[By Stanslous Ngosa]
Public health surveillance is the ongoing systematic collection, analysis, and interpretation of data, closely integrated with the timely dissemination of these data to those responsible for preventing and controlling disease and injury.
Stronger public health surveillance systems allow public health experts to accurately describe and assess the state of health problems. Without surveillance, public health experts would be stabbing blindly at health problems, which is a waste of precious resources. Understanding the pathogen involved helps scientists understand where and how to intervene.
It is against this background that government established the Zambia National Public Health Institute (ZNPHI) as an independent national public health institute. ZNPH, with a legal mandate, functions as a statutory body under the Ministry of Health, with a central building that accommodates all of its functions, as well as established operational procedures and systems.
Recognising the critical importance of the public health functions of the ZNPHI, the Ministry of Health is working on two fronts: engendering sustainability in the ZNPHI through its establishment. The organisational development of ZNPHI is guided by an advisory group and steering committee that lead the implementation of a comprehensive operational plan. The operational plan reflects all of the important considerations for achieving the goals for ZNPHI operations, including financial management, procurement, organisational structure, staffing, space, governance, legal framework, and financial sustainability.
This process has preliminary support from the U S President’s Emergency Plan for AIDS Relief (PEPFAR), U S Centers for Disease Control and Prevention (CDC), and the International Association of National Public Health Institutes, but will require longer term support to ensure sustainability of the public health priorities outlined in its plan.
The government recognises the critical role that the ZNPHI plays and is committed to establishing the ZNPHI as a permanent and effective public health feature in the health landscape of the country.
A number of dedicated surveillance officers existed at facility and district levels, creating gaps in essential disease detection and reporting. Zambia also had several large, vertical surveillance systems which were fragmented across various levels of the health system.
Although information systems, including Health Management Information Services and District Health information software existed, gaps in national public health laboratory services, as well as the absence of a national integrated data repository, making it difficult for the Ministry of Health to present a timely and accurate picture of disease trends to public health stakeholders.
By refocusing on the core structure of the Integrated Disease Surveillance and Response and other surveillance systems, ZNPHI has improved the quality, efficiency, and usefulness of disease surveillance and data reporting in Zambia. This has led to improved detection of changes in epidemiologic trends that may signify an event of public health concern so that the MoH can respond appropriately. In addition, beginning with HIV case-based surveillance and the Zambia Population-based HIV Impact Assessment data, ZNPHI has integrated vertical surveillance systems and work towards the development of a national data repository to house these data.
The Ebola crisis in West Africa highlighted the importance of public health emergency preparedness and response capacity. Prior to the ZNPHI, there was no dedicated structure in Zambia to coordinate the public health aspects of emergency preparedness and response activities. The MoH led these activities through the National Epidemic Response Committee and there was a national rapid response team that engaged in an adhoc manner.
These challenges made it difficult for the MoH to carry out critical policy actions during a public health emergency and could challenge the MoH’s ability to communicate effectively with the country’s leaders, public and the media during a crisis.
By establishing an Emergency Operations Centre and associated emergency preparedness and management protocols, ZNPHI now serves as a focal point to effectively prepare for and manage public health crises and report to the MoH to carry out relevant policy decisions. In the absence of a dedicated national public health laboratory system to coordinate public health laboratory functions, the laboratory which are critical to implementing the International Health Regulations and Integrated Disease Surveillance and Response, functions were carried out in clinical laboratories, which all had a different focus.
The government developed a coordinated approach to the surveillance, prevention and control of diseases of public health importance though the strengthening of the laboratory facilities/network and subsequent development of a national public health laboratory service and network.
Establishing a dedicated National Public Health Laboratory and network significantly increased the Ministry of Health’s ability to detect diseases of national and international importance and respond in a timely and efficient manner, thus saving Zambians’ lives and enhancing national and global health security.
The inclusion of a dedicated health information systems unit at the ZNPHI ensured generation of timely, high quality data on all national notifiable and priority diseases, conditions and events to inform policy and programmes. Additionally, the public health bulletin established under this unit serves to provide to health professionals and the public, an authoritative, timely, and influential source of information and recommendations for actions to minimise public health threats.
Without a highly regarded and user-friendly public health bulletin to rapidly disseminate critical public health information, the population cannot fully benefit from surveillance data and the findings of national and international outbreak investigators and other public health researchers. While the MoH’s national research agenda includes many priority public health questions, governmental financial support for this research is limited, and there are gaps in translating research into policy and public health impact.
The MoH, therefore, now fills these gaps by authorising ZNPHI to address priority public health research and program evaluations and communicate findings to policymakers. By filling this gap, the MoH and policy makers are well-informed and able to take action based on evidence that is grounded in scientifically sound findings and makes efficient use of available resources.
Under this strategic priority, ZNPHI works with the MoH, National Health Research Authority and existing network of strong research partners to provide technical input into the development of a well-informed national public health research agenda.
A strong public health workforce is critical to the Institute’s ability to achieve its mission and meet the public health needs of the Zambian population. ZNPHI supports the MoH by working to develop a public health workforce that is adequate and competent to meet national needs. This responsibility includes monitoring the workforce in terms of existing capacity and unmet needs, providing training and continuing education for ZNPHI employees or other public health professionals, advocating for strong public health curricula or providing technical support to public health professionals to improve their job performance.
It is, therefore, indisputable that without surveillance, public health experts would be stabbing blindly at health problems, which is a waste of precious resources and this can affect the attainment of Universal Health Coverage.
The author is head of media relations at the Ministry of Health.