Evaluation of the surveillance system in Kiryandongo Refugee Settlement, Kiryandongo District, Uganda, April 2017

Abstract

Introduction: Integrated Disease Surveillance and Response (IDSR) involves surveillance of priority diseases and conditions, and is implemented in many African countries, including Uganda. During humanitarian emergencies, public health surveillance systems such as IDSR may face challenges. We assessed the capacity of health facilities (HF) in Kiryandongo District, a district with a large and recent refugee influx, to perform IDSR core functions. Methods: We visited five HF serving refugee settlements and one serving the host community. We interviewed HF in-charges, surveillance Focal Persons, and District Health Team (DHT) members about their capacity to perform IDSR. We reviewed paper-based forms in IDSR to evaluate system attributes during April 2016-March 2017. We determined the average weekly health Management Information System (HMIS) reporting rate for weeks 1-13 of 2017. Results: All HFs were well-staffed. However, half of the 12 suspected disease outbreaks reported in the past year were not investigated. The average weekly reporting rate was 79% (target: 80%). Barriers to IDSR included absence of standard case definition booklets (50%) and updated paper forms (67%), incomplete filling of registers, and inadequate data analysis (33%). The District Epidemic Preparedness and Response Committee (DEPRC) was non-functional. Conclusion: There was low capacity of the district to conduct IDSR, which could have slowed detection of and response to outbreaks. We recommended IDSR refresher trainings in two-year cycles and supplying guidelines to all HFs. The DEPRC and DHT should be strengthened through funding, regular meetings, and supplies of essential commodities.