Jones Caroline, Abeku Tarekegn A, Rapuoda Beth, Okia Michael, Cox Jonathan
Department of Infectious & Tropical Disease, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
Soc Sci Med. 2008 Jul;67(2):292-300. doi: 10.1016/j.socscimed.2008.03.001. Epub 2008 Apr 29.
Malaria epidemics represent a significant public health problem in the highlands of Africa. Many of these epidemics occur in low resource settings, where the development of an effective system for malaria surveillance has been a key challenge. Between 2001 and 2006, the Highland Malaria Project (HIMAL) established a programme to develop and test a district-based surveillance system for the early detection and control of malaria epidemics in four pilot districts in Kenya and Uganda. An innovative feature of the programme was the devolution of responsibility for the detection of epidemics from the central Ministry of Health to District Health Management Teams. The implementation of the programme offered the opportunity to test both the technical aspects of the system and to examine the practical issues relating to the operation of the programme in the context of the existing health system. To investigate the attitude of key staff towards the programme, and their perceptions of its impact on their working practices, interviews were carried out among 52 health staff at district level and in the Ministries of Health in Kenya and Uganda. The transfer of responsibility for the early detection of epidemics to the districts had resulted in perceptions of individual empowerment among district-based staff. This, together with improved support supervision, was a key factor in sustaining motivation and improved surveillance. The enhanced support supervision also produced capacity benefits that extended beyond improved malaria surveillance. However, these improvements occurred in the context of increased logistical support (the provision of transport, fuel and travel allowances) which the participants believed was essential to the functioning of an effective system. With this proviso, the district-based malaria early warning system was perceived to be manageable, effective and sustainable in the context of the current health system.
疟疾流行是非洲高地一个重大的公共卫生问题。其中许多疫情发生在资源匮乏地区，在这些地区，建立有效的疟疾监测系统一直是一项关键挑战。2001年至2006年期间，高地疟疾项目（HIMAL）制定了一项计划，在肯尼亚和乌干达的四个试点地区开发并测试一个基于地区的监测系统，用于早期发现和控制疟疾疫情。该计划的一个创新特点是将疫情检测责任从中央卫生部下放到地区卫生管理团队。该计划的实施提供了一个机会，既可以测试系统的技术方面，也可以在现有卫生系统背景下研究与该计划运作相关的实际问题。为了调查关键工作人员对该计划的态度以及他们对该计划对其工作实践影响的看法，对肯尼亚和乌干达地区一级以及卫生部的52名卫生工作人员进行了访谈。将疫情早期检测责任转移到地区，使地区工作人员产生了个人赋权感。这与加强支持性监督一起，是维持积极性和改善监测的关键因素。加强支持性监督还带来了能力提升，其影响超出了改善疟疾监测的范围。然而，这些改进是在后勤支持增加（提供交通、燃料和差旅津贴）的背景下实现的，参与者认为这对有效系统的运作至关重要。在这一前提下，基于地区的疟疾早期预警系统在当前卫生系统背景下被认为是可管理、有效和可持续的。
