Developing experience and evidence in surveillance

implementation in Tanzania

Dr. Patrick Swai

USAID/Tanzania

Milestones of IDS in Tanzania• 1998 National level assessment• 1998 Adoption of IDS strategy• 1999 Implementation plan developed• 2000 IDS Task Force created• 2001 National IDS guidelines for 13 priority diseases• 2001 Lab networking guidelines• 2002 Development of draft District analysis book • 2002 The coordinated implementation team initiated

implementation in focus districts

Source of USAID funds for IDS implementation in Tanzania

• Africa Bureau – Providing support to WHO, (including the 1998 assessment)

• Tanzania Mission – operationalizing the IDS strategy and strengthening surveillance implementation

• Bureau of Global Health – developing evidence of successful programming around surveillance; dissemination of tools, materials, and lessons learned to other countries

USAID-funded partners in local IDS implementation in Tanzania

• National Institute for Medical Research (NIMR)

• Partners for Health Reform plus (PHRplus)

• Centers for Disease Control and Prevention -- NCID and EPO/DIH

• CHANGE Project

• HealthTech

WHO

Nat’l

District

Facilities

Communities

Reg’l

Strategy, guidelines, tools

Policy, direction, plan, country guidelines

Support for lab, outbreak investigation, training

Hub of decision making, response/ action and resource mobilisation

Identify cases, report, respond and participate in public health actions

Know what to report when to health care system for action;Participate in response and prevention

Structure of the Tanzania Health System and Relevance for IDS

How the implementation team contributes to IDS strengthening

• WHO/AFRO – support to creating strategy, guidelines, and tools

– IDSR guidelines provide a comprehensive technical definition of a functioning system.

– Local implementation process is beyond the scope of regional guidelines

• Local-level (country) implementation: operationalize the strategy and guidelines

Selected districts for IDS strengthening

Zone District

Northern Arusha (Manyara) Babati

Mbulu

Eastern Dodoma Dodoma rural

Mpwapwa

Southern Mtwara Masasi

Tunduru

Southern Highland Ruvuma

Rukwa

Tunduru

Nkasi

Western Tabora Igunga

Tabora Urban

Lake Kagera

Mwanza

Muleba

Mwanza urban

Questions for country level implementation:

• What obstacles do districts, facilities, and communities face in operationalizing the system?

• What are the best strategies for overcoming these obstacles?

What are some of the obstacles that districts in Tanzania face?

• Very limited diagnostic confirmation capacity• Lack of adequate communications between levels• Barriers to adequate transport of specimens• Low motivation and capacity for analysis (and

use) of information for public health action• Poor coordination of available resources• Undefined roles and responsibilities for IDS• National level standards and policies missing

Need a guiding “road map” for operationalizing IDSR

How we are breaking ground in implementation in Tanzania

• Support the development of new ID surveillance and public health action technologies and tools for both epidemic and non-epidemic diseases

• Conduct research into critical issues surrounding ID surveillance and response that will support its successful adoption by other countries

• Coordinate with global and national institutions to provide training to develop the necessary skills needed for ID surveillance and response

How we are breaking ground in implementation in Tanzania

• Disseminate lessons learned • Develop successful examples of ID surveillance

and response that can be adopted by other districts in Tanzania and other countries to address the real obstacles at local levels

Implications for other countries for implementing IDSR

• Provide a model for other countries• Answer questions with operations research• Development of best practices• Documentation and transfer of experiences and

lessons learned• Dissemination of tools and materials for

implementation

Thank you!