Improve on disease surveillance

By Dr. David Mukanga

WESTERN Uganda sits at the heart of the Albertine Region that is endowed with numerous animal species many of which are also disease reservoirs.

In addition, Uganda shares borders with at least two socio-politically fragile states; South Sudan and the Democratic Republic of the Congo (DRC).

The weak health systems at the border place Uganda at a heightened risk for disease outbreaks. 

Unfortunately, disease surveillance systems that would pick up these threats at source are either weak or absent.

The World Health Organization Regional Office for Africa reports that between January and May 2012 alone, there have been at least seven major infectious disease outbreaks in Africa.

The DRC has reported over 14,000 cholera cases while South Sudan has faced recent outbreaks of polio, meningitis and rift valley fever. 

Uganda has had four Ebola outbreaks since 2000 that have claimed nearly 300 lives, including the ongoing outbreak that in Kibaale district.

Often, these disease outbreaks cause mass hysteria, loss of life, reduction in work productivity, wastage of scarce resources and greatly disrupt economic activity.

Cholera outbreaks in Africa cost the continent at least $72m in 2007.

Weak surveillance systems under report epidemics with many epidemics going through their natural cycle and dying off undetected. 

Effective control and prevention of outbreaks require reliable public health systems.

To address the need for improved surveillance systems that provide relevant and accurate epidemiologic and laboratory information.

Most African countries have adopted the Integrated Disease Surveillance and Response (IDSR) strategy whose major goal is to strengthen district-level surveillance capacities for detecting, confirming and responding to priority diseases that affect African communities.

The disease surveillance system in Uganda follows the IDSR approach and is integrated within the existing health system structures right from the communities, lower health facilities and laboratories, to the regional and central level laboratories and the Ministry of Health.

This surveillance system is, however, faced with a number of challenges. Whereas surveillance officers exist at district and regional levels, they are inadequate and often lack the necessary resources to undertake their work. 

With high staff attrition, regular training of new staff has become a permanent need.

Only about 13% of the health facilities have adequate specimen collection and transport materials for outbreak investigations.

Surveillance officers lack adequate facilitation such transportation or communication means which greatly delay information relay from the affected communities. 

The ongoing Ebola outbreak underscores the urgent need for quality surveillance and laboratory services to achieve timely detection and confirmation of public health threats.

Weak surveillance systems are partly responsible for the continued occurrence of these epidemics in our settings. 

While the Ministry of Health may have the will, their limited financial and human resources make it difficult to operate.

Funding for integrated disease surveillance and response from stands at only about sh50 per person per year and yet timely access to this funding to is often a nightmare due to system bottlenecks.

What is needed is the political commitment backed with financial support to the health sector. While partners will continue to support the country to build its capabilities, the Government needs to pick its fair share of the pie.

The private sector needs to donate towards this noble cause as part of its corporate social responsibility. 

The public too needs to play an active role in public health surveillance by being vigilant and reporting suspected cases of strange diseases to the nearest health facility.

The writer works with AFENET and the article was co-authored by Drs. Olivia Namusisi, Peter Wasswa and Sheba N. Gitta, all working with AFENET