1. Developing experience and evidence in surveillance implementation in Tanzania Dr. Patrick Swai USAID/Tanzania

2. Milestones of IDS in Tanzania 1998 National level assessment 1998 Adoption of IDS strategy 1999 Implementation plan developed 2000 IDS Task Force created 2001 National IDS guidelines for 13 priority diseases 2001 Lab networking guidelines 2002 Development of draft District analysis book 2002 The coordinated implementation team initiated implementation in focus districts

3. Source of USAID funds for IDS implementation in Tanzania Africa Bureau – Providing support to WHO, (including the 1998 assessment) Tanzania Mission – operationalizing the IDS strategy and strengthening surveillance implementation Bureau of Global Health – developing evidence of successful programming around surveillance; dissemination of tools, materials, and lessons learned to other countries

4. USAID-funded partners in local IDS implementation in Tanzania National Institute for Medical Research (NIMR) Partners for Health Reform plus (PHRplus) Centers for Disease Control and Prevention -- NCID and EPO/DIH CHANGE Project HealthTech

5. WHO Nat’l District Facilities Communities Reg’l Strategy, guidelines, tools Policy, direction, plan, country guidelines Support for lab, outbreak investigation, training Hub of decision making, response/ action and resource mobilisation Identify cases, report, respond and participate in public health actions Know what to report when to health care system for action; Participate in response and prevention Structure of the Tanzania Health System and Relevance for IDS

6. How the implementation team contributes to IDS strengthening WHO/AFRO – support to creating strategy, guidelines, and tools –IDSR guidelines provide a comprehensive technical definition of a functioning system. –Local implementation process is beyond the scope of regional guidelines Local-level (country) implementation: operationalize the strategy and guidelines

7. Selected districts for IDS strengthening ZoneDistrict NorthernArusha (Manyara)Babati Mbulu EasternDodomaDodoma rural Mpwapwa SouthernMtwaraMasasi Tunduru Southern HighlandRuvuma Rukwa Tunduru Nkasi WesternTaboraIgunga Tabora Urban LakeKagera Mwanza Muleba Mwanza urban

9. Questions for country level implementation: What obstacles do districts, facilities, and communities face in operationalizing the system? What are the best strategies for overcoming these obstacles?

10. What are some of the obstacles that districts in Tanzania face? Very limited diagnostic confirmation capacity Lack of adequate communications between levels Barriers to adequate transport of specimens Low motivation and capacity for analysis (and use) of information for public health action Poor coordination of available resources Undefined roles and responsibilities for IDS National level standards and policies missing Need a guiding “road map” for operationalizing IDSR

11. How we are breaking ground in implementation in Tanzania Support the development of new ID surveillance and public health action technologies and tools for both epidemic and non-epidemic diseases Conduct research into critical issues surrounding ID surveillance and response that will support its successful adoption by other countries Coordinate with global and national institutions to provide training to develop the necessary skills needed for ID surveillance and response

12. How we are breaking ground in implementation in Tanzania Disseminate lessons learned Develop successful examples of ID surveillance and response that can be adopted by other districts in Tanzania and other countries to address the real obstacles at local levels

13. Implications for other countries for implementing IDSR Provide a model for other countries Answer questions with operations research Development of best practices Documentation and transfer of experiences and lessons learned Dissemination of tools and materials for implementation

14. Thank you!