Baseline Assessment of Public Health Surveillance in the Kingdom of Swaziland

Harriet Nuwagaba-Biribonwoha, Nhlanhla Nhlabatsi, William MacWright, Vusie Lokotfwako, Tony A. Trong, Paige Ryland, Affan Shaikh, Joy Sylvester, Scott J. McNabb


ObjectiveTo assess essential support functions for Integrated DiseaseSurveillance and Response(IDSR) in the Kingdom of Swaziland andmake recommendations for a national IDSR Roadmap.IntroductionImplementation of the IDSR framework for fulfillment of theInternational Health Regulations (2005) ([IHR 2005]) has beenchallenging in Swaziland due to distribution of IDSR functions acrossunits within the Strategic Information Department (SID) and otherexternal departments within the Ministry of Health. We conducted aqualitative assessment and a Strength, Weaknesses, Opportunities andThreats (SWOT) analysis of current public health surveillance (PHS)support structures to inform implementation of IDSR.MethodsKey informant interviews, focus group discussions, and a deskreview were performed. Participants were personnel at essential units,departments and programs at the national level as well as at healthfacilities and clinics at regional and local levels. Transcripts werecoded into SWOT matrices using MAXQDA for each building blockof PHS: structures, workforce, resources, processes (detect, report,assess/analyze, respond, feedback), and informatics.ResultsSelected Strengths included existence of immediate notifiabledisease reporting through the Epidemic and Pandemic Response unit(EPR) and reporting of summary health facility data to the HealthManagement Information System (HMIS) unit and laboratorynetwork. Weaknesses included lack of clear roles and responsibilitiesfor IDSR among SID units, limited coordination between SID units,lack of data sharing, lack of Standard Operating Procedures (SOPs),uncoordinated case investigations and response, minimal analysisconducted for public health surveillance and limited feedback forreporters..Identified opportunities were political will for establishing ofroles and responsibilities and mechanisms for coordination anddata sharing. Threats were limited data access, limited funding forfeedback, lack of analysis for IDSR and paper-based reportingConclusionsCurrently there is limited use of surveillance data for decisionmaking due to lack of coordination. Findings were presented at adissemination meeting to representatives of relevant departments,and there was consensus on the need to clearly define the role andresponsibilities of different programs for IDSR. In March 2016, aconsensus meeting was held to designate roles and responsibilitiesfor IDSR, a direct result of this assessment. Additional resourcesand funding is needed to support these highly important initiatives toensure the safety and health security of the Swazi nation.

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Online Journal of Public Health Informatics * ISSN 1947-2579 *