Institute of Public Health (Former Department of Tropical Hygiene and Public Health) Im Neuenheimer Feld 324, University of Heidelberg, Heidelberg, Germany D-69120.
BMC Public Health. 2013 Jun 13;13:575. doi: 10.1186/1471-2458-13-575.
Monitoring the progress of the Integrated Disease Surveillance (IDS) strategy is an important component to ensure its sustainability in the state of Maharashtra in India. The purpose of the study was to document the baseline performance of the system on its core and support functions and to understand the challenges for its transition from an externally funded "project" to a state owned surveillance "program".
Multi-centre, retrospective cross-sectional evaluation study to assess the structure, core and support surveillance functions using modified WHO generic questionnaires. All 34 districts in the state and randomly identified 46 facilities and 25 labs were included in the study.
Case definitions were rarely used at the periphery. Limited laboratory capacity at all levels compromised case and outbreak confirmation. Only 53% districts could confirm all priority diseases. Stool sample processing was the weakest at the periphery. Availability of transport media, trained staff, and rapid diagnostic tests were main challenges at the periphery. Data analysis was weak at both district and facility levels. Outbreak thresholds were better understood at facility level (59%) than at the district (18%). None of the outbreak indicator targets were met and submission of final outbreak report was the weakest. Feedback and training was significantly better (p < 0.0001) at district level (65%; 76%) than at facility level (15%; 37%). Supervision was better at the facility level (37%) than at district (18%) and so were coordination, communication and logistic resources. Contractual part time positions, administrative delays in recruitment, and vacancies (30%) were main human resource issues that hampered system performance.
Significant progress has been made in the core and support surveillance functions in Maharashtra, however some challenges exist. Support functions (laboratory, transport and communication equipment, training, supervision, human and other resources) are particularly weak at the district level. Structural integration and establishing permanent state and district surveillance officer positions will ensure leadership; improve performance; support continuity; and offer sustainability to the program. Institutionalizing the integrated disease surveillance strategy through skills based personnel development and infrastructure strengthening at district levels is the only way to avoid it from ending up isolated! Improving surveillance quality should be the next on agenda for the state.
监测综合疾病监测（IDS）战略的进展是确保其在印度马哈拉施特拉邦可持续性的重要组成部分。本研究的目的是记录该系统在核心和支持功能方面的基准表现，并了解从外部资助的“项目”向州拥有的监测“计划”过渡所面临的挑战。
采用多中心、回顾性横断面评估研究，使用世界卫生组织（WHO）通用问卷对结构、核心和支持监测功能进行评估。该研究纳入了该州的 34 个区和随机选定的 46 个设施和 25 个实验室。
在边缘地区很少使用病例定义。各级实验室能力有限，使病例和疫情确认受到影响。只有 53%的区能够确认所有优先疾病。粪便样本处理在边缘地区最为薄弱。在边缘地区，缺乏运输介质、训练有素的工作人员和快速诊断检测是主要挑战。数据分析在区和设施两个层面都很薄弱。在设施层面（59%）比在区层面（18%）更好地理解疫情阈值。没有达到任何疫情指标目标，最终疫情报告的提交情况最差。反馈和培训在区层面（65%；76%）明显好于设施层面（15%；37%）。监督在设施层面（37%）优于区层面（18%），协调、沟通和后勤资源也是如此。合同兼职职位、招聘中的行政延误和空缺（30%）是影响系统性能的主要人力资源问题。
马哈拉施特拉邦在核心和支持监测功能方面取得了显著进展，但仍存在一些挑战。支持功能（实验室、运输和通讯设备、培训、监督、人力和其他资源）在区层面尤其薄弱。结构整合和建立州和区常设监测官员职位将确保领导力；提高绩效；支持连续性；并为该计划提供可持续性。通过在区层面开展基于技能的人员发展和基础设施加强，将综合疾病监测战略制度化是避免其孤立的唯一途径！提高监测质量应该是该州的下一个议程。
