According to the CDC guidelines, “a flexible public health system can adapt to changing information needs, or operating conditions with little additional time, personnel, or allocated funds .” In the current context, the review of the trachoma surveillance system is contributing towards the flexibility of the system. Other dimensions of flexibility are the ability of the system to respond to new demands for information (i.e. different statistics or performance measures), and/or the integration of information from the system with other information sources to achieve a fuller picture of the ‘at risk’ population and other associated public health issues faced by the population (such as environmental factors).

The CDC guidelines point out that a limitation in assessing flexibility is that it can usually only be tested retrospectively, that is, when a new demand of the current system emerges. The new demand on the system is the ability to accurately measure the extent of trachoma and monitor efforts in reducing its prevalence. Although the aggregate level of reporting trachoma information has generally been supported by stakeholders, aggregate data poses a major limitation for alternative statistics to be drawn from the system, such as those related to a different age group in terms of the school-based screening. Another limitation of the system, which has already been discussed, is the ability to generate reports that are useful in monitoring the effectiveness of trachoma control programs, especially at the local level.

Flexibility would be greatly improved by the reporting of person-level trachoma surveillance data to the NTSRU. Apart from enhancing flexibility, it may also enhance data quality and simplicity in instances where data are already collected and entered into local systems at person-level (and then manipulated to fit the aggregate reporting structure). Additionally, person-level data would allow information to be captured on re-infection rates of individuals with trachoma. The evaluators are aware that some stakeholders believe that collection and reporting of data at person-level is not required and would not add value to current surveillance reports. On balance, notwithstanding the advantages, the evaluators consider that person level reporting to the national surveillance system is not necessary, although local person-level data collection should be considered in any enhancements of the systems supporting the collection and transfer of information to the NTSRU.

Findings: With respect to the flexibility component of the current national trachoma surveillance system, the evaluation team finds:

  • flexibility of the current ‘system’ cannot easily be measured, however, the current system is inflexible in terms of obtaining statistics on trachoma prevalence and control activities, other than a limited set of tables; and
  • the system can be enhanced by:
        • exploration of collection of data at person level;
        • creation of a capacity to retrieve flexible user defined reports from the NTSRU access database (or its replacement), immediately following data entry; and
        • this capacity needs to be supplemented with adequate training on how to use the Access database, perhaps by developing a user of page

          85CDC (2001) Updated Guidelines for Evaluating Public Health Surveillance Systems. Recommendations and Reports July 27, 2001/50(RR13);1-35