INTEGRATED DISEASE SURVEILLANCE PROJECT 12 TRAINING MANUAL FOR STATE & DISTRICT SURVEILLANCE OFFICERS INTRA AND INTER-SECTORAL COORDINATION AND SOCIAL MOBILIZATION Module -12 233
CONTENTS 1. Introduction 235 2. Specific Instructional Objectives 235 3. Format of the Training Session at a Glance 235 4. Key Points to Remember 236 5. Group Activities 236 6. Frequently Asked Questions 238 7. Handout on Intra and Inter-sectoral Co-Ordination and 238 Social Mobilisation 8. Evaluation Questions 241 234
1. INTRODUCTION Integration of surveillance activities of various health Programmes is one of the primary objectives of IDSP. To achieve this various departments of health and non-health in the government will need to share information generated by the surveillance mechanisms. At the grass root level the same people are doing the surveillance for various agencies. However from district level onwards the information goes through various channels. Through IDSP there should be effective sharing of information on surveillance to all stakeholders both of health department and of other governmental and nongovernmental agencies. People participation in surveillance activities is bought about by bringing in school teachers, village leaders and panchayat members in the surveillance related work and sharing the information at the grass root with these partners. The District surveillance officer and medical officers of CHC and PHC play an important part in this activity. 2. SPECIFIC INSTRUCTIONAL OBJECTIVES At the end of the session, the Participant will be able to successfully 1) List sectors, departments and agencies operating in the district which to work together for success of IDSP in your district. i. Government Health Non-Health ii. Private / NGO Health Non-Health 2) Describe and define the institutional mechanisms already existing and those to be developed for ensuring intersectoral and intrasectoral coordination at district level. 3) Describe the strategies and action plan for mobilizing community participation in IDSP. 4) Describe activities related to data collection, consolidation, analysis and dissemination of information related to existing vertical disease control Programmes at the district level to facilitate integration under IDSP. 3. FORMAT OF THE TRAINING SESSION AT A GLANCE DURATION OF SESSION 235 2 HOURS UNIT NO CONTENT METHODOLOGY TENTATIVE TEACHING AIDS DURATION 1. Intersectoral Lecture followed by 20 Minutes Training modules/ Coordination Module reading 10 Minutes Multimedia Projector/ Module Discussion 30 Minutes overhead projector 2. Intersectoral Group Activity 60 Minutes Training Modules Coordination Exercises Module
4. KEY POINTS TO REMEMBER IDSP is a new initiative. The purpose of IDSP is to make integration and coordination within and between the different departments a reality. The philosophy of IDSP is coordinating all the surveillance activities under the DSO (integrating between private and public, Medical college and Health services rural and urban, the services for NCD and Communicable disease prevention). Inter-sectoral coordination is perhaps the biggest challenge in the implementation of IDSP and the sustainability of the whole Programme depends on the extent of achievement of inter-sectoral and intra-sectoral coordination. The sustainability of the Programme need continued efforts for social mobilization. People s participation is the key factor for complete coverage of the Programme and also for timely reporting of the exact health events happening in the community. Integrated and coordinated surveillance will help for effective pooling and sharing of resources, avoid resource wastage and is expected to improve the efficiency, quality and sustainability of the Programme. Every effort should be made by MO/DSO to bring up the burning issues such as non-action/non-reporting in the IDCC (Interdepartmental coordination committee) and the MO/DSO should highlight the results (positive and negative factors) undertaken taken by various departments This should be combined with various vertical Programme persons and also state level officers and other relevant state departments. In view of the fact that coordination needs leadership qualities, effective communication and resource availability, the commitment of the key person in the district Viz. the DSO/MO will be critical for the success of the Programme. 5. GROUP ACTIVITIES 1. Identify and list the various agencies and stakeholders involved in IDSP in your district. Describe the specific role functions of these stakeholders. 2. Discuss the dynamics of their interactions for IDSP and identify the key constraints (administrative, social/cultural, ethical/legal, Financial, geographic or access, personal attributes like age difference, ego problems), which can act as barriers for effective inter-sectoral/ intra-sectoral coordination for IDSP. 3. Carefully learn the following organogram locate the barriers and constraints operating at each point and identify the strategies for effective inter-sectoral and intra-sectoral coordination. 236
ORGANOGRAM FOR DISTRICT District Programme Manager Polio, Malaria, TB, HIV - AIDS CMO (Co. Chair) Water Board Chief District PH Laboratory Superintendent Of Police District Data Manager (IDSP) Pollution Board Chairperson* District Surveillance Committee IMA NGO District Training Officer (IDSP) District Panchayat Chairperson District Surveillance Officer (Member Secretary) Medical College if any * District Collector or District Magistrate Exercises Group activity 1: (4 persons: 20 minutes) A mock coordination meeting with collector, DMO, DSO & CHC MO Scenario 1: DSO describes the scenario of considerable under reporting of cases from an area as a presents a burning issue Everybody needs to react by creative comments. Evolve a strategy to solve this issue and will not happen again Scenario 2: There are serious deficiencies in the form of poor budget allocation in the District plan for POL Chalk out the strategies for alternate means of resource mobilization Group activity 2: (4 persons: 20 minutes) Social mobilization and community participation Identification of People participation groups in the district for involvement in IDSP activities 237
Identification of steps and strategies for getting to people thorough religious leaders, using public announcements etc. Group Activity-3 An outbreak of fever suddenly started in one of the urban slums in your district. What mechanisms have been put in place to facilitate coordination of various stakeholders for successful surveillance? Identify the challenges and opportunities for intrasectoral and intersectoral coordination in IDSP. 6. FREQUENTLY ASKED QUESTIONS 1) Who all can be identified as community stakeholders? Anybody who can provide information on the possible occurrence of the diseases included in the IDSP Programme will be a community stakeholder. For example it could be a school teacher or informal community leader etc. The participants could enumerate other possible community stakeholders. 2) At what level non-health department can be involved in IDSP? This could be decided based on the different diseases and different regions. Example could be discussed in the group activity. 7. HANDOUT ON INTRA AND INTER-SECTORAL COORDINATION & SOCIAL MOBILIZATION 7.1 Social Mobilization and Community Participation Disease surveillance cannot be sustained unless the community stakeholders support the data collection and the health system recognizes them as true partners. Therefore, a well-planned social mobilization strategy will have to be put in place to obtain valid and reliable data with high sensitivity. Involvement of community In areas where health workers enjoy a good relationship with their communities, people come forward and volunteer the desired information. Several health workers are in regular contact with village elders particularly ladies, pradhan, panchayat members, chauwkidar and other community members who tell them about the occurrence of diseases. Current efforts are based on individual initiative taken by some enthusiastic health staff. The community members, press, and local leadership often give information about epidemics. There are rumours registers kept in PHCs and sub-centers. Thus community is already contributing significantly in the current efforts of disease surveillance and detection of outbreaks. 238
Socio-cultural issues to be taken up for social mobilization campaign There are several socio-cultural barriers prevailing in the communities across the country that influence the sensitivity of data collected for surveillance activities. Social mobilization campaign in IDSP will need to address all diseases associated with socio-cultural beliefs. Stakeholder who can be involved All those individuals and organizations that operate as an interface between the health system and the community will be identified as community stakeholders. The stakeholders will be involved proactively during the planning and implementation phase of IDSP. To meet these objectives, the stakeholders will be made members of the district surveillance and block surveillance committee in rotation basis. Social mobilization strategies: The aim of the social mobilization campaign under the IDSP will be: To create awareness among the partners, notably the private practitioners, NGOs and the community about existing health Programmes, IDSP, the potential benefits, areas in which their participation will be solicited To establish an institutional mechanism to involve community and their leaders Develop a system of providing regular feedback to the community about disease occurrence, the responses to surveillance and impact of disease control Programmes IEC must address all the issues that are likely to improve the sensitivity of the surveillance data, particularly the prevalent socio-cultural beliefs and gender disparities To increase the reach of the campaign, all channels of communication are to be used; these will include electronic media, press, hoardings, handbills, posters, and inter-personal communication through health providers at all levels Content and messages of the campaign targeted at health workers and private practitioners will be different from that meant for the community, panchayat members, local influential persons and NGOs. Whenever a community stakeholder contributes significantly to disease surveillance activities, a small function or meeting of the district surveillance committee could be convened and the stakeholder s contribution recognised in the meeting. This is expected to help to boost the morale of the community stakeholders. Similar sitespecific methods could be adopted at different sites. 7.2 Feedback and sharing information for effective intersectoral and intrasectoral coordination: Sharing of information with all stakeholders for effective public health action is the primary purpose of the IDSP. Regular reports generated by the district surveillance unit will be shared with all the stakeholders of the Programme at the district level and 239
all reports generated by the state surveillance unit will be shared by the stakeholders at the state level. The reports will be available through Internet / intranet services which can be obtained by dial up services to the district surveillance unit and through the IDSP network at the district level. The stakeholders include: Periphery District State Medical officer of PHCs, Sentinel Private Practitioners, Community representatives etc. All members of the district surveillance unit All members of the state surveillance unit In addition the State Surveillance Officer will publish a monthly surveillance bulletin. The state surveillance unit may contract private agencies to do this work. 7.3 Involvement of medical colleges We need better coordination between the medical colleges and the district health authorities. Diseases presented at medical colleges are not usually reported to surveillance officers due to communication gaps. In IDSP, a defined role for all the medical colleges of the country is being proposed. (Refer operational manual for details) The participation of medical colleges will not only help IDSP activities as outlined above but, also help the institutions in the teaching and training of medical and paramedical undergraduates and postgraduate students and in operational research in surveillance related issues. This would give students an opportunity to have hands on experience in surveillance while under training for the first time in the country, as they are the future health care providers and managers of the various Programmes. This would mean sustainability on a long-term basis for the IDSP Programme. 7.4 Mechanisms for Inter sectoral co-ordination in disease Surveillance The mechanisms for inter sectoral and intra-sectoral co-ordination in order to achieve effective disease surveillance is likely to be different for specific diseases as well as in different situations. An outbreak of jaundice could be an example to discuss this activity. The departments involved apart from health are: Water supply and sanitation, Media for IEC activities, veterinary dept. local bodies and NGOs working in the area. In the health dept itself, lab facilities to identify the cause of the jaundice, vaccination Programmes, rapid response team activity, management of the patients in hospitals will have to work together as a team to provide data on the extent and impact of the outbreak for the policy makers and the public. 240
8. EVALUATION QUESTIONS 1. List the stakeholders that need to work together for the successful IDSP in your district Governmental. Health Non Health Non-Governmental Health Non Health 2. What are the activities specified in IDSP to sustain effective surveillance of diseases by Community leaders Medical Colleges One other governmental dept 3. What mechanisms have been put in place to coordination of surveillance activities of various vertical health Programmes in IDSP (e.g.- Malaria, AFP, RNTCP)? 241