AIDS Surveillance

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Unit 9 Evaluating a Public Health Surveillance
System
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Warm Up Questions Instructions

• Take five minutes now to try the Unit 9 warm up
  questions in your manual.
• Please do not compare answers with other
  participants.
• Your answers will not be collected or graded.
• We will review your answers at the end of the
  unit.

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What You Will Learn

• By the end of this unit you should be able to
• list tasks for evaluating a surveillance system
• develop a plan for evaluating your own countrys
  surveillance system

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Why Evaluate?

• Evaluation ensures that your HIV/AIDS
  surveillance system remains effective as the
  epidemic shifts over time.
• If your system is no longer effective, you will
  not have the right information to control
  HIV/AIDS.

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Purpose of Evaluation

• Appraise and prioritise the disease events to be
  kept under surveillance
• Assess how the system can detect and report these
  diseases
• Assess the quality of the epidemiologic
  information produced

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Purpose of Evaluation, Cont.

• Assess how the system can respond to these
  diseases
• Assess how surveillance results affect disease
  control and policy
• Identify which elements of the system can be
  enhanced in order to improve the quality of
  information

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Figure 9.1. Elements of an Evaluation
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Six Evaluation Tasks

• Engage the stakeholders in the evaluation.
• Describe the surveillance system to be evaluated.
  
• Focus the evaluation design.
• Gather credible evidence regarding the
  performance of the surveillance system.

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Six Evaluation Tasks, Cont.

• Justify and state conclusions and make
  recommendations.
• Ensure use of evaluation findings and share
  lessons learned.

For more detail, refer to the Updated Guidelines
for Evaluating Public Health Surveillance Systems
(Centers for Disease Control and Prevention,
2001), available at www.cdc.gov/mmwr/preview/mmwrh
tml/rr5013a1.htm
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Task 1 Engaging Stakeholders in the Evaluation

• Stakeholders include
• Public health practitioners
• Healthcare providers
• Data providers and users
• Community representatives
• Governments at the district, provincial and
  national levels
• Governmental, non-governmental, professional and
  private non-profit organisations

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Task 1 Engaging Stakeholders in the Evaluation,
Cont.

• Examples of ways to engage stakeholders include
• Hold a community meeting to discuss plans for the
  evaluation.
• Hold one-on-one meetings with the key people
  listed above.
• Invite participants to join the evaluation team.

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Class Discussion Task 1

• Task 1 is to engage stakeholders.
• Who would this be, in your case?
• Why is this task important?

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Task 2 Describe the Surveillance System to be
Evaluated

• The evaluation should describe
• The public health importance of the
  health-related event under surveillance
• The purpose and operation of the system
• The resources used to operate the system

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Class Discussion Task 2

• Task 2 is to describe the surveillance system.
• In your case, where would you find the type of
  information listed in the task?

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Task 3 Focus the Evaluation Design

• Determine the specific purpose of the evaluation.
• Identify stakeholders who will receive findings.
• Consider what to do with the information
  generated from the evaluation.
• Specify the questions that will be answered.
• Determine the standards for assessing the
  performance of the system.

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Class Discussion Task 3

• For task 3
• What are some ways you can think of to design an
  evaluation?
• How would you know what to evaluate?

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Task 4 Gather Credible Evidence Regarding the
Performance of the Surveillance System
Describe the surveillance system in terms of its

• Simplicity
• Flexibility
• Data quality
• Acceptability
• Positive predictive value

• Representativeness
• Timeliness
• Stability
• Data use/ dissemination

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Class Discussion Task 4

• Task 4 concerns gathering data.
• Should there be a time limit on gathering data?
• What would you do if you found that some clinics
  didnt have data or had incomplete data?

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Task 5 State Conclusions and Make Recommendations

• Conclusions can be justified through appropriate
  analysis, synthesis, interpretation and judgment
  of the gathered evidence.
• Recommendations should address modifications and
  continuations of the public health surveillance
  system.

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Class Discussion Task 5

• In task 5, you are asked to make recommendations.
• How is this typically done in your district or
  region?

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Task 6 Ensure Use of Findings and Share Lessons
Learned

• Develop strategies for communicating the findings
  from the evaluation.
• Tailor recommendations to relevant audiences.
• Recommendations for improvements should be
  distributed to all partners and sites involved in
  sentinel surveillance.

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Class Discussion Task 6

• Task 6 concerns communications.
• How would you decide whom to send your final
  report to?
• In your case, would the report go to subject
  matter experts, perhaps Ministry of Health
  HIV/AIDS experts?
• If not, how could you make sure that the people
  reading the report would understand what you were
  saying?

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In Summary

• Evaluating your HIV/AIDS surveillance system is
  important, to ensure that remains effective as
  the epidemic changes over time.
• The tasks that you should implement during this
  evaluation include
• engaging stakeholders
• describing the surveillance system
• focusing the evaluation design
• gathering evidence on the systems performance
• stating conclusions and recommendations
• sharing the lessons learned

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Warm Up Review

• Take a few minutes now to look back at your
  answers to the warm up questions at the beginning
  of the unit.
• Make any changes you want to.
• We will discuss the questions and answers in a
  few minutes.

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Answers to Warm Up Questions

• 1. List three stakeholder groups that should be
  engaged during the evaluation of the surveillance
  system.

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Answers to Warm Up Questions

• 1. List three stakeholder groups that should be
  engaged during the evaluation of the surveillance
  system.
• public health practitioners
• healthcare providers
• government officials
• representatives of affected communities
• non-profit and donor organizations
• etc.

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Answers to Warm Up Questions, Cont.

• 2. If there is a high probability that cases
  identified by the surveillance system are
  actually cases of HIV infection, the system is
  said to have high
• a. sensitivity
• b. representativeness
• c. acceptability
• d. positive predictive value

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Answers to Warm Up Questions, Cont.

• 2. If there is a high probability that cases
  identified by the surveillance system are
  actually cases of HIV infection, the system is
  said to have high
• a. sensitivity
• b. representativeness
• c. acceptability
• d. positive predictive value

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Small Group Discussion Instructions

• Get into small groups to discuss these questions.
  
• Choose a speaker for your group who will report
  back to the class.

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Small Group Reports

• Select one member from your group to present your
  answers.
• Discuss with the rest of the class.

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Case Study Instructions

• Try this case study individually.
• Well discuss the answers in class.

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Case Study Review

• Follow along as we go over the case study in
  class.
• Discuss your answers with the rest of the class.

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Questions, Process Check

• Do you have any questions on the information we
  just covered?
• Are you happy with how we worked on Unit 9?
• Do you want to try something different that will
  help the group?

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