Assessment of Factors Affecting the Implementation of the Integrated Disease Surveillance and Response in Public Health Care Facilities - The Case of Rufunsa District, Zambia

Abstract

Late reporting of disease outbreaks and other health related events of public health significance have been linked to poor implementation of the Integrated Disease Surveillance and Response (IDSR). As such strengthening the capacity of health workers involved in IDSR implementation is required. The main objective of this study was to assess the factors affecting the implementation of the IDSR in public health care facilities in Rufunsa District, Zambia. A cross-sectional facility based descriptive study design as well as observation was done in which 34 study subjects were conveniently sampled from the 9 health facilities in the district. Data collection was done using a pretested semi structured questionnaire and an institutional-tailored observational checklist. Analyses were done using SPSS version18. The study revealed that factors that affected the implementation of the IDSR were low knowledge levels among Health Workers about IDSR as only 36.3% of them received training in IDSR in the last 12 months at the time of this study. Other factors that created gaps in the implementation of IDSR were negative attitudes of the health workers as 9.0% of them were of the opinion that the IDSR system wasted much of their time, as its implementation interfered with their clinical work and about 51.5% were demoralised as they felt that support from the managers at the District, Province and Ministry of Health Headquarters was inadequate. Poor practices of health workers towards IDSR was also identified as a factor affecting IDSR Implementation. For instance, it was revealed that about 27.3% of the health workers either infrequently or never reported a disease which required mandatory reporting in the last 12 months as they stated that the process of reporting was cumbersome as the forms were too many and complicated. They further echoed that IDSR implementation lacked prompt feedback from the Managers at the District. Resource-wise, all facilities in the district lacked adequate resources for IDSR implementation. For example between 11.1 to 44.4% of the health facilities lacked one or more types of reporting forms. Other resources lacking were electricity, and good network connectivity since about 51.5% relied on mobile phones for sending reports which required prompt feedback. Therefore, to ensure effective IDSR implementation, adequate funding directed to the strengthening of IDSR activities should be deliberately put in the budget's yellow book. Regular IDSR trainings are to be offered to health workers which should be followed by mentorship and supervision by the District and Provincial Health Offices as well as the Ministry of Health.