According to the CDC Guidelines, “stability refers to the reliability (i.e. the ability to collect, manage, and provide data properly without failure) and availability (the ability to be operational when it is needed) of the public health surveillance system. Unreliable and unavailable surveillance systems can delay or prevent necessary public health action98. The current national trachoma surveillance system consists of:
- personnel at the NTSRU (initially CERA and now MEGA);
- personnel that coordinate and/or undertake the screening;
- personnel that perform the data entry,
- a Microsoft Access database;
- technical/expert advisory group.
This biggest issue with the system is the collection of data on paper which could be misplaced or lost. Trachoma surveillance data are not normally entered into the system at the time of screening, rather they are entered by the regional trachoma surveillance coordinator on receipt of the data or on return to his/her office (in priority order of other commitments, therefore possibly months after the screening has occurred). Once the data are entered into the system it is sent via email to the jurisdictional health department for verification and then forwarded by email to the NTSRU (except in SA where it is sent directly from AHCSA to the NTSRU). Delays in the NTSRU receiving the data are due to tardy data entry by regional health staff or delays in jurisdictional health department staff reviewing the data.
The volume of data collected annually on trachoma surveillance activities is quite small compared to other surveillance systems (e.g. childhood immunisations, etc), so the amount of data collected and transferred to the NTSRU can be sent via email. The Access database is able to manage the volume of data and process it in a timely manner. Verification checks on the data can be quite lengthy but this is not due to inadequacy of the system rather untimely responses from those asked queries about the data. Once received, the surveillance data are stored in password protected files at CERA and now MEGA and are backed up daily as part of the routine back-up of the organisation’s systems.
According to the CDC guidelines a lack of dedicated resources might affect the stability of a public health surveillance system. The level of dedicated resources at the point of data collection varies between the jurisdictions. In WA, public health units are charged with coordinating and/or undertaking the surveillance activities and entering the data into the NTSRU access database. In NT the trachoma screening program is mostly integrated with the Health School Aged Kids (HSAK) screening program which is undertaken by the Maternity Child and Youth teams located in each regional centre. The HSAK teams coordinate and/or undertake the surveillance activities. The trachoma surveillance coordinator receives the paper forms from the HSAK teams and then enters the data into the NTSRU database. In SA the coordinator for the Eye Health & Chronic Disease Specialist Support Program coordinates and undertakes the surveillance activities and enters the data into the NTSRU access database. The evaluation has found that, due to a range of reasons, the jurisdictions receive differing levels of funding from different sources. In SA the entire surveillance activity is reliant on one person, hence the trachoma surveillance system is considered unstable.
In terms of the resources dedicated to receiving, analysing and reporting on the trachoma surveillance system, when CERA managed the NTSRU they had a dedicated project officer working full time on the surveillance system and at the time of data analysis and reporting (approximately six months of the year) assigned other staff to complete the work. Representatives of CERA advised that the fee proposed in their tender submission to manage the NTSRU was insufficient, in relation to staffing required, especially in the beginning when the system and processes were being established.
Findings: With respect to the use of the stability of the national surveillance system evaluation team finds:
- there are only small quantities of data involved in the current system, thereby simplifying the processes of data collection and reporting and the associated infrastructure; and
- the current system is considered to be stable in NT and WA but not in SA due to the fact that its operation in that State relies on only one person;
- the stability of the current system can be improved by ensuring that there are adequate resources allocated to the data collection and processing tasks.top of page
98CDC (2001) Updated Guidelines for Evaluating Public Health Surveillance Systems. Recommendations and Reports July 27, 2001/50(RR13);1-35