Transcript IDSP module 11

Monitoring, supervision and
quality assurance
Integrated Disease Surveillance Programme (IDSP)
district surveillance officers (DSO) course
Preliminary questions to the group
• Were you already involved in monitoring and
supervision of surveillance?
• If yes, what difficulties did you face?
• What would you like to learn about
monitoring and supervision of surveillance?
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Outline of the session
1. Monitoring indicators
2. Supportive supervision
3. Quality improvement
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Monitoring
• Under the responsibility of the district
surveillance office
• Based upon standardized indicators reviewed
on a regular basis
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Monitoring
Surveillance activities to be monitored
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•
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•
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Collection and compilation of data
Laboratory
Analysis and interpretation
Follow-up action
Feedback
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Monitoring
Weekly indicators of collection and
compilation of data
• Assess
 Timeliness of reports
 Completeness of reports
• Indicators
 Number of reporting units providing
regular/timely/complete reports
 Number of sentinel private practitioners
providing regular/timely/complete reports
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Monitoring
Creative monitoring solutions,
Haryana, 2007
• District register
keeping track of
reports
• Reporting units that are
not timely are flagged
with a highlighter
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Monitoring
Colour-coded monitoring of reporting,
Mayurbhanj district, Orissa, India, 2004
Legend
Timely, complete
Timely, incomplete
Complete, not timely
Incomplete and late
No reports
The colour coding stimulates
reporting units that
are not performing
WEEKS
Baripada (DHH)
B.Pahad CHC
B.posi
Bahalda CHC
Barasahi CHC
Betnati CHC
Bijatala PHC
Dukura CHC
G.mahisani PHC
Jamda PHC
Jashipur CHC
K.tandi UHPHC
Kaptipada CHC
Karanjia, SDH
KC Pur PHC
Khunta PHC
Kostha CHC
Kuliana PHC
ManadaCHC
Rangamatia PHC
Raruan PHC
RG PHC
RR Pur, SDH
SC Pur PHC
Shirsa CHC
Sukruli PHC
T.mundaCHC
Tato PHC
Tiring PHC
Udala, SDH
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2
3
4
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Monitoring
Proportion of complete surveillance reports,
Dhenkanal district, Orissa, India, 2002
100
90
Completeness (%)
80
70
60
50
40
30
20
10
0
Monitoring
W51
W49
W47
W45
W43
W41
W39
W37
W35
W33
W31
W29
W27
W25
W23
W21
W19
W17
W15
W13
W11
W9
W7
W5
W3
W1
9 Weeks
Proportion of timely surveillance reports,
Dhenkanal district, Orissa, India, 2002
100
Percentage of timeliness
90
80
70
60
50
40
30
20
10
0
W51
W49
W47
W45
W43
W41
W39
W37
W35
W33
W31
W29
W27
W25
W23
W21
W19
W17
W15
W13
W11
W9
W7
W5
W3
W1
Weeks
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Monitoring
Proportion of reports from district to state in
Integrated Disease Surveillance Programme
(IDSP) phase 1 states, India, 2006-7
100%
90%
% of districts reporting
80%
70%
60%
50%
40%
30%
20%
10%
0%
Week 48
Week 52
Week 4
Week 8
Week 12
Weeks
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In Time (Within Week) Late Reporting
Not Reporting
Proportion of reports from district to state in
Integrated Disease Surveillance Programme
(IDSP) phase 2 states, India, 2006-7
100%
90%
% of districts reporting
80%
70%
60%
50%
40%
30%
20%
10%
0%
Week 48
Week 52
Week 4
Week 8
Week 12
Weeks
In Time (Within Week) 12Late Reporting Not Reporting
Reported varicella and typhoid cases (log
scale), Darjeeling, West Bengal, India, 2000-4
100000
Figure 3: Re porte d varice lla and typhoid cas e s , Darje e ling
dis trict, WB, India, 2000-2004
Ty phoid
Varicella
Number of cases (Log)
10000
1000
100
10
1
2000
2001
2002
2003
2004
Years
Interpretation: The parallel increase between varicella
(that should be constant) and typhoid suggests that increasing
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rates of typhoid are secondary
to improved reporting CDC for TPP
Laboratory performance indicators
• Proportion of laboratory specimens received
in good condition
• Proportion of laboratory specimens received
with completed form
• Proportion of results reported within seven
days after receipt of specimens
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Monitoring
Analysis and interpretation of data
• Number of outbreaks detected by the system
• Production of analysis reports
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Monitoring
Number of diarrhea outbreaks detected before
and after a new surveillance system,
Dhenkanal district, Orissa, 1997-2002
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Orissa multi-disease
surveillance system
Number of outbreaks
50
40
30
20
10
0
1997
1998
1999
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2000
Years
2001
2002
Monitoring
Follow-up action indicators
• Proportion of outbreaks detected within one
incubation period
• Proportion of outbreaks that have been
investigated
• Proportion of outbreaks investigated within
48 hours of detection
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Monitoring
Feedback indicators
• Number of monthly meetings at community
health centre with surveillance staff, over
last 6 months
• Number of village health committee
meetings attended by primary health centre
staff every 3 months
• Number of newsletters published
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Monitoring
Input indicators
• Percentage of positions filled
• Percentage of staff at each level trained
• Percentage of districts with functional rapid
response team
• Percentage of districts with functional
laboratories
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Monitoring
Proportion of vacancies among commmunity
health workers, Dhenkanal, Orissa, India, 2002
100%
90%
80%
Vacant
In position
Proportion (%)
70%
60%
50%
40%
30%
20%
10%
0%
Health workers, female
Health workers, males
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Monitoring
Prerequisites for supervision
• Job description
 Should clearly describe the surveillance activity
to be performed by each category of health staff
• Resources
 Required by supervisory team to perform this
activity
• Attitude
 Supervision should not be a fault finding mission
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Supervision
Preparing a supervision visit
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•
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Review the previous supervisory visit reports
Prepare supervisory plan
Visit each reporting unit at least quarterly
Make a check list to review activities
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Supervision
The supervision visit
• Activities during the visit
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


Use checklist
Observe
Review records
Conduct focus group discussions with staff
• Provide feedback
 Underline achievements
 Mention opportunities for improvement
• Recommend actions with a time frame
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Supervision
Potential activities to improve
the quality of surveillance (1/2)
• Ensure that necessary resources and incentives
identified in the programme have been provided to
the functionaries
• Identify the right person for the right task and
change work responsibility to suit the individual
• Conduct site visits to identify and supervise the
activities of the functionaries
• Identify weakness and help with additional training
of personnel on site as required
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Quality
Potential activities to improve
the quality of surveillance (2/2)
• Keep personnel contact to understand problems
associated with functionary
• Discuss persisting problems to identify solution at
the district surveillance monthly meetings and take
appropriate actions specified by the group
• Give written instructions on the solutions suggested
by the group to the functionary
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Quality
Data quality issues
• Data entry errors
• Missing values
• Attraction to round figures
• Bias related to lack of representativity
 Cases more severe
 Urban > rural
 Source not represented
(private sector, GPs)
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Data quality signs: Frequency distribution of dates of
onset for all notifiable diseases, USA, 1989
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12
Notifications x 1000
Peaks at “easy to remember ” dates
suggesting artifacts
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8
6
4
2
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Day of
the month
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Central agencies responsible
for quality control
• Central surveillance office
• National Institute of Communicable Diseases
(NICD)
• Indian Council of Medical Research (ICMR)
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Quality
Other agencies identified by the Ministry
of Health and Family Welfare for
external evaluation
• World Bank
• World Health Organization
• United States Centers for Diseases Control
and prevention (CDC)
• INDIACLEN
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Quality
Take home messages
1. Follow monitoring indicators
2. Supervise regularly and supportively
3. Look at all opportunities to improve quality
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Additional reading
• Section 4 of IDSP operations manual (Report
1, page 56-7)
• Section 9 of IDSP operations manual
• Module 11 of training manual
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