1. 2003 Pan American Health Organization.... Roles and Responsibilities Branka Legetic, PAHO-WHO Regional Advisor STEPS STROKE training Curacao 15,16 November 2010

2. 2003 Pan American Health Organization Stroke as one of the 3 main causes of death 1st%2nd%3rd % Anguilla14.7Argentina8.2Antigua and Barbuda8.3 Brazil10.7Belize6.7Canada7 French Guyana8.7Barbados8.8Colombia7.4 Guadeloupe11.9Bermuda7.4Haiti8.6 Guyana10.9Cayman Islands6.4Montserrat8.8 Martinique12.2Chile9.6Nicaragua7.7 Panama11.2Costa Rica6.3Puerto Rico5.8 Paraguay10.6Cuba10.4Trinidad and Tobago10.7 Suriname12.9Dominican Republic10 St. Kitts and Nevis10.1Ecuador6.2 Uruguay12.4Peru4.8 St. Lucia12.1 United States6.9 Venezuela7.2 Virgin Islands (US)7.6

3. 2003 Pan American Health Organization Roles and Responsibilities A number of entities involved with the coordination of STEPS stroke surveillance, with representation covered at the: Country Sub-regional, and Regional levels A number of entities involved with the coordination of STEPS stroke surveillance, with representation covered at the: Country Sub-regional, and Regional levels

4. 2003 Pan American Health Organization Stroke Surveillance Network STEPS Stroke Surveillance Site (SSS) Site Coordinator Site Data Collection Team International Coordination and Support Technical Advisers WHO/PAHO/CAREC NCD manager WHO/PAHO regional advisers International Stroke Society

5. 2003 Pan American Health Organization Site Coordinator The STEPS stroke surveillance (SSS) site coordinator is the local principal investigator. This key person is responsible for planning and coordinating the local STEPS Stroke surveillance study.

6. 2003 Pan American Health Organization Site Coordinator Level of Authority Negotiate and obtain resources for the whole stroke study Oversee progress of nation, sub- national, district or local STEPS stroke implementation Contribute to disease prevention and health promotion activities Negotiate and obtain resources for the whole stroke study Oversee progress of nation, sub- national, district or local STEPS stroke implementation Contribute to disease prevention and health promotion activities

7. 2003 Pan American Health Organization Site Coordinator Core Roles RoleDescription 1Planning and preparing for a STEPS Stroke study. 2Applying for participation. 3Identifying and securing local funding and / or "in kind" support. 4Handling ethical approval. 5Recruiting and training interview staff. 6Supervising data collection and adjudicating difficult diagnoses. 7Reporting results. 8Planning and preparing for future studies. 9Liaising with the International coordination and support (ICS), local authorities, WHO/PAHO NCD regional, country and CAREC representatives and other stakeholders. 10Completing test stroke cases provided by ICS for quality control purposes.

8. 2003 Pan American Health Organization Site Data Collection Staff Trained to collect study data and enter it into the stroke register Roles may vary depending on the scope of study Trained to collect study data and enter it into the stroke register Roles may vary depending on the scope of study RoleDescription 1Actively identifying stroke patients admitted to (or occurring within) the hospital on a daily or weekly basis. 2Retrospectively reviewing records of stroke patients. 3Resolving difficult cases (where a patient needs to be assessed by an experienced medical practitioner or neurologist). 4Recording patient details on the Stroke instrument 5Entering instrument data into the register (using the data entry tool) 6Following up with patients at day 28. 7Liaising with and reporting any difficulties to the site coordinator.

9. 2003 Pan American Health Organization International Coordination and Support (ICS) PAHO/WHO/CAREC provide technical support and guidance ICS oversees the practical and logistical issues PAHO/WHO/CAREC provide technical support and guidance ICS oversees the practical and logistical issues

10. 2003 Pan American Health Organization ICS Core Roles Core roles include: –Register surveillance site participation –Support site coordinator –Provide access and support to STEPS surveillance tools –Ensure quality control Core roles include: –Register surveillance site participation –Support site coordinator –Provide access and support to STEPS surveillance tools –Ensure quality control

11. 2003 Pan American Health Organization ICS Support Dissemination of Methodology through translation of the Manual to Spanish and Portuguese Temporary advisors for consultancy Dissemination of Methodology through translation of the Manual to Spanish and Portuguese Temporary advisors for consultancy

12. 2003 Pan American Health Organization ICS Support Advocacy Develop links between NGOs, PAHO- WHO and CAREC Expand number of surveillance sites Liaise with site coordinators Advocacy Develop links between NGOs, PAHO- WHO and CAREC Expand number of surveillance sites Liaise with site coordinators

13. 2003 Pan American Health Organization ICS Support Receive applications for participation Update and Maintain STEPS Stroke Surveillance Manual Develop, maintain and modify Stroke Data Entry Tool (DET) Collect and collate data Receive applications for participation Update and Maintain STEPS Stroke Surveillance Manual Develop, maintain and modify Stroke Data Entry Tool (DET) Collect and collate data