2005年-世界发展银行全球_Pakistans_Public_Health_Surveillance_System___A_Call_to_Action_110页_7mb

Pakistan's Public Health Surveillance System: A Call to Action Summary

Core Content

This report presents a joint assessment of Pakistan's public health surveillance system, conducted by the Ministry of Health, the Government of Pakistan, the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the World Bank between 2004 and 2005. The assessment focuses on three key areas: communicable disease surveillance, vital registration/statistics and maternal and child health (MCH) surveillance, and non-communicable disease (NCD) and behavioral risk factor surveillance. The goal is to identify strengths, gaps, and recommendations for improving the system to support disease prevention, control, and the achievement of health-related Millennium Development Goals (MDGs).

Main Findings and Recommendations

Communicable Disease Surveillance

• Current Status:

  • The AFP/polio surveillance system is well-functioning and has contributed significantly to reducing polio incidence.
  • However, the system is fragmented and lacks integration with other health programs.
  • There is a need for a unified surveillance system that includes all priority diseases.

• Key Recommendations:

  • Establish discrete surveillance units at federal, provincial, and district levels, distinct from the Health Management Information System (HMIS).
  • Develop a legal framework that mandates disease reporting and defines responsibilities at all administrative levels.
  • Transition the AFP/polio system into the mainstream of the health system to ensure its sustainability and expansion to other diseases.
  • Integrate surveillance activities across programs to improve efficiency and reduce workload.
  • Promote resource sharing among programs to enhance data collection, analysis, and reporting.
  • Build the capacity of health workers in applied epidemiology, outbreak response, public health informatics, and lab diagnostics.
  • Develop a public health laboratory network (PHLN) to support disease monitoring and outbreak response, with clear standards, guidelines, and communication protocols.

Vital Registration / Statistics and MCH Surveillance

• Current Status:

  • Vital registration in Pakistan is at very low levels, with only 80% coverage estimated over 3–5 years.
  • The system is primarily managed by the National Database and Registration Authority (NADRA), with pilot programs in Lahore and Sialkot.
  • MCH programs such as the Lady Health Workers (LHW) and HMIS are in place but lack integration and comprehensive data.

• Key Recommendations:

  • Develop a long-term 10-year plan to create a complete vital registration and statistics system.
  • Strengthen birth and death reporting through MCH programs, including LHW-MIS, HMIS, hospitals, and the private sector.
  • Implement a SAVVY (Sample Vital Registration and Verbal Autopsy) system to provide cause-specific mortality estimates and risk factor data.
  • Standardize birth and death certificates using WHO recommendations to improve data quality and utility.
  • Expand verbal autopsy systems to include additional information on maternal and infant deaths for better policy development and intervention planning.

NCD and Behavioral Risk Factor Surveillance

• Current Status:

  • A National Action Plan (NAP) for NCDs and behavioral risk factors exists, but implementation is slow.
  • There is a lack of standardized information systems and data collection tools for NCDs and risk factors.

• Key Recommendations:

  • Implement the NCD National Action Plan with a phased approach.
  • Develop comprehensive information systems at the district level to support NCD surveillance.
  • Enhance human resources, infrastructure, and capacity for NCD prevention and control.
  • Conduct surveys on NCD risk factors to guide policy and intervention strategies.

Key Issues and Next Steps

Major Public Health Surveillance Issues in Pakistan

• Fragmented systems leading to inefficiencies.
• Lack of integration between different surveillance components.
• Insufficient legal and regulatory frameworks for disease reporting.
• Limited resources and funding for surveillance activities.
• Weak data utilization and feedback mechanisms.
• Poor coordination between public and private sectors.
• Inadequate laboratory capacity and diagnostic support.

Steps to Establish an Effective System

• Develop a minimum package for surveillance over the next five years.
• Implement a stepwise approach to build and integrate the surveillance system.
• Ensure sustainable financing through collaboration with federal and provincial governments.
• Strengthen information and communication infrastructure to support modern surveillance.
• Promote capacity building for health workers and surveillance units.
• Ensure data sharing and interoperability between different data sources and systems.

Conclusion

An effective public health surveillance system is essential for disease prevention, control, and the achievement of health-related MDGs in Pakistan. The AFP/polio system serves as a model for success, but broader integration, standardization, and resource sharing are needed to support a comprehensive, functional, and sustainable system. The report emphasizes the importance of a unified surveillance framework, legal mandates, and capacity development in improving public health outcomes.