LESSON 3

Considerations in Planning
Public Health Surveillance
 Lesson Objectives
• Describe the steps in planning public
health surveillance
• Describe the rationale for each
planning step
• Describe the activity involved in each
planning step
 Class model
• Introduction by fascilitator
• Discussion base on topic to set up
planning surveillance
• Ref:
– Steven teutsch, 1994. Priciple and prctice
of ph surveillance, ch.3
– WHO, 1999. who recomended surveillance
standards
• presentation each group after session
 Review of surveillance
1. Public health surveillance is the
systematic and ongoing assessment of
the health of a community
2. Includes timely collection, analysis,
interpretation, and dissemination of
data
3. Surveillance should lead to action
 Why Plan Surveillance ?
1. To meet changing needs of society
and the public health community
2. To understand and respond to those
needs, an organized approach to
planning, developing,
implementing, and maintaining
surveillance system is necessary
3. To obtain information for action
 Steps in Planning
Surveillance (p19teutsch)
1. Establish objectives
2. Develop case definitions
3. Develop data collection system
4. Develop data collection instruments
5. Develop and test analytic approach (data
analysis)
6. Field test method
7. Determine dissemination mechanism and
ensure access at different level
8. Determine evaluation method
 Establishing objectives
1. First, critical point in planning a
surveillance system
2. At initial stage of planning, you
must decide “what do you need
to know?”
 Criteria for determining
high-priority events for surveillance
1. Quantitative and qualitative approaches
a. Frequency e. Communicability
b. Severity f. Public interest
c. Direct – indirect cost g. Emerging issues
d. Preventability h. Criteria based on
consensus process
2. Other programmatic considerations
a. Impact
b. Effectiveness
c. Political
d. Evaluate control/prevention measures
 Elements of a clear case
definitions
• Clinical and laboratory diagnosis
• Criteria for time
• Criteria for place
• Criteria for person
• Epidemiological features of disease
• Potentially categorized by the degree of
certainty regarding diagnosis as “conformed”,
“suspect”, or “possible”
• High sensitivity and specificity may be desired
 Factors influencing
case definitions
• Increase in knowledge

• Criteria for defining case

 Determining data
collection system

• Method of data collection

• Balance between system and its
purpose
• Timelines
• Type of condition
• Need for lab-based information
 Types of data
collection system
• Vital recorded system

• Existing data gets

• Existing registries or surveys

 Passive Systems
• Simple
• Less expensive
• Limited by variability
• Incompleteness in reporting
• May not be representative and may
fail to identify outbreaks
• Portrays trends
 Active system
• Conditions of particular importance
• Validate the representativeness of passive
reports
• Assure more complete reporting of
conditions
• Can be used with specific epidemiologic
investigations
• More expensive than passive system
• Can be used for time periods
 Sentinel surveillance
systems
• Selected persons report the event(s) at
regular intervals

• May be active of passive

• Discussed in next lessons [lesson 4]

 Uses of Limited
Surveillance systems
• Resolve specific problems

• Identify all cases

• Use for logistic or economic

reasons
 Development of data
collection instruments
• Standardizations

• Ability to link
• Limit data to only those data
needed at a given level
 Purpose of field testing

• Detect problems in data collection

system
• Identify problems with validity
• Correct problems with data collection
system before implementation
 Elements of field testing
• Types of data to be collected in a
surveillance system
• Data sources
• Data collection methods
• Procedures for handling the information
Why Plan your Analysis ?

To assure that the data

source and collection
process are adequate
 Why interpret and
Disseminate Information ?
• Help decision makers the implications
of information
• Facilitate consequent implementation
of public health action
 Interpretation of
information
• Present information clearly
• Know your audience
 Considerations for
Dissemination
• Balance access with privacy constraints
• Provide analyses and recommendations
• Use clear and concise materials
• Use communications media
• Use current audiovisual technology
 What Can You Find Out Through
Evaluating Your System?
• Determine whether purpose of surveillance system have been
met
• Determine whether system generated data needed to provide
answers to problems
• Determine if information was timely
• Determine usefulness for researchers, public health
professionals
• Determine if development of system was worth to continue
• Determine if participants wish to continue
• Determine ways to enhance attributes of system
– timeliness – sensitivity
– simplicity – predictive value positive
– flexibility – representativeness
– acceptability – cost-effectiveness
 Why Involve
Others in Planning?

• Increase potential that data

needed to collected
• Facilitate communications
• Facilitate consensus regarding
priorities and methods
consistent with needs and
resources of those involved
 Who Should be Involved
in Planning?
• Anticipated users • Laboratories
• Clinicians • Volunteer agencies
• Policy makers • Program manager
• Hospitals • Public/community groups
• Professional groups • Administrative groups
• State and local • Justice departments or
health department other interest group