Download Training report on National Early Warning Alert and Response

Training report on National Early Warning Alert and Response
Surveillance
Background:
Prior to 2009, the Ministry of Health had no systematic notifiable disease surveillance
system for infectious diseases. After 2009 Annual Health Conference, the Ministry of
Health entrusted the Public Health Laboratory to institute notifiable disease surveillance
system on priority diseases of national concern. In 2010, the Public Health Laboratory
developed first edition of national notifiable disease surveillance guideline. However,
due to changes in disease pattern and operational problem faced in implementing the
previous surveillance guideline, the list of national notifiable disease surveillance
guideline has been revised in 2014 to reinforce and strengthen the existing disease
surveillance system. The revised guideline also included an event-based surveillance
(EBS) to complement and supplement the indicator based notifiable diseases
surveillance which is also one of the IHR requirements. Since various acute syndromes
were incorporated in the revised list of notifiable diseases and also an even based
surveillance, the name of the current revised guideline has been changed to “National
Early Warning Alert and Response Surveillance (NEWARS)”.
Figure 1: Notifiable disease surveillance guidelines
Notifiable diseases surveillance being a national disease surveillance system for rapid
response, there was a need to develop web based system for real time reporting from
the health centers. The web based reporting system was developed and introduced by
PHL in 2012. However, due to limited internet accessibility in the districts, the web
based reporting was accessible only up to district health office and hospitals. Therefore,
this has not materialized the real time reporting problem from the health centers in the
communities because conventional reporting system require health centers to report to
their respective district health offices and then district health offices report to PHL in the
web based system on behalf of health centers which further delay reporting.
To address the reporting problem in all health centers and most importantly to get real
time events reporting from the field with incorporation of event based surveillance, PHL
has redesigned existing web based reporting system as per the revised guideline and
developed in-house mobile SMS reporting system because mobile network coverage is
very high in the country. The in-house developed web based and mobile SMS reporting
system was also piloted successful in few health centers and was ready for
implementation in 2014. However, due to lack of fund support to train health
professionals, PHL could not introduce the web based and mobile SMS reporting
system.
Overall Objectives:
To operationalize “National Early Warning Alert and Response Surveillance” guideline
and introduce re-designed web based and mobile SMS reporting system developed to
strengthen the existing notifiable disease surveillance system in the country.
Specific Objectives:
1. To train health professionals/workers on revised national notifiable disease
surveillance guideline “NEWARS”
2. To train heath professional/workers on online real time reporting application
developed: Web based and Mobile SMS based on NEWARS guideline.
3. Provide hands on training and simulation of Web based and Mobile SMS
reporting system.
Expected Outcome of the training:
1. Health professionals/workers are thorough with “NEWARS” guideline and reporting
system.
2. Implement the NEWARS guideline and start reporting immediately after the training
using either web based or mobile SMS platform.
3. Trained health professionals/workers to facilitate in sensitizing/training other health
workers, Village Health Workers, and counterpart from other relevant stakeholders
including general public on event reporting.
1st batch (Mongar and Lhuntse districts)
2nd batch (Trashigang and Trashiyangtse districts)
3rd batch (Bumthang, Trognsa and Zhemgang districts) 4th batch (Punakha, Gasa and Wangdi districts)
5th batch (Thimphu, Haa and Paro districts)
7th batch (Chukha and Samtse districts)
6th batch (Tsirang, Dagana, & Sarpang districts)
8th batch (Pemagatshel and SamdrupJongkar districts)
Training Outcome:
1. Trained health professional/workers National Early Warning Alert Response
Surveillance (NEWARS) guideline.
2. Trained health professional/workers from 228 hospitals and BHU’s on web
based and mobile SMS reporting system.
3. Hospitals and BHU’s started NEWARS reporting web based and mobile SMS
reporting system.
4. Strengthened real time reporting of national notifiable diseases/syndromes and
events.
Recommendation:
1. All health centers proposed for roll out of NEWARS training for other health
workers.
2. Health centers recommended PHL to develop register for documentation of
weekly reporting based on NEWARS guideline.
3. Most health professionals/workers had concern on double reporting for some
diseases or syndromes because of case referral. To minimize/avoid double
reporting, health professionals/workers recommended to include provision in the
system to reflect referral cases.
4. Recommended to include of death in the event reporting system since death is
possible during events.
5. To facilitate data collection for list of notifiable diseases/syndromes, health
professionals/workers from hospitals recommended PHL to developed seal for
list of notifiable diseases/syndromes and distribute to hospitals which can be kept
at reception and use it on prescription when patients comes for registration in the
hospital.
6. Health professionals/workers recommended to develop clinical training module
for list of notifiable diseases/syndromes and conduct training, because the data
collection and reporting need to be done based on clinical diagnosis and health
professionals/workers need proper training for consistency diagnosis and
reporting.
7. Severe dengue to be removed from list of notifiable diseases/syndromes to avoid
confusion and double reporting with dengue fever.
8. Include mumps in the list of notifiable diseases/syndromes since mumps cannot
fit under any list of notifiable diseases/syndromes for reporting.
9. Scrub typhus is now known to be endemic in most places in the country and
reporting under fever with rash syndromes would lead to under reporting of
scrub
typhus
and
other
ricketssial
diseases.
Therefore,
health
professionals/workers recommended to add Ricketssial disease as one of the
notifiable diseases/syndromes list.
10. The health centers recommended in discontinuing the existing ARI reporting to
ARI/CDD program after health centers start reporting in the PHL reporting
system because ARI and SARI are syndromes to be reported as per the revised
list of notifiable diseases/syndromes.
Resolution:
1. Except three referral hospitals, all health centers to immediately implement
NEWARS guideline and start reporting in web based and mobile SMS reporting
platform.
2. PHL will recharge money incurred for SMS texting from private mobile number to
PHL reporting system every year because there is no technology with both
mobile service providers to provide SMS service on lease line.
3. Trained
health
professionals/workers
to
facilitate
in
training
of
professionals/workers on reporting system and their registration with PHL.
health