OJPHI: Vol. 5
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Journal ID (publisher-id): OJPHI
ISSN: 1947-2579
Publisher: University of Illinois at Chicago Library
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©2013 the author(s)
open-access: This is an Open Access article. Authors own copyright of their articles appearing in the Online Journal of Public Health Informatics. Readers may copy articles without permission of the copyright owner(s), as long as the author and OJPHI are acknowledged in the copy and the copy is used for educational, not-for-profit purposes.
Electronic publication date: Day: 4 Month: 4 Year: 2013
collection publication date: Year: 2013
Volume: 5E-location ID: e80
Publisher Id: ojphi-05-80

Identification and Assessment of Public Health Surveillance Gaps under the IHR (2005)
Ngozi Erondu*1
Betiel Hadgu Haile1
Lisa Ferland1
Meeyoung Park1
Affan Shaikh1
Heather Meeks2
Scott JN McNabb1
1Public Health Practice, Atlanta, GA, USA;
2Defense Threat Reduction Agency, Washington, DC, USA
*Ngozi Erondu, E-mail: ngozierondu@gmail.com


To conceive and develop a model to identify gaps in public health surveillance performance and provide a toolset to assess interventions, cost, and return on investment (ROI).


Under the revised International Health Regulations (IHR [2005]) one of the eight core capacities is public health surveillance. In May 2012, despite a concerted effort by the global community, the World Health Organization (WHO) reported out that a significant number of member states would not achieve targeted capacity in the IHR (2005) surveillance core capacity.

Currently, there is no model to identify and measure these gaps in surveillance performance. Likewise, there is no toolset to assess interventions by cost and estimate the ROI.

We developed a new conceptual framework that: (1) described the work practices to achieve effective and efficient public health surveillance; (2) could identify impediments or gaps in performance; and (3) will assist program managers in decision making.


Published articles and grey-literature reports, manuals and logic model examples were gathered through a literature review of PubMed, Web of Science, Google Scholar, and other databases. Logic models were conceived by categorizing discrete surveillance inputs, activities, outputs, and outcomes. Indicators were selected from authoritative sources or developed and then mapped to the logic model elements. These indicators will be weighted using the principle component analysis (PCA), a method for enhanced precision of statistical analysis. Finally, on the front end of the tool, indicators will graphically measure the surveillance gap expressed through the tool’s architecture and provide information using an integrated cost-impact analysis.


We developed five public health surveillance logic models: for IHR (2005) compliance; event-based; indicator-based; syndromic; and predictive surveillance domains. The IHR (2005) domain focused on national-level functionality, and the others described the complexities of their specific surveillance work practices. Indicators were then mapped and linked to all logic model elements.


This new framework, intended for self-administration at the national and subnational levels, measured public health surveillance gaps in performance and provided cost and ROI information by intervention. The logic model framework and PCA methodology are tools that both describe work processes and define appropriate variables used for evaluation. However, both require real-world data. We recommend pilot testing and validation of this new framework. Once piloted, the framework could be adapted for the other IHR (2005) core capacities.


Defense Threat Reduction Agency and the World Health Organization

1.. Implementation of the International Health Regulations., Stat. Resolution WHA65.23 (26 May 2012).
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4.. Organization WHInternational Health Regulations (2005) (Second Edition). Second Edition. 2008
5.. Sturtevant JL, Anema A, Brownstein JS. The new International Health Regulations: considerations for global public health surveillanceDisaster Med Public Health Prep 2007;1(2):117–21. Epub 2008/04/05.
6.. Lyons S, Zidouh A, Ali Bejaoui M, Ben Abdallah M, Amine S, Garbouj M, et al. Implications of the International Health Regulations (2005) for communicable disease surveillance systems: Tunisia’s experiencePublic Health 2007;121(9):690–5. Epub 2007/06/05.
7.. Calain P. Exploring the international arena of global public health surveillanceHealth Policy Plan 2007;22(1):2–12. Epub 2007/01/24.
8.. Baker MG, Forsyth AM. The new International Health Regulations: a revolutionary change in global health securityN Z Med J 2007;120(1267):U2872. Epub 2007/12/25.
9.. Cash RA, Narasimhan V. Impediments to global surveillance of infectious diseases: consequences of open reporting in a global economyBulletin of the World Health Organization 2000;78(11):1358–67. Epub 2001/01/06.
10.. Fidler DP. Globalization, international law, and emerging infectious diseasesEmerg Infect Dis 1996;2(2):77–84. Epub 1996/04/01.
11.. Organization WHWorld Health Organization: Disease Surveillance Weekly Epidemiological Record [Internet]1998

Article Categories:
  • ISDS 2012 Conference Abstracts

Keywords: Public health surveillance, Evaluation, IHR (2005), Gaps assessment, Cost-impact analysis.

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