SURVEILLANCE OF MORBIDITY AND MORTALITY
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- Title
- SURVEILLANCE OF MORBIDITY AND MORTALITY
- extracted text
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Primary Health Care Management Advancement Programme
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SURVEILLANCE OF
MORBIDITY AND MORTALITY
MODULE
FACILITATORS GUIDE
-3
3
. 3
4
Dedicated to
Dr. Duane L. Smith (1939-1992),
Dr. William B. Steeler (1948-1992)
and all other health leaders, managers and workers
who follow their example in the effort to bring quality health
care to all in need.
5 31
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The Primary Health Care Management Advancement
Programme has been funded by the Aga Khan Foundation
Canada, the Commission of the European Communities,
the Aga Khan Foundation U.S.A., the Aga Khan
Foundation’s head office in Geneva, the Rockefeller Foun
dation, the Canadian International Development Agency,
Alberta Aid, and the United States Agency for Interna
tional Development under two matching grants to AKF
USA. The first of these grants was, "Strengthening the
Management, Monitoring and Evaluation of PHC Pro
grams in Selected Countries of Asia and Africa" (cooper
ative agreement no. OTR-0158-A-00-8161-00, 19881991); and the second was "Strengthening the Effective
ness, Management and Sustainability of PHC/Mother and
Child Survival Programs in Asia and Africa" (cooperative
agreement no. PCD-0158-A-00-1102-00, 1991-1994).
The development of Modules 6 and 7 was partially funded
through in-kind contributions from the Primary Health
Care Operations Research project (PRICOR) of the Center
for Human Services under its cooperative agreement with
USAID (DSPE-6920-A-00-1048-00).
This support is gratefully acknowledged. The views
and opinions expressed in the PHC MAP materials are
those of the authors and do not necessarily reflect those
of the donors.
All PHC MAP material (written and computer files) is
in the public domain and may be freely copied and
distributed to others.
Contents
FOREWORD ................................................................................................. 1
SESSION 1: INTRODUCTION AND OVERVIEW ........................... 7
Transparencies
4-1: Workshop objective..................................................................... 13
4-2: Surveillance ................................................................................ 14
4-3: Limitations of surveillance ........................................................ 15
4-4; Surveillance methods................................................................. 16
4-5: Steps in setting up a surveillance system ................................ 17
SESSION 2: SPECIFY OBJECTIVES AND
DEFINE SURVEILLANCE DATA (STEPS 1 AND 2)....................... 19
Transparencies
4-6: Session 2: Objectives................................................................... 24
4-7: Information for surveillance objectives................................... .25
4-8: Sources of possible indicators .................................................. 28
SESSION 3: SPECIFY SURVEILLANCE METHODS AND
DATA COLLECTION PROCEDURES (STEPS 3 AND 4)..............29
Transparencies
4-9: Session 3: Objectives................................................................... 32
4-10: Data sources................................................................................ 33
4-11: Substeps for designing collection procedures.......................... 34
4-12: Rules for recording cases............................................................35
4-13: Types of instruments ................................................................. 36
Module 4: FG; contents
SESSION 4: COLLECT, REPORT AND
ANALYSE THE DATA (STEPS 5 AND 6) ........................................... 37
Transparencies
4-14: Session 4: Objectives ................................................................. 41
4-15: Training topics ............................................................................ 42
4-16: Supervision requirements ..........................................................43
4-17: Possible data patterns ............................................................... 44
4-18: Factors influencing number of cases reports .......................... 45
SESSION 5: INVESTIGATE CAUSATION (OPTIONAL)
(STEP 7)........................................................................................................... 47
Transparency
4-19: Session 5: Objective ................................................................... 49
SESSION 6: DEVELOP AN ACTION PLAN AND
PRESENT REPORTS (STEPS 8 AND 9)............................................. 51
Transparencies
4-20: Session 6: Objective ................................................................... 55
4-21: Action plan components............................................................56
4-22; Guidelines for preparing reports ............................................... 57
Module 4: FG; contents
Foreword
■d
What is the purpose of the Facilitator’s guide?
The Facilitator’s guide contains a suggested workshop design for use by
individuals who will help PHC managers and staff learn how to use the
Primary Health Care Management Advancement Programme (PHC MAP)
series. There is a Facilitators guide for each module in the PHC MAP series.
What information does it contain?
Each Facilitators guide contains instructions for conducting a workshop
on one of the modules in the PHC MAP series using the information
contained in the User’s guide.
The instructions are arranged in one to two hour sessions. The number
of sessions depends on the amount of information and/or the number of
steps contained in the User’s guide. The first page of each session lists
session objectives, major topic headings, time required, and materials and
equipment. The following pages describe the instructional activities in
outline form.
The outline is divided into two columns. The right-hand column
indicates what the facilitator says or does to conduct the session. The
left-hand column lists the handouts, overhead transparencies, or other
materials needed to support the activity. Copies of these materials, suitable
for duplication, appear at the end of the session in which they are first used.
Some transparencies are used in more than one session.
How are the workshops organised?
The first session of each workshop contains activities designed to
introduce the PHC MAP series and explain its importance to PHC
programmes, present an overview of the workshop, explain the purpose of
the module, review specific terms or concepts used in the module, and
Module 4: FG; foreword
if
2
acquaint the participants with the organisation and content of the Users
guide.
The final session of each workshop contains activities designed to review
key points of the User’s guide, if appropriate, help participants prepare an
action plan, and brings the workshop to a formal conclusion. The sessions
in between present the steps required to accomplish the purpose of the
module and provide an opportunity for participants to apply those steps
to their own programmes.
Each workshop is designed to be given on consecutive days, uninter
rupted except for breaks, meals, and rest, if the workshop is longer than
one day. It is recognised, however, that situations vary and the PHC MAP
modules will be used singly or in combination by individuals and or
ganisations in the field and on university campuses. Therefore, it is
expected that the workshops described in the Facilitator’s guides will be
adapted to fit a range of circumstances. Indeed, those who facilitate PHC
MAP workshops are encouraged to make adaptations to meet the needs
of participants and/or specific PHC programmes.
Who can be a facilitator?
Ideally, the person who serves as facilitator has training and experience
in the fields of public health, management, planning, and evaluation, as well
as sampling and survey design. It is recommended that this person also be
skilful in working with small groups.
The facilitator should be someone from outside the PHC programme,
perhaps from another agency or a university. As a person with no direct
interest in the programme, the facilitator can be neutral in disagreements
that may arise and help the group members resolve an issue objectively.
Having an outside person as facilitator also allows the programme director,
who usually has a leadership role, to contribute his or her knowledge and
experience as a full participant in the work of the group.
It is also recommended that a facilitator have a full set of PHC MAP
User’s guides and Facilitator’s guides. It is sometimes necessary, in the
course of completing one module, to refer to information in another module.
Who should participate in the workshop?
The primary audience for the PHC MAP series is the team that manages
PHC programmes or other population-based health programmes in either
the public or private sector. An example of a PHC management team in
the public sector is the core staff of a district ranging from 100,000 to
300,000 in size of population served.
ii
Module 4: FG; foreword
3
An example of a PHC management team in the private sector is the
core staff of an NGO that provides PHC services to a specific population
in a given geographic area. The average size of the service population may
range from 40,000 to 60,000, but may be as small as 10,000 or more than
100,000. In either case, the management team should have:
• the knowledge and skills needed to complete the steps in the module
• the time and resources required to collect and analyse the required data
• the authority to plan and implement improvements in management
systems and procedures based on this analysis.
If feasible, teams from several districts or from several PHC programmes
within a given NGO, may work simultaneously with one facilitator to
complete a module. It is recommended that one facilitator work with no
more than four teams or 20 people at one time.
What does the facilitator do?
Understands the needs of participants. If the facilitator is working
with one PHC programme, the most efficient way to gather information
about participants and the programme in which they work is to meet with
the PHC director to determine:
• the nature of the PHC programme (services provided, size and description
of area served, number and type of facilities, number and qualifications
of staff, community involvement, computer capability, strengths, major
problems, etc.)
• if information needs have been clearly identified
• previous staff training in management information systems or related
topics
• resources available for training (time, space, equipment)
• possibility for subsequent technical assistance to workshop participants.
Understands the content of Module 1. Read the User’s guide and
Facilitator’s guide for Module 1 and consider options for workshop delivery.
• The purpose of Module 1 is to help participants select priority information
needs and to review some basic concepts underlying management
information systems. Depending on participant background, the amount
of time available, and the need to establish priorities among management
information needs, Module 1 can be presented in its entirety, limited to
Level 1: Quick start, limited to the PHC MAP systems framework, or in
Module 4: FG; foreword
4
summary form as contained in the first session of the Facilitator’s guides
for Modules 2 through 9.
• If information needs have not been clearly identified and participants
have no background in systems, then Module 1 should be presented in
full. The selection of the next module will depend upon priorities set by
the participants as they complete the steps in Module 1.
• If information needs have been clearly identified and participants have
no background in systems, then that portion of Module 1 can be added
to the first session of the selected module.
• If information needs have been clearly identified and participants have a
background in systems, then the overview of PHC MAP in the selected
module will be sufficient.
Understands the content of the selected module. Read the User’s
guide and Facilitator’s guide for the selected module and consider options
for workshop delivery.
• Depending upon the length of the module and the availability of staff for
training, the workshop sessions may be presented as described in the
Facilitator’s guide, or workshop sessions may be delivered at intervals (for
example, every morning for a certain number of days, one session per
week, or one day per week for three or four weeks).
• If follow-on technical assistance is available, the content of the module
could be presented in the workshop and the application of the procedure
to the PHC programme could be conducted on the job.
• Participants could plan steps in the workshop, complete them on the job,
and bring the results to the next workshop session. This approach is
particularly applicable to Module 2 which requires development of a
questionnaire, selection of a survey sample, training of data collectors,
and data collection. These steps cannot actually be carried out within the
time limits of the workshop as contained in the Module 2 Facilitator’s
guide.
• Other options are possible depending upon the circumstances of each
situation.
Determines what programme information, if any, is needed for
completion of the module. For example, census data and lists of households
are required to complete some of the steps in Module 3.
Module 4: FG; foreword
5
Determines the most appropriate people to attend the workshop. For
example. Module 7 is best completed by those responsible for planning,
training, supervision, logistics, and other management services.
Discusses the delivery options and participants with the PHC manager
and make decisions regarding the most appropriate option and participant
selection. Also determines if the needed information is available and if it
is not, the alternatives for obtaining the information.
Notifies participants of the date, time, and purpose of the
workshop and confirms attendance. Initial notice of the meeting may come
from the PHC manager, with follow-up by the facilitator.
Prepares the agenda, using as a model the sample in Session 1 of the
Facilitator’s guide for the selected module.
Inspects the room where the workshop will be held and answers these
questions:
• Is the room large enough to seat all the participants?
• Can chairs and tables be arranged in a variety of ways; all participants
around one table; participants in groups of three or four at smaller tables?
• Is the lighting adequate?
• Can temperature and humidity be controlled?
• Is there an electrical outlet for an overhead projector?
• Is a microphone necessary for everyone to hear and to be heard?
• Are toilets conveniently located?
• Is the site convenient to parking, restaurants and public transportation?
• Are supporting facilities available and convenient: duplication, word
processing, computers?
Prepares notes to conduct the workshop using the session outlines in
the Facilitator’s guide for the selected module, and makes the necessary
adaptations. Refer to the appropriate User’s guide for content.
Duplicates the worksheets and other handouts as indicated in
the Facilitator’s guide and obtains the necessary equipment.
Conducts the workshop as planned.
Provides follow-on assistance, if appropriate.
Module 4: FG; foreword
7
Session 1: Introduction and overview
Objectives:
Participants will be able to:
• Explain the purpose of Module 4.
• Define surveillance as used in Module 4.
• Name at least two purposes of surveillance.
• Distinguish between quantitative and qualita
tive surveillance.
• Explain how surveillance data contribute to
PHC programme planning.
Session outline:
I. Introduction (30 minutes)
II. Overview of workshop (10 minutes)
III. Purpose of Module 4 (10 minutes)
IV. Module 4 User’s guide (10 minutes)
V. Definitions, purposes and principles (30 mi
nutes)
Materials:
Module 4 User’s guide
Handout 4-1:
Sample Agenda
Transparency 4-1: Workshop objective
Transparency 4-2: Surveillance
Transparency 4-3: Limitations of surveillance
Transparency 4-4: Surveillance methods
Transparency 4-5: Steps in setting up a sur
veillance system
Equipment:
Flip chart, stand, markers, masking tape, over
head projector and screen
Module 4: FG; session 1
8
Session 1: Introduction and overview
I.
Introduction (30 minutes)
Note: Omit Section I if you have presented Mod
ule 1, or some other module, immediately prior to
the presentation of Module 4
Name tags
or place cards
Flip chart
A. OPENING REMARKS
• Introduce self and other staff, as necessary.
• Explain your role in the workshop.
• If you do not know the participants, ask each
one to state his or her name, position title, and
job location.
Note: If the group is larger than 6 or 8, you may
wish to have them wear name tags or place cards
with their names at places where they are sitting.
• Ask each participant to complete this sen
tence: "As a result of attending this workshop,
I expect..." and write their responses on the
flip chart.
• When all responses have been recorded, say
that you will return to this list after giving an
overview of the workshop.
B. OVERVIEW OF PHC MAP
• Explain why information is important or
PHC programmes.
• Summarise PHC MAP programme, includ
ing:
Purpose of PHC MAP
Title and purpose of each module and other
materials.
• Make the following points about PHC MAP:
Has been field tested and revised toensure
use fulness to PHC programme staff.
Module 4: FG; session 1
9
•3
Session 1: Introduction and overview
Modules can be used in any sequence.
Materials can, and should, be adapted to fit
a particular situation.
The procedures outlined in the modules can
be adopted as routine monitoring activities in
a PHC programme.
• Explain why MAP is being introduced in this
PHC programme.
Note: The specific programme and should pro
vide the answers to these questions:
Why are we doing this workshop?
What do we expect to achieve?
It may be appropriate for the PHC manager to
make these remarks.
II.
Overview of workshop (10 minutes)
Transparency 4-1
Workshop objective
• Review the workshop objectives.
• Distribute and review the workshop agenda,
Handout 4-1 Sample
agenda
describing the activities that will take place to
accomplishthe workshop objectives.
• Review the expectations contributed by particippants at the beginning of the session.
Indicate which ones will be met and which
ones will not and why.
Suggest, if possible, alternatives for meet
ing expectations that will not be met in this
workshop.
• Ask for questions or comments.
Module 4: FG; session 1
10
Session 1: Introduction and overview
III.
Purpose of module 4 (10 minutes)
• Explain that the purpose of Module 4 is to
help PHC programme staff set up and operate
a local surveillance system, using simple and
inexpensive tools.
• Discuss the value of collecting surveillance
data and how it relates to other modules in the
PHC MAP series.
IV.
Module 4 User’s guide (10 minutes)
Module 4 User's guide
• Distribute a User’s guide to each participant.
• Highlight key sections of the User’s guide.
Quick start, with a computer programme.
Introduction to surveillance principles.
Step-by-step directions for designing and
operating a surveillance system.
Appendices containing blank worksheets
and other reference material that will be used
in the workshop.
References, glossary and list of acronyms
and abbreviations.
V.
Definitions, purposes and principles (30 minutes)
Transparency 4-2
Surveillance
Module 4. Users guide,
page 3
• Define surveillance and discuss its purposes
in PHC programmes.
Distinguish between quantitative and
qualitative surveillance.
Stress the importance of collecting only
necessary data.
Refer participants to the example in the
User’s guide, discuss the example, and ask
them if the data represented are the result of
quantitative or qualitative surveillance.
Module 4: FG; session 1
n
Session 1: Introduction and overview
Transparency 4-3:
Limitations of
surveillance
Transparency 4-4:
Surveillance methods
Transparency 4-5:
Steps in setting up a
surveillance system
Discuss some limitations of surveillance.
• Discuss the principles of an effective surveil
lance system as participants follow along in
their User’s guide.
• Explain the four surveillance methods rec
ommended in this module, and the advantages
and disadvantages of each.
• Review briefly the steps in Module 4, includ
ing expected outcomes.
• Ask for questions or comments on the defini
tions and principles, the module as a whole,
and the workshop itself.
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Module 4: FG; session 1
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SAMPLE
AGENDA MODULE 4*
Session 1
(1 hr, 30 mins)
Introduction
and overview
Session 2
(1 hr, 45 mins)
Specify objectives
and define surveillance data
(Steps 1 & 2)
Session 3
(1 hr, 20 mins)
Speficy surveillance
methods and data collection
procedures
(Step 3 & 4)
Session 4
(1 hr, 40 mins)
Collect, report and analyse
the data
(Step 5 & 6)
Session 5
(1 hr, 20 mins)
Investigate causation
(Optional)
(Steps 7)
Session 6:
(1 hr, 20 mins)
Develop an action plan and
present reports
(Step 8 & 9)
‘For an actual presentation, substitute the appropriate clock hours in the first column.
Module 4. FG; session 1; handout 4-1
13
3
WORKSHOP OBJECTIVE
Design and operate a surveillance
system using the principles, steps
and materials contained in Module 4
3
3
&
Module 4: FG; session 1; transparency 4-1
14
SURVEILLANCE
Surveillance of morbidity and
mortality is the collection and
analysis of selected health and
vital events to:
• identify, investigate, control epidemics
• identify populations at risk
• confirm disease control priorities
• evaluate input of activities on incidence
and prevalence
• monitor trends
B7
Module 4: FG; session 1; transparency 4-2
15
s LIMITATIONS OF
I3 SURVEILLANCE
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• Labour intensive activity
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• Tabulation and analysis are time
consuming
• Limited to a few key indicators
• Several years of data collection is nec
essary to identify trends
• Difficult to assess impact if population
is small, or if no control group
• Reporting of surveillance data is often
incomplete
&
Module 4: FG; session 1; transparency 4-3
SURVEILLANCE
METHODS
• Routine reporting system
• Sentinel reporting system
• Surveys and special studies
• Case or outbreak investigation
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• Vital registration systems
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• Census
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* STEPS IN SETTING UP A
J SURVEILLANCE SYSTEM
Step 1:
Specify objectives
Step 2: Define data to collect
Step 3: Specify method(s)
3
3
Step 4: Develop data collection and
reporting procedures
Step 5: Collect and report data
Step 6: Analyse data
Step 7:
Investigate causation
(optional)
Step 8: Develop an action plan
Step 9: Prepare and present reports
to to
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Module 4: FG; session 1; transparency 4-5
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19
Session 2: Specify objectives and define
surveillance data (Steps 1 and 2)
Objectives:
Participants will be able to follow the directions
in the Module 4 User’s guide to:
• Specify the purpose, scope, and time period of
the surveillance; the users of the surveillance
information; the target group; the type and
frequency of surveillance.
• Determine what data the system will collect,
how frequently, from which source, and using
which procedure.
Session outline:
I. Introduction (5 minutes)
II. Specify the objectives of the surveillance (40
mintes)
111. Define the surveillance data to collect (60
minutes)
Materials:
Module 4 User’s guide
Transparency 4-6: Session 2: Objectives
Transparency 4-7: Information for surveil
lance objectives
Transparency 4-8; Sources of possible in
dicators
Handout 4-2:
Worksheet for specifying
objectives
Handout 4-3:
Worksheet for specifying
surveillance procedures
Module 4: FG; session 2
20
Equipment:
Flip chart, stand, markers, masking tape, over
head projector and screen
Module 4: FG; session 2
r
'■-3
21
3
3
Session 2: Specify objectives and define surveillance
data (Steps 1 and 2)
I. Introduction (5 minutes)
’3
• Explain that the purpose of this step is to
Note; If Module 1 has not been completed, decide
now as a group what the overall information needs
are for the PHC programme.
• Remind participants that what they choose
Handout 4-2: Worksheet
for specifying objectives
Transparency 4-7:
Information for
surveillance objectives
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decide on and record the objectives of the
surveillance system.
• Refer participants to the completed Work
sheets A and B, pages 20-21 from Module 1 (if
done) to review their overall information
needs.
to monitor should be based on overall pro
gramme goals, but will not be able to cover
everything.
• Review and discuss the categories of infor
mation needed to formulate specific surveil
lance objectives.
• Distribute the worksheet and direct partic
ipants to complete it in small groups for their
catchment area. Refer participants to the
sample completed worksheet on page 11, Mod
ule 4 for guidance as needed.
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Note: Groups of 4-5 participants are recommen
ded if the group is large to increase opportunity
for individual participation. If more than one
PHC is represented, groups should be formed on
the basis of programme.
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• Review the session objectives.
• Describe briefly the session activities.
II. Specify the objectives of the surveillance (40 minutes)
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Transparency 4-6:
Session 2: Objectives
Module 4: FG; session 2
Ask a spokesperson from one group to
report the items checked for purpose with
supporting arguments.
Invite other groups to report on differences
and help participants reach consensus on any
differences.
Repeat 1 and 2 for other sections of the
worksheet.
• Ask for questions and comments.
III.
Define the surveillance data to collect (60 minutes)
• Explain that this step will help determine
Handout 4-3:
Worksheet for specifying
surveillance methods
precisely which data the surveillance system
will collect, how frequently, from which source,
and using which procedure.
• Distribute the worksheet and explain each
section as the participants (working in groups
assigned in 11 above) complete the first three
columns on the worksheet. State that the
second part of the worksheet will be
completed in Step 3.
• Direct participants to enter target groups
identified in Step 1 in the first column.
• Discuss considerations for completing
column 2:
Mortality
Cause of death
Refer participants to Table 3 on page 22
for causes that can be determined by inter
view.
Review verbal autopsy approach in Ap
pendix E.
Module 4: FG; session 2
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• Facilitate discussion of the completed work
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Session 2: Specify objectives and define surveillance
data (Steps 1 and 2)
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Session 2: Specify objectives and define surveillance
data (Steps 1 and 2)
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Transparency 4-8:
Sources of possible
indicators
Module 4: FG; session 2
Review Appendix D for a discussion of
feasibility of determining cause of maternal
and childhood deaths.
Morbidity
Refer participants to Table 2, page 19, for
a list of priority diseases.
Refer participants to Appendix B for
more detailed information.
Cause of disease
How much information should be col
lected?
Suggest sources for specifying indicators
which are entered in the first column.
Ask for questions and comments.
24
SESSION 2: OBJECTIVES
1. Decide on and record the objectives of
the surveillance system
2. Determine data to be collected and
frequency, source(s), and procedure(s)
Module 4: FG; session 2; transparency 4-6
25
5
3
INFORMATION FOR
SURVEILLANCE
3
3 OBJECTIVES
3
3
J
• Purpose(s)
J
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3
3
• Users
• Scope
• Target groups
-•Sj
M • Cases and/or causes
• Other topics
• Time period and frequency
Module 4: FG; session 2; transparency 4-7
26
WORKSHEET FOR SPECIFYING
OBJECTIVES OF SURVEILLANCE
PURPOSE(s)
Assess needs
Identify risk factors
Identify outbreaks
__ Identify unusual events
Explain causes
Monitor trends
Evaluate impact on
Other:________ _
__ Other: __________ —
USER(s)
Board of directors
Government officials
Supervisors
Donors
_
PHC Manager
Community
PHC Staff
CDC*
Other: _________
Other: __________ —
SCOPE
Geographic area(s):___
Programme service(s):_
TARGET GROUP(s)
Women 15-59 yrs
Married women 15-49 yrs
_ Pregnant women
Other:__________ —
Children 1 month
Children 12-23 months
Children 1-4 yrs
__ Children 5 yrs
CASES
CAUSES
Mortality
__ Morbidity
_ Mortality
Morbidity
OTHER
Specify:
Specif: __
TIME PERIOD:_________ ______ FREQUENCY: _ —
'Local communicable disease centre
Module 4: FG; session 2; handout 4-2
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Module 4: FG; session 2; handout 4-3
WORKSHEET FOR SPECIFYING
SURVEILLANCE METHODS
Step 2: Define the surveillance data to collect
Step 3: Select the surveillance methods
DATA COLLECTION
Target group
Mortality/
morbidity/other
Indicator
Frequency
Source
Method*
’Routine, sentinel, sample survey/special study, case/outbreak investigation, verbal autopsy
28
SOURCES OF POSSIBLE
INDICATORS
• Module 1
• Appendix B
• Module 5
Module 4: FG; session 2; transparency 4-8
29
Session 3: Specify surveillance methods
and data collection procedures (Steps 3
and 4)
Objectives:
Participants will be able to follow the directions
in the Module 4 User’s guide to:
• Specify surveillance methods for each of the
indicators selected in Session 2.
• Design data collection procedures.
Session outline:
I. Introduction (10 minutes)
II. Select the surveillance methods (30 minutes)
III. Develop the data collection and reporting
procedures (40 minutes)
Materials:
Module 4 User’s guide
Transparency 4-9: Session 3: Objectives
Transparency 4-4: Surveillance methods
Transparency 4-10: Data sources
Transparency 4-11: Substeps for designing
collection procedures
Transparency 4-12: Rules for recording cases
Transparency 4-13: Types of instruments
Equipment:
Flip chart, stand, markers, masking tape, over
head projector and screen
Module 4: FG; session 3
30
Session 3: Specify surveillance methods and data
collection procedures (Steps 3 and 4)
I. Introduction (10 minutes)
Transparency 4-9:
Session 3: Objectives
User’s guide
• Review session objectives.
• State that this session covers Steps 3 and 4
in designing and operating a surveillance sys
tem and includes completion of columns 4, 5
and 6 on the worksheet for specifying the
surveillance procedures and will guide partic
ipants in developing the data collection proce
dures and instruments.
II. Select the surveillance methods (30 minutes)
Handout 4-3: Worksheet
for specifying
surveillance procedures
Transparency 4-10:
Data sources
Transparency 4-4:
Surveillance methods
IB
that more than one surveillance
method can be used, and that the methods can
be modified to better suit the needs of the
programme.
• Instruct participants to return to Handout
4-3, and explain considerations for columns
4 and 5 as they complete them.
Frequency of data collection/reporting de
pends on routine or priority indicators.
Primary and secondary data sources.
• Review the possible methods and advantages
and disadvantages of each as presented in
Session 1.
• Facilitate the discussion as participants
select the appropriate methods.
• Ask for questions and comments.
• Explain
Module 4: FG; session 3
31
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Session 3: Specify surveillance methods and data
collection procedures (Steps 3 and 4)
III. Develop the data collection and reporting procedures (40
minutes)
• Review the substeps involved in designing
Transparency 4-11:
Substeps for designing
data collection procedures.
data collection procedures
• Explain that every disease that will be moni
SI
User’s guide
Transparency 4-12:
Rules for recording cases
Transparency 4-13:
Types of instruments
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tored requires a case definition to ensure that
all healthworkers use the same definitions and
criteria.
Refer participants of Appendix B for ex
amples of standard and lay definitions of com
mon diseases.
Review important rules for identifying and
recording cases.
• Explain the three types of instruments used
in surveillance, and what circumstances war
rant the use of each, referring participants to
examples of each in the User’s guide when
appropriate.
Registers
Survey questionnaires
Case investigation
Ask participants to examine daily clinical
treatment records, CHW activities registers or
other forms used in their PHC programme
and determine whether those forms supply the
data they have specified on their worksheet.
Direct participants to indicate how the forms
should be modified to correct any deficiencies
they find.
Ask for questions and comments.
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Module 4: FG; session 3
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SESSION 3: OBJECTIVES
1. Select surveillance methods
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2. Design collection procedures
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Module 4: FG; session 3; transparency 4-9
33
DATA SOURCES
• Primary
• Secondary
Module 4: FG; session 3; transparency 4-10
34
SUB-STEPS FOR
DESIGNING COLLECTION
PROCEDURES
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• Develop operational definitions of cases
• Develop or revise the data
collection/recording instruments
• Pretest the instruments
Module 4: FG; session 3; transparency 4-11
JT
35
RULES FOR RECORDING
CASES
• Avoid double-counting
• Only count those cases that have been
diagnosed by a health worker
• Count current cases only
Module 4: FG; session 3; transparency 4-12
TYPES OF INSTRUMENTS
• Registers
• Survey questionnaires
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• Case investigation
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36
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Module 4: FG; session 3; transparency 4-13
-
37
Session 4: Collect, report and analyse
the data (Steps 5 and 6)
Objectives:
Participants will be able to follow the directions
in the Module 4 User’s guide to:
* Plan surveillance activities for their PHC pro
gramme, based on the methods selected and
procedures developed.
• Plan the analysis of their surveillance data.
Session outline:
I. Introduction (10 minutes)
II. Collect and report the data (30 minutes)
III. Analyse the data (60 minutes)
Materials:
Module 4 User’s guide
Transparency 4-14: Session 4: Objectives
Transparency 4-15: Training topics
Transparency 4-16: Supervision requirements
Transparency 4-17: Possible data patterns
Transparency 4-18: Factors influencing num
ber of cases reported
Equipment:
Flip chart, stand, markers, masking tape, over
head projector and screen
Module 4: FG; session 4
U-1-
Session 4: Collect, report and analyse the data (Steps
5 and 6)
Introduction (10 minutes)
I.
Transparency 4-14:
Session 4. Objectives
• Review session objectives.
. Explain that this session will guide partici
&
pants in planning the collection, reporting and
analysis of their data.
II.
Collect and report the data (30 minutes)
• Explain the importance of good training and
Transparency 4-15:
Training topics
Transparency 4-16:
Supervision requirements
supervision of staff involved in data collection,
tabulation, and reporting for a successful sur
veillance system.
• Review who should be trained and ask par
ticipants to review the worksheet for specify
ing surveillance procedures and list who will
be involved in collecting, tabulating, and re
porting their data.
• Review the recommended training topics.
Note: Point out the special requirements for case
investigations but explain them fully only if it is a
method chosen by participants in the workshop.
• Discuss what types of supervision will be
needed, and facilitate a discussion of any
special supervision needs participants foresee
for their surveillance method(s).
• Discuss what is meant by quality control and
assist participants to plan as a group ways of
ensuring a level of quality for their chosen
methodfs).
• Discuss data collection, tabulation, and re
porting requirements for each type of surveil
lance method, stressing those which were
selected in Step 1.
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Module 4: FG; session 4
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Session 4: Collect, report and analyse the data (Steps
5 and 6)
• Ask for questions and comments.
III.
Analyse the data (60 minutes)
Note: If possible, provide a set of actual or hy
pothetical surveillance data for participants to
work from.
• Remind participants about the importance of
analysis at each level of the surveillance sys
tem.
• Review ways of tabulating surveillance data
and refer participants to an example of each
in the Users guide.
Summary tables
Disease charts
Maps and charts
Note: The User’s guide includes some informa
tion on computing rates and ratios for large popu
lations. Include this information only if appro
priate for the participants in the workshop.
• Explain that the purpose of analysis is to
Transparency 4-17:
Possible data patterns
Transparency 4-18:
Factors influencing
number of cases reported
Module 4: FG; session 4
identify patterns and, possibly, causes of dis
eases or death.
Present possible data patterns and what
they might indicate.
Explain that sentinel systems allow for
more detailed analyses, such as correlation.
Point out that changes in disease patterns
may reflect a change in health status or a
change in the quality/amount of surveillance.
Review the major factors that can influence
the number of cases reported.
Suggest other analyses that participants
may wish to perform.
Session 4: Collect, report and analyse the data (Steps
5 and 6)
User’s guide
• Refer participants to the tables, charts, and
maps on pages 38-41 and ask them to analyse
them for patterns and what they might indi
cate about health status or the surveillance
system.
Note: If possible, provide additional surveillance
data showing different patterns to give partici
pants more practice in analysing data.
• Ask for questions or comments.
Module 4: FG; session 4
SESSION 4: OBJECTIVES
1. Plan surveillance activities for their
PHC programme
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2. Plan the analysis of their surveillance
data
Module 4: FG; session 4; transparency 4-14
43
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* SUPERVISION
3 REQUIREMENTS
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* Supervisors should be sure that inter
viewers:
• Follow up on all designated cases and
deaths
• Follow up on all incomplete answers
• Encourage probing
• Write all responses down
• Use local language or dialect
• Summarise and verify answers
Module 4: FG; session 4; transparency 4-16
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44
52-
POSSIBLE DATA
PATTERNS
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• Spikes
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• Clusters
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• Trends
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• Systematic variations
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Module 4: FG; session 4; transparency 4-17
• completeness of reporting
• seasonal variation
• epidemics or outbreaks
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FACTORS INFLUENCING
NUMBER OF CASES
REPORTED
• other factors
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• coverage
Module 4: FG; session 4; transparency 4-18
Session 5: Investigate causation
(optional) (Step 7)
Objectives:
Participants will be able explain what is involved
in conducting investigations to determine the
cause of certain diseases, health problems, or
deaths.
Session outline:
I. Introduction (5 minutes)
II. Case/outbreak investigations (15 minutes)
111. Verbal autopsies (25 minutes)
Materials:
Module 4 User’s guide
Transparency 4-19: Session 5: Objective
Equipment:
Flip chart, stand, markers, masking tape, over
head projector and screen
Module 4: FG; session 5
48
Session 1: Investigate causation(optional) (Step 7)
I. Introduction (5 minutes)
Transparency 4-19:
Session 5: Objectives
• Review session objective.
• Remind participants that investigating
causation requires special training, is time
consuming and is done on a selective basis.
II. Case/outbreak investigations (15 minutes)
Module 4 User’s guide,
page 46
• Review general guidelines for conducting a
case or outbreak investigation.
• Refer participants to Appendix C and explain
each section of the prototype form.
• Explain that a form will be needed for each
case selected for investigation.
• Explain that analysis of this information will
help to identify the main cause of the problem
and plan preventive action.
• Ask for questions or comments.
III. Verbal autopsies (25 minutes)
Module 4 User’s guide,
page 46
• Review general guidelines for conducting
verbal autopsies and refer participants to Ap
pendix D for further information and guide
lines.
• Refer participants to Appendix E and review
protocols for child and maternal death inves
tigations.
• Explain that analysis of this information will
also help to identify the main cause of the
problem and plan preventive action.
• Ask for questions and comments.
Module 4: FG; session 5
49
&
&
* SESSION 5: OBJECTIVE
Participants will be able to explain
what is involved in conducting
investigations to determine the
cause of certain diseases, health
problems, or deaths
& &
& & & & & & & &
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Module 4: FG; session 5; transparency 4-19
51
Session 6: Develop an action plan and
present reports (Steps 8 and 9)
Objectives:
Participants will be able to follow the directions
in the Module 4 User’s guide to develop action
plans to prevent unnecessary disease and death
based on the surveillance data collected.
Session outline:
I. Introduction (10 minutes)
II. Develop an action plan (20 minutes)
III. Prepare and present reports (30 minutes)
IV. Next steps (15 minutes)
V. Conclusion (10 minutes)
Materials:
Module 4 User’s guide
Transparency 4-20: Session 6: Objective
Transparency 4-21: Action plan components
Transparency 4-22: Guidelines for preparing
reports
Handout 4-4:
Worksheet for developing
action plans
Equipment:
Flip chart, stand, markers, masking tape£oj(er
head projector and screen
Module 4: FG; session 6
52
Session 6: Develop an action plan and present reports
(Steps 8 and 9)
I.
Introduction (10 minutes)
Transparency 4-20:
Session 6: Objective
II.
• Review session objective.
• Give a brief overview of session activities.
Develop an action plan (20 minutes)
• Explain that surveillance data is used to plan
Transparency 4-21:
Action plan components
Module 4 User’s guide,
page 48
Handout 4-4: Worksheet
for developing action
plans
ways to prevent unnecessary disease and
death.
• Review options for developing solutions to an
identified problem
Modules 4 and 6
Problem-solving guide
Brainstorming with staff, community repre
sentatives, and others
• Review what should be included in an action
plan once a viable solution is found.
• Refer participants to the example at the bot
tom of the page.
• Direct participants to complete the work
sheet for one action based on the analysis of
tables, charts, and maps in Session 4.
• Ask one or two participants to read their
example aloud and invite other participants to
comment on its appropriateness, clarity, and
feasibility for the stated analysis.
• Ask for questions and comments.
Module 4: FG; session 6
53
Session 6: Develop an action plan and present reports
(Steps 8 and 9)
III.
Prepare and present reports (30 minutes)
• Remind participants that although the data
Transparency 4-22:
reports™25 f°r preparin9
IV.
generated by the surveillance system proposed
in this module should address the concerns of
session objectives and of local PHC managers,
it should also be useful at other levels.
• Review the guidelines for preparing reports.
• Explain the importance of complete docu
mentation.
• Ask for questions or comments.
Next steps (15 minutes)
• Briefly summarise the steps in this module
and the outcomes of each step.
• Direct participants to review their completed
worksheets and write down the actions that
they need to take when they return to the job
to:
Complete the worksheets for objectives for
surveillance and for surveillance methods.
Develop data collection procedures.
Implement or improve surveillance of mor
bidity and mortality in their PHC programme.
• Ask each participant (or participant team) to
briefly describe the actions they will take when
they return to their jobs. (The format on Hand
out 4-4 is appropriate for this action plan).
Module 4: FG; session 6
54
Session 6: Develop an action plan and present reports
(Steps 8 and 9)
Conclusion (10 minutes)
Flip chart of
expectations from
Session 1
• Review the expectations participants ex
pressed at the beginning of the workshop and
ask them to assess informally how well they
think those expectations have been achieved.
If any were not achieved, ask how the work
shop could be improved to make that happen.
• Thank participants for their time and atten
tion, congratulate them on the effort they
put into the workshop, and wish them good
luck in implementing their plans.
Note: Indicate what follow-on assistance will be
available, if appropriate.
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Module 4: FG; session 6
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* SESSION 6: OBJECTIVE
51
Develop action plans to prevent
unnecessary disease and death
based on surveillance data
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Module 4: FG; session 6; transparency 4-20
56
ACTION PLAN
COMPONENTS
• WHAT
• WHO
• WHEN
Module 4: FG; session 6; transparency 4-21
57
GUIDELINES FOR
PREPARING REPORTS
• Review original objectives
• Review tables, charts, and maps
• Prepare a short explanatory of each
• Order them in logical sequence
• number of cases
• number of deaths
• number of trends
• Discuss major issues
• Summarise actions planned or taken
Module 4: FG; session 6; transparency 4-22
5R
WORKSHEET FOR DEVELOPING ACTION
PLANS
ACTION TO TAKE
RESPONSIBLE
DATES
OTHER
(What)
(Who)
(When)
(Where, how, resources)
Module 4: FG; session 6; handout 4-4
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PHC MAP MANAGEMENT COMMITTEE
EKT ~----------- -
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Dr. Ronald Wilson • Aga Khan Foundation, Switzerland (Co-Chair)
Dr. Jack Bryant • Aga Khan University, Pakistan (Co-Chair)
Dr. William Steeler • Secretariat of His Highness the Aga Khan, France (Co-Chair)
Dr. Jack Reynolds • Center for Human Services, USA (PHC MAP Director)
Dr. David Nicholas • Center for Human Services, USA
Dr. Duane Smith • Aga Khan Foundation, Switzerland
Dr. Pierre Claquin • Aga Khan Foundation, Switzerland
Mr. Aziz Currimbhoy • Aga Khan Health Service, Pakistan
Mr. Kabir Mitha • Aga Khan Health Service, India
Dr. Nizar Verjee • Aga Khan Health Service, Kenya
Ms. Khatidja Husein • Aga Khan University, Pakistan
Dr. Sadia Chowdhury • Aga Khan Community Health Programme, Bangladesh
Dr. Mizan Siddiqi • Aga Khan Community Health Programme, Bangladesh
Dr. Krasae Chanawongse • ASEAN Institute for Health Development, Thailand
Dr. Yawarat Porapakkham • ASEAN Institute for Health Development, Thailand
Dr. Jumroon Mikhanorn • Somboon Vacharotai Foundation, Thailand
Dr. Nirmala Murthy • Foundation for Research in Health Systems, India
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PHC MAP TECHNICAL ADVISORY COMMITTEE
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Dr. Nirmala Murthy • Foundation for Research in Health Systems, India (Chair)
Dr. Krasae Chanawongse • ASEAN Institute for Health Development, Thailand
Dr. Al Henn • African Medical and Research Foundation (AMREF), formerly of
the Harvard Institute for International Development
Dr. Siraj-ul Haque Mahmud • Ministry of Planning, Pakistan
Dr. Peter Tugwell • Faculty of Medicine, University of Ottawa, Canada
Dr. Dan Kaseje • Christian Medical Commission, Switzerland, formerly of the
University of Nairobi, Kenya
6
KEY PHC MAP STAFF AT THE CENTER FOR HUMAN SERVICES
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Dr. Jack Reynolds (PHC MAP Director)
Dr. Paul Richardson
Dr. David Nicholas
Dr. Wayne Stinson
Ms. Maria Francisco
Dr. Neeraj Kak
Ms. Lori DiPrete Brown
Ms. Pam Homan
Dr. Lynne Miller-Franco
Ms. Mary Millar
- Media
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