Surveillance system integration: reporting the results of a global multicountry survey

Abstract

Objectives: Currently, there is no comprehensive picture of the global surveillance landscape. This survey examines the current state of surveillance systems, levels of integration, barriers and opportunities for the integration of surveillance systems at the country level, and the role of national public health institutes (NPHIs).

Study design: This was a cross-sectional survey of NPHIs.

Methods: A web-based survey questionnaire was disseminated to 110 NPHIs in 95 countries between July and August 2022. Data were descriptively analysed, stratified by World Health Organization region, World Bank Income Group, and self-reported Integrated Disease Surveillance (IDS) maturity status.

Results: Sixty-five NPHIs responded. Systems exist to monitor notifiable diseases and vaccination coverage, but less so for private, pharmaceutical, and food safety sectors. While Ministries of Health usually lead surveillance, in many countries, NPHIs are also involved. Most countries report having partially developed IDS. Surveillance data are frequently inaccessible to the lead public health agency and seldomly integrated into a national public health surveillance system. Common challenges to establishing IDS include information technology system issues, financial constraints, data sharing and ownership limitations, workforce capacity gaps, and data availability.

Conclusions: Public health surveillance systems across the globe, although built on similar principles, are at different levels of maturity but face similar developmental challenges. Leadership, ownership and governance, supporting legal mandates and regulations, as well as adherence to mandates, and enforcement of regulations are critical components of effective surveillance. In many countries, NPHIs play a significant role in integrated disease surveillance.

Keywords: Communicable disease control; Communicable diseases; Integrated disease surveillance; Population health surveillance; Surveillance.

Fig. 1.

Survey responses as a proportion of IANPHI member institutions* by World Bank income group and WHO region. *Does not include CARPHA, which is an IANPHI regional affiliate.

Fig. 2.

Relationship between reported IDS maturity and country income group.

Fig. 3.

Level of data integration (as a proportion of responses) of surveillance systems. In a limited number of cases, respondents indicated data were collected but insufficient information was provided to determine if data were accessible and/or integrated. In these events, the case has been classified as ‘collected but inaccessible’ as the most conservative degree of data integration based on response.

Fig. 4.

Barriers to integrated disease surveillance. In countries with either a developed or partially developed IDS system, these factors reflect challenges experienced in setting up and running the IDS system. In countries without an IDS system, these are factors that have prevented the establishment of an IDS system. Factors included governance (leadership, accountability, regulation, and enforcement); finance (inadequate investment, multiyear budget not available); data availability (requisite data not collected, not collected to a suitably high standard, or not shared by the organisations who are responsible for collecting that data); data sharing and ownership (lack of involvement, unclear roles and responsibilities, internal politics, unclear lines of reporting and accountability, territorialism, conflict/uncertainty re: intended use of data); IT systems (incompatible IT systems to migrate data, migration from paper to electronic format, suboptimal IT systems, data security, data protection); analysis and reporting (lack of statistical package, unavailability of big data analysis); laboratory (lack of testing capabilities, lack of multisectoral reporting, lack of provider reporting); and workforce capacity and capabilities (lack of multisectoral training, lack of analytical skills, lack of data collection skills).