Training report on National Early Warning Alert and Response

Surveillance

Background:

Prior to 2009, the Ministry of Health had no systematic notifiable disease surveillance

system for infectious diseases. After 2009 Annual Health Conference, the Ministry of

Health entrusted the Public Health Laboratory to institute notifiable disease surveillance

system on priority diseases of national concern. In 2010, the Public Health Laboratory

developed first edition of national notifiable disease surveillance guideline. However,

due to changes in disease pattern and operational problem faced in implementing the

previous surveillance guideline, the list of national notifiable disease surveillance

guideline has been revised in 2014 to reinforce and strengthen the existing disease

surveillance system. The revised guideline also included an event-based surveillance

(EBS) to complement and supplement the indicator based notifiable diseases

surveillance which is also one of the IHR requirements. Since various acute syndromes

were incorporated in the revised list of notifiable diseases and also an even based

surveillance, the name of the current revised guideline has been changed to “National

Early Warning Alert and Response Surveillance (NEWARS)”.

Figure 1: Notifiable disease surveillance guidelines

Notifiable diseases surveillance being a national disease surveillance system for rapid

response, there was a need to develop web based system for real time reporting from

the health centers. The web based reporting system was developed and introduced by

PHL in 2012. However, due to limited internet accessibility in the districts, the web

based reporting was accessible only up to district health office and hospitals. Therefore,

this has not materialized the real time reporting problem from the health centers in the

communities because conventional reporting system require health centers to report to

their respective district health offices and then district health offices report to PHL in the

web based system on behalf of health centers which further delay reporting.

To address the reporting problem in all health centers and most importantly to get real

time events reporting from the field with incorporation of event based surveillance, PHL

has redesigned existing web based reporting system as per the revised guideline and

developed in-house mobile SMS reporting system because mobile network coverage is

very high in the country. The in-house developed web based and mobile SMS reporting

system was also piloted successful in few health centers and was ready for

implementation in 2014. However, due to lack of fund support to train health

professionals, PHL could not introduce the web based and mobile SMS reporting

system.

Overall Objectives:

To operationalize “National Early Warning Alert and Response Surveillance” guideline

and introduce re-designed web based and mobile SMS reporting system developed to

strengthen the existing notifiable disease surveillance system in the country.

Specific Objectives:

1. To train health professionals/workers on revised national notifiable disease

surveillance guideline “NEWARS”

2. To train heath professional/workers on online real time reporting application

developed: Web based and Mobile SMS based on NEWARS guideline.

3. Provide hands on training and simulation of Web based and Mobile SMS

reporting system.

Expected Outcome of the training:

1. Health professionals/workers are thorough with “NEWARS” guideline and reporting

system.

2. Implement the NEWARS guideline and start reporting immediately after the training

using either web based or mobile SMS platform.

3. Trained health professionals/workers to facilitate in sensitizing/training other health

workers, Village Health Workers, and counterpart from other relevant stakeholders

including general public on event reporting.

1st batch (Mongar and Lhuntse districts) 2nd batch (Trashigang and Trashiyangtse districts)

3rd batch (Bumthang, Trognsa and Zhemgang districts) 4th batch (Punakha, Gasa and Wangdi districts)

5th batch (Thimphu, Haa and Paro districts) 6th batch (Tsirang, Dagana, & Sarpang districts)

7th batch (Chukha and Samtse districts) 8th batch (Pemagatshel and SamdrupJongkar districts)

Training Outcome:

1. Trained health professional/workers National Early Warning Alert Response

Surveillance (NEWARS) guideline.

2. Trained health professional/workers from 228 hospitals and BHU’s on web

based and mobile SMS reporting system.

3. Hospitals and BHU’s started NEWARS reporting web based and mobile SMS

reporting system.

4. Strengthened real time reporting of national notifiable diseases/syndromes and

events.

Recommendation:

1. All health centers proposed for roll out of NEWARS training for other health

workers.

2. Health centers recommended PHL to develop register for documentation of

weekly reporting based on NEWARS guideline.

3. Most health professionals/workers had concern on double reporting for some

diseases or syndromes because of case referral. To minimize/avoid double

reporting, health professionals/workers recommended to include provision in the

system to reflect referral cases.

4. Recommended to include of death in the event reporting system since death is

possible during events.

5. To facilitate data collection for list of notifiable diseases/syndromes, health

professionals/workers from hospitals recommended PHL to developed seal for

list of notifiable diseases/syndromes and distribute to hospitals which can be kept

at reception and use it on prescription when patients comes for registration in the

hospital.

6. Health professionals/workers recommended to develop clinical training module

for list of notifiable diseases/syndromes and conduct training, because the data

collection and reporting need to be done based on clinical diagnosis and health

professionals/workers need proper training for consistency diagnosis and

reporting.

7. Severe dengue to be removed from list of notifiable diseases/syndromes to avoid

confusion and double reporting with dengue fever.

8. Include mumps in the list of notifiable diseases/syndromes since mumps cannot

fit under any list of notifiable diseases/syndromes for reporting.

9. Scrub typhus is now known to be endemic in most places in the country and

reporting under fever with rash syndromes would lead to under reporting of

scrub typhus and other ricketssial diseases. Therefore, health

professionals/workers recommended to add Ricketssial disease as one of the

notifiable diseases/syndromes list.

10. The health centers recommended in discontinuing the existing ARI reporting to

ARI/CDD program after health centers start reporting in the PHL reporting

system because ARI and SARI are syndromes to be reported as per the revised

list of notifiable diseases/syndromes.

Resolution:

1. Except three referral hospitals, all health centers to immediately implement

NEWARS guideline and start reporting in web based and mobile SMS reporting

platform.

2. PHL will recharge money incurred for SMS texting from private mobile number to

PHL reporting system every year because there is no technology with both

mobile service providers to provide SMS service on lease line.

3. Trained health professionals/workers to facilitate in training of health

professionals/workers on reporting system and their registration with PHL.