An evaluation of integrated disease surveillance and response within the community and health facility in three regions of Ghana

Thesis (Dr.P.H.)--Boston UniversityAn evaluation was conducted in three regions of Ghana to determine if the strategy described within the Technical Guidelines for Integrated Disease Surveillance and Response in Ghana (2002) is achieving its intended objectives within the health facility and community and to provide recommendations to stakeholders. A comprehensive review of documents and interviews of key informants at each level of the strategy from the national surveillance team to the community-based surveillance (CBS) volunteer were conducted. The strategy can only be described as useful at the level of the health facility. Within all but one sub-district evaluated, the community level of the strategy cannot be described as useful due to its declining state. System attributes of the facility (CDC surveillance evaluation indicators) were found to be sufficient. With few exceptions, the core functions were generally operating at a minimal level, however. Although technical determinants (i.e. guidelines, training materials and reporting forms) were found to be of high quality and appropriate, many essential materials were lacking within the facilities sampled. Organization and workforce and workforce performance determinants were found to be lacking in a number of key areas. A number of concrete recommendations resulted from this evaluation. The CBS volunteer component should be eliminated from the national strategy. Key community members, especially those involved in health-related activities, should be sensitized to identify and report. Clinicians should be provided with training within facilities with a focus on managing and sustaining the seven core functions. Districts and facilities should routinely monitor the availability of the IDSR guidelines, standard case definitions, and all essential documents. A national initiative holding all health facilities accountable for weekly and monthly reporting is warranted, as well as an increased expectation of health facility level management of the seven core functions. Several ingredients are needed to achieve an exemplary IDSR strategy, including: review of the technical materials created for Ghana during the implementation of IDSR in the three northern regions; strategic allocation of resources; an increased focus on the role of the clinician; consideration of demographic change, especially on the periphery of large cities; and strong political will