|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 2 | Page : 57-58
Role of surveillance in the strengthening of the public health care delivery system
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Chennai, Tamil Nadu, India
|Date of Web Publication||8-Dec-2014|
Saurabh R Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, 3rd Floor, Thiruporur-Guduvancherry Main Road, Ammapettai, Sembakkam, Kancheepuram - 603 108, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shrivastava SR, Shrivastava PS, Ramasamy J. Role of surveillance in the strengthening of the public health care delivery system. J Clin Sci 2014;11:57-8
|How to cite this URL:|
Shrivastava SR, Shrivastava PS, Ramasamy J. Role of surveillance in the strengthening of the public health care delivery system. J Clin Sci [serial online] 2014 [cited 2020 Apr 1];11:57-8. Available from: http://www.jcsjournal.org/text.asp?2014/11/2/57/146507
In the last few decades, the world has seen not only the emergence and reemergence of multiple infectious diseases but also a significant hike in the incidence of lifestyle disorders and other noncommunicable diseases.  In fact, a major proportion of the burden of these diseases has been observed in the developing countries (low- and middle-income countries), which indirectly reflects the inefficiency of the public health system to plan and implement sufficient measures that can counter the rising trend of these diseases.  Furthermore, to achieve such a goal, there is a crucial need for a comprehensive strategy, which in turn requires access to reliable, representative, complete, and timely health information obtained through a health surveillance system.  This complete health-/disease-related information will not only assist clinicians but also enable policy makers to identify the felt needs of the people, and thereby facilitate the process of taking evidence-based decisions and judicious allocation of resources. ,
Surveillance in this context has been defined as a continuous process of systematic collection, analysis, and interpretation of health-related data, which is of crucial importance to the planning, implementation, and evaluation of health services, along with the timely dissemination of such services to those who need to know.  Surveillance is a fundamental role of public health, which can assume multiple character and dimensions (viz., epidemiological/nutritional surveillance, etc.). , However, the main objectives of surveillance are to provide information about new and changing trends in the health status of a population (viz., morbidity, mortality, health indicators, environmental hazards, health practices, the prevalence of risk factors, and other factors that may affect health); to furnish feedback to assist in modifications of the health strategies; and to issue timely warnings of public health disasters so that interventions can be mobilized.  Although the process of surveillance was initially restricted to infectious diseases, in recent years the scope of surveillance has widened enormously (finds application in congenital malformations, cancer, chemical poisoning, injuries, illnesses after natural disasters, vaccination coverage, prevalence of drug-resistant organisms, etc.). ,,
Despite the availability of the confirmatory evidence regarding the utility of health-related information obtained from a surveillance system, the process of establishment of a surveillance system and monitoring its functioning is quite challenging.  The first and foremost challenge is the minimal level of coordination between the developers of the surveillance system and the decision makers, where very often the specific needs of decision makers are ignored.  In addition, other challenges like the use of inappropriate or different definitions/forms across different countries;  the need of a technical person to facilitate the professional analysis and sophisticated judgment of data;  no training sessions for the health care providers about the rationale of the system and its importance in improving the health of members of the community;  and the dependence on slow and outdated mechanisms (viz., paper-driven or no means of communication in remote areas); , eventually contribute to either underreporting or overreporting of observed cases.
To counter the challenges and improve the efficiency of the health surveillance system, it is of utmost importance that surveillance system should be flexible and tailor-made to local needs.  Furthermore, advocating the use of standardized definitions (for disease and its diagnostic criteria) and standardized reporting forms across different countries to enable international comparison,  organizing periodic training sessions for the workers to enable them to understand the importance of surveillance, , adopting multiple technologies like short message services/web-based disease surveillance to bring about an improvement in communication between various stakeholders (e.g., clinicians, epidemiologists, and decision makers) even in remote areas, ,, and encouraging the use of electronic health records and social media  has been recommended to improve the efficiency and reliability of the national health surveillance system. In addition, it has been proposed that disease events are automatically created on receiving a case or a laboratory report, and triaged in real time to state and local public health personnel without any human intervention to avoid any delay or human error. 
In conclusion, the health surveillance system can play an indispensable role in the strengthening of the public health care delivery system at the local, national, and global levels and in developing a comprehensive database of the health status of the general population.
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