Medical Universities and Sate Hospitals Integrated Surveillance - 1 Food and Water Safety Animal Health Vital Registration Nosocomial Infections MoH NRL TB Dispens. NRL Group D Other systems…?

27. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 27 Primary Health Care and Hospitals Provincial Health Directorates Intermediate level MoH NRL National Focal Point Reporting Feedback Integrated Surveillance - 2

28. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 28 Evidence Based Policy / Critical Appraisal of Literature Operational Research (OR) Monitoring & Evaluation (M&E) Surveillance & Lab Guidelines Management & Organisational Development (M&OD) CDS&C System Development Model

29. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 29 Next Steps Building on the broad base of ESCCDS I: ESCCDS II –Development of National Electronic Surveillance –Bench laboratory training –20 Cohort II surveillance and control Fellows –National Conference EC 2008 funding –IHR integrated surveillance strengthening –? Turkish Field Epidemiology Training Programme

30. Epidemiological Surveillance & Control of CDs in Turkey European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe 30 Thank you Robert Hartley Stevens Project Manager RST@.euro.who.int