1. SEARO –CSR Early Warning and Surveillance System Module Prioritization in EWAR Methodology and Objectives

2. SEARO –CSR Early Warning and Surveillance System Module Objectives of this lecture To describe the rationale of prioritizing diseases for EWAR To define the methodology of prioritization To give an example of how prioritization is carried out by WHO

3. SEARO –CSR Early Warning and Surveillance System Module Prioritization Rationale Methodology Prioritization exercise Determining priorities is a process of assessing the relative importance or value of alternative concerns.

4. SEARO –CSR Early Warning and Surveillance System Module Rationale Methodology Prioritization exercise Human and financial resources are limited Public health risks change over time International context Too many diseases impair surveillance Prioritization

5. SEARO –CSR Early Warning and Surveillance System Module Past experiences Rationale Methodology Prioritization exercise All countries should review their list of priority diseases for surveillance periodically, Adaptation of the Delphi method using workshops and combinations of e-mail/mail and workshop sessions.

6. SEARO –CSR Early Warning and Surveillance System Module Prioritization Criteria 1.Present burden of disease 2.Case fatality ratio 3.Epidemic potential 4.Potential threat/emergence/changing pattern 5.Health gain opportunity through public health activities 6.Social and economic impact 7.International regulations or programmes for surveillance and control 8.Public perception Rationale Methodology Prioritization exercise

7. SEARO –CSR Early Warning and Surveillance System Module WHO-proposed adaptation of the Delphi method Rationale Methodology Prioritization exercise a Steering Committee formulates a list of diseases, and criteria to include/exclude diseases for surveillance a Steering Committee formulates a list of diseases, and criteria to include/exclude diseases for surveillance list is presented in a workshop to a group of key people involved in surveillance list is presented in a workshop to a group of key people involved in surveillance Each participant scores the diseases against the criteria Each participant scores the diseases against the criteria A summary of results is used to assess with statistical parameters group agreement A summary of results is used to assess with statistical parameters group agreement Results are discussed in plenary and, if the group feels that there is not enough agreement, a second round of scoring can be undertaken Results are discussed in plenary and, if the group feels that there is not enough agreement, a second round of scoring can be undertaken

8. SEARO –CSR Early Warning and Surveillance System Module Steps in the WHO Prioritization exercise 1st step: Appointment steering committee 2nd step: Preparation 3rd step: Prioritization workshop 4th step: Postworkshop activities Rationale Methodology Prioritization exercise

9. SEARO –CSR Early Warning and Surveillance System Module 1st step: Appointment steering committee Suggested 8-12 members. –ministry of health executive director –head of the surveillance department/unit –heads of ministry of health or other ministry departments involved in surveillance –WHO representative and/or other international partners –other relevant partners. Rationale Methodology Prioritization exercise

10. SEARO –CSR Early Warning and Surveillance System Module Tasks Agree on the objective and approach Rationale Methodology Prioritization exercise

11. SEARO –CSR Early Warning and Surveillance System Module 2nd step: Preparation of prioritization exercise Agreeing the approach for the prioritization exercise Planning the implementation Preparing the score sheet Preparing the disease fact sheet Inviting the participants Rationale Methodology Prioritization exercise

12. SEARO –CSR Early Warning and Surveillance System Module Example of score sheet for participants Rationale Methodology Prioritization exercise Disease BurdenCFR Epidemic potential Potential threat Effect PH activitie s Social & econo mic IHR Public perception Anthrax Brucella Cholera Dengue Diphtheria JE Hepatitis A

13. SEARO –CSR Early Warning and Surveillance System Module Step 3: Prioritization workshop Introduction to the workshop Discussion and clarification of the criteria and the disease list First round of scoring Ranking and summary of the results –For each disease, sum of raw scores (criteria) –Each disease has a total score => ranking of disease –To show degree of consensus: median score, inter-quartile range Rationale Methodology Prioritization exercise

14. SEARO –CSR Early Warning and Surveillance System Module Example of scoring results Rationale Methodology Prioritization exercise

15. SEARO –CSR Early Warning and Surveillance System Module Step 3: Prioritization workshop Feedback and discussion Second (and subsequent rounds) of scoring Presentation of results Rationale Methodology Prioritization exercise

16. SEARO –CSR Early Warning and Surveillance System Module Step 4: Post-workshop activities Report writing Report on prioritization to health authorities Rationale Methodology Prioritization exercise

17. SEARO –CSR Early Warning and Surveillance System Module Next steps after prioritization To strengthen surveillance and response activities FOCUS should be on TOP priority diseases. No real cut-off point: number of diseases under surveillance adapted to needs and resources Rationale Methodology Prioritization exercise

18. SEARO –CSR Early Warning and Surveillance System Module Next steps after prioritization Low scoring diseases –consider discontinuing surveillance efforts –review surveillance objectives –look for alternative ways to get information Rationale Methodology Prioritization exercise

19. SEARO –CSR Early Warning and Surveillance System Module Next steps after prioritization Priority diseases not under surveillance Priority diseases already under surveillance For each priority disease, revise –Lab capacity –Training needs –Guidelines Rationale Methodology Prioritization exercise

20. SEARO –CSR Early Warning and Surveillance System Module References WHO guidelines. Setting priorities in communicable disease surveillance WHO/CDS/EPR/LYO/2006.3Setting priorities in communicable disease surveillance Fink A, Kosecoff J, Chassin M, Brook R. Consensus methods: characteristics, and guidelines for use. American Journal of Public Health Medicine, 1984, 74:979–983. Carter A. Establishing goals, techniques and priorities for national communicable disease surveillance. Canadian Journal of Infectious Disease, 1991, 2:37–40. Doherty J. Establishing priorities for national communicable disease surveillance. Canadian Journal of Infectious Disease, 2000, 11:21–24. Horby P, Rushdy A, Graham C, O'Mahony M. PHLS overview of communicable diseases 1999. Communicable Disease and Public Health, 2001, 4:8–17. Hubert B, Haury B. Orientations pour la révision des modalités de surveillance des maladies transmissibles en France. Bulletin Epidémiologique Hebdomadaire, 1996, Rushdy A, O'Mahony M. PHLS overview of communicable diseases 1997: results of a priority setting exercise. Communicable Disease Report, 1998, 8:1–12. Valenciano M. Définition des priorités dans le domaine des zoonoses non alimentaires 2000-2001. Institut de Veille Sanitaire, 2002 (http://www.invs.sante.fr/publications/2002/def_priorite_zoonoses) Weinberg J, Grimaud O, Newton L. Establishing priorities for European collaboration in communicable disease surveillance. European Journal of Public Health, 1999, 9:236–240.

21. SEARO –CSR Early Warning and Surveillance System Module Question Time 1.Why should the prioritization exercise be conducted? 2.Do you agree with the WHO approach to prioritization?