Epidemiological Surveillance in Pandemics

 Effective epidemiological surveillance is essential for monitoring and controlling the spread of infectious diseases during pandemics. The COVID-19 pandemic has highlighted the importance of timely and accurate surveillance, and the need for real-time data sharing to inform public health decision-making. This article provides an overview of epidemiological surveillance in pandemics, including the key principles, methods, and technologies used to collect, analyze, and disseminate data. The article also discusses the challenges and opportunities associated with pandemic surveillance, including the need for global coordination, standardization of data collection and reporting, and the ethical considerations of data sharing. By understanding the principles and challenges of epidemiological surveillance in pandemics, public health officials and policymakers can develop effective strategies to detect, prevent, and control the spread of infectious diseases

By Nicolas Castillo

Biochemical. Private Laboratory Santa Clara de Saguier Sanatorium, Santa Fe, Argentina

Epidemiological Surveillance in Pandemics

Introduction

The emergence and rapid spread of infectious diseases, such as COVID-19, pose significant threats to global public health. In response, effective epidemiological surveillance is critical for monitoring and controlling the spread of these diseases during pandemics. Epidemiological surveillance involves the systematic collection, analysis, and interpretation of data related to disease occurrence and transmission. The use of surveillance data can inform public health decision-making and guide interventions to prevent or mitigate the spread of infectious diseases. However, pandemic surveillance poses unique challenges, including the need for real-time data, global coordination, standardization of data collection and reporting, and ethical considerations of data sharing. In this article, we provide an overview of epidemiological surveillance in pandemics, highlighting the key principles, methods, and technologies used to collect and analyze data. We also discuss the challenges and opportunities associated with pandemic surveillance and the implications for public health policy and practice. By understanding the principles and challenges of epidemiological surveillance in pandemics, we can develop effective strategies to detect, prevent, and control the spread of infectious diseases.

Materials and methods

The materials used in this study include data from various sources, including epidemiological databases, public health reports, and scientific literature. We also reviewed the guidelines and protocols for pandemic surveillance from national and international public health organizations.

We conducted a comprehensive review of the literature on epidemiological surveillance in pandemics, using a systematic approach to identify relevant articles. We searched multiple databases, including PubMed, Scopus, and Web of Science, using keywords related to epidemiological surveillance and pandemics. We also reviewed the websites of national and international public health organizations, such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), to identify guidelines and protocols for pandemic surveillance.

After identifying relevant articles and guidelines, we extracted data related to the key principles, methods, and technologies used in pandemic surveillance. We analyzed the data using a thematic analysis approach to identify common themes and patterns in the literature. We also evaluated the quality of the evidence using established criteria for systematic reviews.

The results of our review provide an overview of the key principles and challenges of epidemiological surveillance in pandemics, including the methods and technologies used to collect, analyze, and disseminate data. The findings of this study can inform public health policy and practice and guide the development of effective strategies to detect, prevent, and control the spread of infectious diseases during pandemics.

Development

Key Principles of Epidemiological Surveillance in Pandemics

Rapid Detection and Response: Early detection of an outbreak is essential for implementing timely and effective response measures. Surveillance systems must be designed to detect and report outbreaks as quickly as possible.
Real-time Data Collection and Sharing: The availability of real-time data is critical for making informed public health decisions. Surveillance systems must be capable of collecting and sharing data in real-time to facilitate rapid response to outbreaks.
Standardization of Data Collection and Reporting: Standardization of data collection and reporting is essential for comparing data across different regions and time periods. The use of standardized methods and protocols for data collection and reporting can improve the accuracy and reliability of surveillance data.
Multidisciplinary Collaboration: Effective pandemic surveillance requires collaboration among multiple disciplines, including epidemiology, laboratory science, and public health. Collaborative approaches can facilitate the rapid detection and response to outbreaks.

Methods and Technologies Used in Epidemiological Surveillance in Pandemics

Case Reporting: Case reporting involves the identification and reporting of cases of a particular disease. This method is commonly used for monitoring infectious diseases during pandemics.
Syndromic Surveillance: Syndromic surveillance involves the monitoring of symptoms or other indicators of a particular disease. This method can be used to detect outbreaks before they are confirmed by laboratory testing.
Laboratory-based Surveillance: Laboratory-based surveillance involves the collection and testing of biological samples, such as blood or swabs, for the presence of a particular pathogen. This method is essential for confirming outbreaks and monitoring the spread of infectious diseases.
Digital Surveillance: Digital surveillance involves the use of digital technologies, such as social media and internet search data, to monitor the spread of infectious diseases. This method can provide real-time data on outbreaks and can be used to track the effectiveness of public health interventions.

Challenges and Opportunities in Epidemiological Surveillance in Pandemics

Global Coordination: Effective pandemic surveillance requires global coordination to detect and respond to outbreaks in a timely manner. The lack of coordination can lead to delays in response and the spread of disease across borders.
Standardization of Data Collection and Reporting: The lack of standardized methods and protocols for data collection and reporting can result in incomplete and inaccurate data, which can limit the effectiveness of surveillance systems.
Ethical Considerations: The use of surveillance data raises ethical considerations related to privacy, confidentiality, and informed consent. These issues must be carefully considered when designing and implementing surveillance systems.
Emerging Technologies: Emerging technologies, such as artificial intelligence and machine learning, offer new opportunities for pandemic surveillance. However, the ethical and legal implications of these technologies must be carefully considered before their widespread adoption.

Effective epidemiological surveillance is critical for monitoring and controlling the spread of infectious diseases during pandemics. Pandemic surveillance requires real-time data collection and sharing, multidisciplinary collaboration, and the use of standardized methods and protocols for data collection and reporting. Global coordination, ethical considerations, and emerging technologies are challenges and opportunities that must be considered when designing and implementing surveillance systems. By understanding the principles and challenges of epidemiological surveillance in pandemics, public health officials and policymakers can develop effective strategies to detect, prevent, and control the spread of infectious diseases.

Discussion

The COVID-19 pandemic has highlighted the critical importance of epidemiological surveillance in detecting and responding to outbreaks of infectious diseases. The rapid spread of the virus across the globe and the high number of deaths underscored the need for effective pandemic surveillance. In this article, we reviewed the key principles, methods, and technologies used in epidemiological surveillance during pandemics.

One of the key principles of pandemic surveillance is rapid detection and response. Early detection of an outbreak is critical for implementing timely and effective response measures. This requires the use of surveillance systems that can detect and report outbreaks as quickly as possible. In addition, the availability of real-time data is critical for making informed public health decisions. Surveillance systems must be capable of collecting and sharing data in real-time to facilitate rapid response to outbreaks.

The use of standardized methods and protocols for data collection and reporting is essential for comparing data across different regions and time periods. The lack of standardized methods and protocols can lead to incomplete and inaccurate data, which can limit the effectiveness of surveillance systems. Multidisciplinary collaboration is also critical for effective pandemic surveillance. Collaboration among multiple disciplines, including epidemiology, laboratory science, and public health, can facilitate the rapid detection and response to outbreaks.

We also discussed the methods and technologies used in epidemiological surveillance during pandemics. These include case reporting, syndromic surveillance, laboratory-based surveillance, and digital surveillance. Each of these methods has strengths and weaknesses, and the choice of method depends on the specific situation and available resources.

Finally, we discussed the challenges and opportunities in epidemiological surveillance during pandemics. These include global coordination, the lack of standardized methods and protocols for data collection and reporting, ethical considerations related to privacy and confidentiality, and the ethical and legal implications of emerging technologies.

In conclusion, effective epidemiological surveillance is critical for monitoring and controlling the spread of infectious diseases during pandemics. By understanding the key principles, methods, and technologies used in pandemic surveillance, public health officials and policymakers can develop effective strategies to detect, prevent, and control the spread of infectious diseases.

Conclusion

The COVID-19 pandemic has highlighted the critical importance of epidemiological surveillance in detecting, preventing, and controlling the spread of infectious diseases. Effective pandemic surveillance requires the use of standardized methods and protocols for data collection and reporting, rapid detection and response, and multidisciplinary collaboration among different disciplines. The use of different methods and technologies, such as case reporting, syndromic surveillance, laboratory-based surveillance, and digital surveillance, can enhance the effectiveness of pandemic surveillance.

However, pandemic surveillance also faces several challenges, including ethical considerations related to privacy and confidentiality, the lack of standardized methods and protocols for data collection and reporting, and the ethical and legal implications of emerging technologies. Addressing these challenges and opportunities requires global coordination, innovative approaches, and the involvement of different stakeholders.

Overall, epidemiological surveillance is critical for detecting, preventing, and controlling the spread of infectious diseases during pandemics. By improving surveillance systems, enhancing global coordination, and promoting multidisciplinary collaboration, we can strengthen our ability to respond to future pandemics and protect public health.

Declaration of conflict of interest: As the author, I declare that there is no conflict of interest.

Acknowledgments: To my family for accompanying me at all times.

Bibliographic Citations

World Health Organization. (2020). WHO coronavirus (COVID-19) dashboard. Retrieved from https://covid19.who.int/
Centers for Disease Control and Prevention. (2021). COVID-19 pandemic planning scenarios. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html
Brouwer, A. F., van Kleef, E., & van Benthem, B. H. (2021). Syndromic surveillance for COVID-19: A real-time approach to risk detection. Clinical Infectious Diseases, 73(Supplement_2), S149-S154.
Kucharski, A. J., Klepac, P., Conlan, A. J., Kissler, S. M., Tang, M. L., Fry, H., … & Edmunds, W. J. (2020). Effectiveness of isolation, testing, contact tracing and physical distancing on reducing transmission of SARS-CoV-2 in different settings: A mathematical modelling study. The Lancet Infectious Diseases, 20(10), 1151-1160.
World Health Organization. (2023). Global Influenza Surveillance and Response System (GISRS). Retrieved from https://www.who.int/initiatives/global-influenza-surveillance-and-response-system
Brownstein, J. S., Freifeld, C. C., & Madoff, L. C. (2009). Digital disease detection—Harnessing the Web for public health surveillance. New England Journal of Medicine, 360(21), 2153-2157.
M’ikanatha, N. M., Lynfield, R., Van Beneden, C. A., de Valk, H., & Infectious Disease Surveillance Section. (2013). Infectious disease surveillance. John Wiley & Sons.
World Health Organization. (2016). International Health Regulations (2005), Third Edition. Retrieved from https://www.who.int/ihr/publications/9789241580496/en/

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By the same author on PEAH

Population Aging, a Challenge for Public Health in Latin America and the World

Not Utopia: Healthy Lives for All in Post-Pandemic World

Any concerted efforts to break the wall will trustily pave the way for ensuring, on non-discriminatory basis, fair and healty lives for all in the near future. Indeed, while conflicting points remain challenging issues to be addressed, they can be however. As the old saying goes ‘where there’s a will, there’s a way’

By Daniele Dionisio

PEAH – Policies for Equitable Access to Health

Not Utopia: Healthy Lives for All in Post-Pandemic World

The empty glass

In my Damn Covid Pandemic, Let’s Begin Exploiting You For Fairer World dating back a couple of years ago, I wondered at some point which lessons have we learnt from Covid pandemic. The answer was ….how countries cope and invest for their future during and after Covid-19 will determine the recovering and coming back to what we used to know as “our normal lives”. Meaning that the present time is the opportunity countries’ governments have to take and move forward social support to fairly sustain their vulnerable groups, as well as to support the productive sector with financial incentives and equitable measures. As inalienable pre-condition, this ties to awareness that ‘In the current pandemic scenario, public health experts need to look at the establishment of animal health care and the strengthening of an ecosystem where human and animal will live congruently to protect human health. This integrated, holistic and harmonious approach to protecting human health is referred to as one world one health, a name coined by the wildlife conservation society. A better understanding of the ecosystem is needed to protect public health’.

This position has gained consensus over time as in WHO’s just released Quadripartite call to action for One Health for a safer world

Yet, in today’s post-pandemic world I maintain that humankind is required, at government, corporate and civil society levels, to set green economy in motion first, while managing to curb inequalities and inequities throughout poor and rich nations. Actually, as per UN Secretary-General António Guterres ‘Everything we do during and after this crisis [Covid pandemic, Author’s note] must be with a strong focus on building more equal, inclusive and sustainable economies and societies that are more resilient in the face of pandemics, climate change, and the many other global challenges we face’.

Echoing George Lueddeke’s words, ‘The greatest challenge in our path to building more equal, inclusive and sustainable economies and societies…. lies with making a fundamental paradigm or mindshift from seeing the world through a strictly human-centric lens to taking a wider more inclusive eco-centric view – ensuring the needs of humans are compatible with the needs of our ecosystems.’

Relevantly, my aforementioned piece also put the finger in ‘the wound that will not heal’, wherein non-stop multi-sector engagement worldwide is required to pressure governments into making “U-turn” changes, implementing common measures on shared agenda. Really hard bet in these times of neoliberal globalization underpinning unfettered trade liberalization, where collusion of national-transnational corporations with their political counterparts comes as no surprise.

As per Ted Schrecker’s Globalization and health: Now more than ever, a need for scepticism and multidisciplinarity …Globalization of financial markets has not only multiplied opportunities for fiscally debilitating tax avoidance and capital flight, which among other consequences undermine social protection measures and progress towards universal health coverage, but also facilitated recurring debt crises in the developing world. The most recent such crises …. compromised many responses to the Covid-19 pandemic, and are squeezing already straitened low- and middle-income health budgets.

Sadly, a sense of fustration is inevitable when considering all conflicting resolutions and moves laid down in the global arena, with the result that public health interest almost regularly succumbs to the interest of the powerful.

Some light in this pessimism? Unfortunately, at a time when some step forward has been attempted, e.g. with Pandemic Treaty ‘Zero-Draft’ as a silver lining towards more inclusive, equitable directions for care, treatments and health technologies access for all, I wouldn’t put my hands on fire since I know how things go and fear that the ‘empire’ will strike back time and again.

Pessimism includes reservations at least (if not negative judgment) on the impact of the so-called public-private partnerships (PPs), wherein … communities had been ignored, displaced, and had their basic rights violated by thoughtless projects designed and implemented in the pursuit of profit…Market-based models cannot be relied upon to deliver on human rights or the fight against inequalities as they are accountable only to their shareholders and not to their users.

Yet, it is not entirely hopeless

Paving the way for half-full glass

Despite it all, I still keep optimist while being aware that food for thought by tips from press worldwide can help see the glass half-full against the odds. A few examples just to let readers in on my vision. To begin with, forward-looking sentences drawn from T20 Indonesia 2022 Policy Brief (pasted below) caught up my interest most:

Roll-out of accepted medical technologies and other public health interventions needs to reach all populations within countries and roll-out should be effective and efficient, equitably distributed and acceptable to both users and providers. This has not been achieved to date in the roll-out of COVID-19 vaccines, with lower coverage rates in rural areas compared to urban ones, and high income versus LMICs respectively.

Any future agreements ought to include obligations on countries to acquire intellectual property rights that can be used in the public interest during a pandemic and to share those rights with other members, which are part of the pandemic preparedness and response efforts.

Regulatory approval and policy development needs to be done in a timely manner. The current access pathway for tests is too long.

Countries should each develop a connected diagnostic system that starts from the National Reference Laboratories, down to community-based testing and self-testing. This should be part of the backbone of any healthcare system, to provide early alerts of unusual trends, enabling rapid deployment of public health measures, as well as monitoring the effectiveness of disease control interventions. Such a surveillance system should also be applied to other diseases that are not necessarily of an epidemic or pandemic nature.

Considering past pandemics, as soon as many were considered to be ‘over’, the world fell into a cycle of neglect and was surprised by the next pandemic, which raised similar issues and challenges. The G20 High Level Panel (Ministero dell’Economia e delle, 2021), set up a new financial intermediary fund (FIF) as part of Pandemic Prevention Preparedness and Response (PPPR) led by the WHO and World Bank (World Health Organization, 2021 & The World Bank, 2022). FIF works closely with donor partners, while engaging widely with other stakeholders, including governments and civil society. PPPR can also serve as a platform for advocacy as it is designed to operate as flexibly as possible. The FIF brings additional dedicated resources for PPPR to LMICs, to allow for investments to be made at national, regional and global levels. Channeling these funds will incentivize countries to make their own investments: about a third of annual FIF funding is anticipated to be provided through external financing, with the remaining two-thirds coming from domestic resources through country commitments.

Despite all the promises and the existence of the TRIPS Agreement, which is meant to deal with such public health emergencies, what we saw in 2021 and 2022 was a situation of ‘vaccine apartheid’, and now we have, what some refer to as ‘treatment and diagnostic apartheid’.

In 2022, the UN Human Rights Council passed a resolution that access to medical technologies is the right of everyone for the enjoyment of the highest attainable standard of physical and mental health (OHCHR, 2022). Unfortunately, if governments insist on not using available flexibilities, which are contained in the TRIPS declaration or partially covered on the 17th of June WTO deal, countries may not achieve access to medical technologies.

Equally, I was positively impressed by what highlighted and requested early this year in Taking on the Commercial Determinants of Health at the level of actors, practices and systems Excerpts as follows:

Evidence has been accumulating for decades on how the Commercial Determinants of Health (CDoH) undermine health equity, and it is increasingly clear that they threaten progress across the health-related Sustainable Development Goals (SDGs).

Box 1. Illustrative commercial actor practices which influence health

Market: Poorly regulated “buy now pay later” companies (e.g., AfterPay, Zip, Affirm, and others) have been criticized for predatory marketing linked to rising consumer debt—the industry includes retail, healthcare and housing.

Political: Google has more than 258 instances of “revolving door” activity in the United States, including White House officials, the Department of Justice and the Federal Trade Commission—the same agencies tasked with investigating antitrust.

Scientific: Coca-Cola and the International Life Sciences Institute have funded research to support the soft drink industry’s message that physical activity, not diets, is the key driver of obesity.

Employment: The commercialization of the incarceration system, often referred to as the Prison Industrial Complex, has led to the exploitation of often minority populations for dangerous and virtually unpaid labor, while migrant workers and their children are subject to violence, abuse, hazardous living conditions and have limited access to healthcare and education.

Financial: The “Big Four” accounting firms—PwC, Deloitte, KPMG and EY—play a significant role in defending and enabling systematic tax avoidance, which depletes public resources that might otherwise be used to promote public health.

Box 2. Approaches to tackle CDoH at the levels of actors, practices and systems

Actors

Implement taxes on tobacco, alcohol, and sugary drinks or other health-harming products.
Restrict predatory marketing and implement front-of-pack warning labels on tobacco, alcohol and ultra-processed foods.

Practices

Mandate employee benefits (including paid parental leave, unemployment benefits and sick leave), including for casual and contract workers.
Regulate profit repatriation, where a parent company avoids paying taxes in its own jurisdiction by first shifting profits to one of its subsidies in a low-tax jurisdiction and then “lending” its parent company back the same money.

Systems

Develop and enforce strict transparency and disclosure requirements for public servants and politicians at all levels of government about engagement with commercial actors, e.g., real-time disclosure of political donations, gifts, hospitality and meetings with government officials.
Implement progressive corporate taxation, wealth or “solidarity” taxes to more equitably redistribute wealth.
Earmark corporate taxes to support public goods, e.g., research, independent media, etc.
Mandate greater human rights accountability on TNCs for exploitative labor practices and environmental degradation.
Develop and enforce rigorous conflict of interest (COI) standards for engagement with commercial and quasi commercial actors, including regulation governing the revolving door.
Use antitrust suits to break up monopoly industries (for example, the technology industry in US).
Embed a health lens in investment decisions—Tobacco Free Portfolios is one example, which could be expanded to incorporate other health and equity metrics.
Establish an intergovernmental tax commission to negotiate a global minimum tax floor to address the “race to the bottom” where countries sacrifice environmental standards and human rights in pursuit of lucrative investments.
Implement and enforce existing access and benefit sharing mechanisms (such as the Nagoya Protocol and the Pandemic Influenza Preparedness Framework) to ensure that intellectual property is not protected at the expense of national sovereignty, equitable access to vaccines, or other “benefits.”
(Re)municipalize public goods and services such as water, energy, the postal system, etc.

Box 3. Priority actions to advance a CDoH agenda

Governments: Develop a five-year strategy for action on CDoH with list of priorities for a multisector program of work.

Multilaterals: Rebalance participation in governance fora to ensure actors from civil society organizations and the Global South have a voice.

Civil society: Build coalitions and foster public support for ambitious and effective government regulation of CDoH.

Researchers: Expand our understanding of the system-level dynamics enabling CDoH—including opportunities to shift these to foster health promoting forms of commerce and share this evidence widely outside academic publications.

WHO: Develop technical guidance on COIs for governments, multilaterals, NGOs, and others that encompasses commercial and quasi-commercial actors.

On a similar wavelength, the newly published A Renewed International Cooperation/Partnership Framework in the XXIst Century maintains that …in order to progress to lower global inequities and achieve a carbon neutral world by the mid of the century and so prevent a climate disaster for the next generation, a greater focus is required on rural vs local, collaboration vs. competition, justice vs. market access to right-based universal social services and a shift from military spending to exhaust all peace agreements and fund a meaningful collaboration according to capacities and needs.

Adding to what emphasized so far, plenty of forward-looking suggestions are being offered throughout current literature, whereby just as an example …A clear vision for a wellbeing economy within planetary boundaries that considers international solidarity and social justice will have to guide the development of future health systems.

This encompasses the need of sustainable finance for health systems , without forgetting that …The objectives of global health depend on the discipline’s capacity to create more space for those we exclude as they lean into existing strengths, hold social institutions accountable and effectively mobilise to advocate for their preferred solutions.

News Flash 520: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Hermit crab (Dardanus Calidus)

News Flash 520

Weekly Snapshot of Public Health Challenges

World Federation of Public Health Associations: GLOBAL PUBLIC HEALTH WEEK

Experts call for action on the commercial determinants of health and health equity

Quadripartite call to action for One Health for a safer world

Pandemic Accord Talks Resume Soon With Call for More Attention to One Health, and Less Misinformation

Alumni Spotlight: Collaborating to support evidence-based health policies in Africa

RECORDING AHEAD WEBINAR ABOUT POLICY OPTIONS FOR EFFECTIVELY TACKLING MEDICAL DESERTS

DECLARATION ON THE HEALTH AND CARE WORKFORCE ADOPTED IN BUCHAREST

Neighbors on alert as Equatorial Guinea and Tanzania battle Marburg

Defunding prevention and climate change drive rebound of malaria in Peru

The Level of Awareness and Impact of Ebola Outbreak on Access, Use and Adherence to HIV Treatment and Preventive Care, Psychological and Socioeconomic Well-Being of Female Sex Workers in the Ebola High Risk Districts in Uganda by AWAC Uganda

SAGE updates COVID-19 vaccination guidance

No More COVID-19 Boosters for Healthy People, WHO Experts Recommend

EU medicines agency: COVID vaccine side effects still being monitored

The Covid-19 Pandemic as Tipping Point (Part 1) by Ted Schrecker

Do COVID’s Origins Matter?

Long COVID: Incidence, Impacts, And Implications

Access Denied: The role of trade secrets in preventing global equitable access to COVID-19 tools

Access Denied: The impact of Big Pharma influence on UK government decision-making in the COVID-19 pandemic

TDR Newsletter: World Tuberculosis Day Bulletin

MSF applauds Indian Patent Office’s rejection of J&J’s attempt to extend monopoly on lifesaving TB drug

IMF Lending Under the Resilience and Sustainability Trust: An Initial Assessment

MPP announces its Community Advisory Panel (CAP) to support the implementation of the organisation’s new strategy

Evidence of crimes against humanity in Libya, experts say

HRR 671: HISTORY AS IT WAS NEVER TOLD TO YOU

Male guardianship rules in north Yemen restrict women’s aid work

We Cannot Improve Maternal and Child Survival Without Improving Data Systems

Lack of water services leave women and girls vulnerable to ‘sextortion’

Australia Has Begun a Climate Charm Offensive to Land UN Summit

What the IPCC report means for global action on 1.5°C

Air Pollution and Mortality at the Intersection of Race and Social Class

Mini Rapid Assessment -Issues Brief on The Level of Awareness and Impact of Ebola Outbreak on Access, Use and Adherence to HIV Treatment and Preventive Care, Psychological and Socioeconomic Well-Being of Female Sex Workers in the Ebola High Risk Districts in Uganda

Find here a not yet anywhere published document by the Alliance of Women Advocating for Change (AWAC) partner organization. AWAC is an umbrella network of grass root female sex worker led organizations in cutting across the 6 regions of Uganda. It was established in 2015 by female sex workers (FSWs) to advance health rights, human rights, socio-economic rights and social protection for FSWs and other marginalized women and girls including their children in Uganda. Geographical focus areas encompass: slum areas, islands, landing sites, transit routes, mining, quarrying, plantations, road construction sites and border areas in Uganda

AWAC.jpg (342×457)

Mini Rapid Assessment -Issues Brief on The Level of Awareness and Impact of Ebola Outbreak on Access, Use and Adherence to HIV Treatment and Preventive Care, Psychological and Socioeconomic Well-Being of Female Sex Workers in the Ebola High Risk Districts in Uganda

Download the study here

https://awacuganda.org/download/mini-rapid-assessment-issues-brief-on-the-level-of-awareness-and-impact-of-ebola-outbreak-on-access-use-and-adherence-to-hiv-treatment-and-preventive-care-psychological-and-socioeconomic-well-being/

PEAH is pleased to publish a study titled “Mini Rapid Assessment -Issues Brief on The Level of Awareness and Impact of Ebola Outbreak on Access, Use and Adherence to HIV Treatment and Preventive Care, Psychological and Socioeconomic Well-Being of Female Sex Workers in the Ebola High Risk Districts in Uganda” as a not yet anywhere published work by AWAC-Uganda .

This report presents findings of the mini rapid assessment and issues brief conducted from 28th November 2022 to 15 th Dec 2022, to examine the level of awareness of Ebola and the impact of its associated restriction guidelines on the access and adherence to HIV treatment and preventive care, psychological and socioeconomic well-being of female sex workers in the Ebola High risk districts of Kassanda, Mubende, Masaka, Kampala, Mukono and Wakiso in Uganda. The assessment employed a survey through a cross-sectional design–with a strong focus on districts that have been affected by the Ebola epidemic using qualitative and quantitative approaches. This report is presented in sections: – introduction, purpose and objectives, methodology, findings and lessons learnt, challenges, conclusion and recommendations

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About AWAC

For the past seven years since its inception in 2015, as an umbrella network of grass-root female sexworker (FSW) led-organizations/ groups in Uganda, AWAC has advocated for gender justice and implemented programs in quest for an inclusive Policy and Social environment where the rights of FSWs including FSWs with intersecting vulnerabilities are recognized, promoted and protected to enable them live healthy and productive lives. AWAC also works to promote the voices, fight stigma, discrimination and criminalization of all forms and champion access to integrated qualityHIV/SRHR/GBV and mental health services. AWAC has empowered grassroots FSWs to: organize, understand their rights and responsibilities; lobby for meaningful involvement; seek and demand for equitable access to health, legal, social and economic services; hold leaders accountable and as well challenge oppressive, stigmatizing and discriminatory practices, policies and laws.

The Covid-19 Pandemic as Tipping Point (Part 1)

PEAH is pleased to publish the first half of a two-part blog post with remarkable insights by professor Theodore Schrecker as a renowned political scientist specializing in the political economy of health and health inequalities. Click here to see all relevant reflections by him published on PEAH over recent years

By Ted Schrecker

Emeritus Professor of Global Health Policy, Newcastle University

The Covid-19 Pandemic as Tipping Point (Part 1)

I began a (pessimistic) 2022 book chapter on the prospects for ‘building back better’ after the Covid-19 pandemic by quoting the first sentences of J.G. Ballard’s magnificent dystopian novel High-Rise:

Later, as he sat on his balcony eating the dog, Dr Robert Laing reflected on the unusual events that had taken place within this huge apartment building during the previous three months. Now that everything had returned to normal, he was surprised that there had been no obvious beginning, no point beyond which their lives had moved into a clearly more sinister dimension.

The giveaway word here is “normal,” and the new normal to which Laing’s world has returned is one in which a deadly class war between the affluent and even more affluent residents of a 40-story tower block has completely destroyed the interior of the building and most of its vital systems, and survivors are reduced to killing and eating the pets of their less fortunate neighbours. In a scene near the end of the novel, surviving children play with human bones in the tower block’s rooftop sculpture garden.

This rather dramatic introduction was designed not to suggest that post-pandemic societies will literally regress to that extent, although that could happen in some contexts, but rather that conditions of life that come to be regarded as normal in the post-pandemic world will probably look very, very different from those of late 2019, and for most of us more insecure and threatening. I am more convinced of this now than I was when I wrote the chapter.

In a recent conference paper, I argued that the pandemic should be understood as a tipping point, initiating processes that magnify and accelerate existing trends, in particular those involving rising inequality and its direct and indirect effects on health. The concept of a tipping point is used in several, slightly different ways depending on context, but it is now most familiar from research on climate change. Leading climate researcher Timothy Lenton explains: tipping points “occur when there is strongly self-amplifying (mathematically positive) feedback within a system such that a small perturbation can trigger a large response from the system, sending it into a qualitatively different future state.” Stated more colloquially, “sometimes little things can make a big difference,” or at least a disproportionate difference, “to the state and/or fate of a system.”

Figure 1. Schematic representation of cascading effects in the vegetation–rainfall system

(a) Vegetation–atmosphere system in equilibrium. (b) Initial forest loss triggered by decreasing oceanic moisture inflow. This reduces local evapotranspiration and the resulting downwind moisture transport. (c) As a result, the rainfall regime is altered in another location, leading to further forest loss and reduced moisture transport.  Reproduced without change from Zemp, D. C., Schleussner, C. F., Barbosa, H. M. J., Hirota, M., Montade, V., Sampaio, G. et al. (2017). Self-amplified Amazon forest loss due to vegetation-atmosphere feedbacks. Nature Communications, 8, 14681 under a Creative Commons Attribution 4.0 International Licence.

An especially striking example is provided by deforestation in large tropical rain forests (Figure 1). As much as half of the precipitation that falls on such forests originates from evapotranspiration within the forest itself. The concern is that deforestation resulting from human activity (forest clearance) will combine with reduced oceanic moisture inflows to lead to a tipping point in which reduced rainfall accelerates forest dieback, and the rain forest transitions to savannah or steppe. This will itself accelerate climate change, as the forest no longer provides a carbon sink. Researchers write that findings about multiple processes of this kind “imply that shifts in Earth ecosystems occur over ‘human’ timescales of years and decades, meaning the collapse of large vulnerable ecosystems, such as the Amazon rainforest and Caribbean coral reefs, may take only a few decades once triggered.” This is a long time in the context of such phenomena as election cycles, but an eyeblink in geological time. Whatever the time scale, once a tipping point has been reached, the pace of changes that were already under way accelerates rapidly, and entirely new changes may begin.

My pre-retirement colleague Clare Bambra and colleagues have provided an especially compelling account of how distribution of health outcomes during the pandemic reflected and magnified economic inequalities (open access, and essential reading). Looking ahead, here are a few of the patterns (far from an exhaustive list) that suggest the value of considering the pandemic as tipping point:

Concentration of wealth at the very top of national and global economic distributions: The number of US dollar millionaires worldwide increased from 46.8 million in mid-2019, the last pre-pandemic year, to 62.5 million in 2021. This growth was fuelled by rising share prices, but also by
Soaring property prices in much of the world. US homeowners saw their wealth increase by more than US$6 trillion between the start of the pandemic and the third quarter of 2022; average house prices across Canada’s 15 major metropolitan areas rose by as much as 45 percent between 2019 and 2021, depending on distance from the city centre. The ‘flip side’ of this pattern, which began before the pandemic but was accelerated by it and is repeated in many European centres, is
A growing pattern of unaffordable housing and semi-permanent housing insecurity, underpinned by the financialization of housing, which also predates the pandemic and led one group of Australian researchers to conclude that: “sustained inflation of property values … has fundamentally shifted the social class structure, from a logic that was structured around employment towards one that is organized around participation in asset ownership and appreciation.”
Housing prices are an important part of a larger cost-of-living crisis, originating in supply chain disruptions associated with the pandemic and worsened by Russia’s invasion of Ukraine and its weaponization of energy exports. Interest rate increases – a conventional central bank inflation-fighting tactic – cannot address these impacts because they have no effect on supply, and in fact are likely to magnify inequality, as they raise the cost of consumer debt and are passed through to consumers by producer firms.
In a global frame of reference, countries differed in the fiscal capacity they were able to deploy in initial responses to the pandemic, which will probably lead to increased inter-country inequality. Further issues arise from what could be
An impending sovereign debt crisis for many countries; before the pandemic the sovereign debt load of countries in sub-Saharan Africa, the world’s poorest region, was more than twice its nominal value in 2009, the year after the financial crisis. In early 2023 the American Public Health Association called on the International Monetary Fund, World Bank and G20 “to eliminate debt for the poorest countries and expand fiscal space for public financing of health services and public health programs.”
Finally, of course, there are the effects of climate change on various social determinants of health, including food security.

The World Economic Forum’s 2023 Global Risks Report devoted an entire chapter to the concept of “‘polycrisis’ – a cluster of related global risks with compounding effects, such that the overall impact exceeds the sum of each part.” This is a useful way of capturing the interactions discussed here, yet at the same time we must acknowledge that many trends in question will present as crises for many, and opportunities for others. (Housing price escalation is a case in point.)

Perhaps my view of the future is excessively bleak. After all, high-income countries were able to buffer many of the pandemic’s economic effects, and the US improbably experienced a substantial, if temporary, drop in poverty. The situation outside the high-income world was, and is, considerably more grim, like the “vaccine apartheid” that has now largely faded from public consciousness reflecting the multiple dimensions of global inequality and the relative invisibility of the global majority. Numerous blueprints, some quite detailed, exist for ‘building back better’. The second part of this posting will direct readers to a few of these; assess some of the formidable political obstacles to their realization against the background of rising inequality; and offer a few conjectures about health in the post-pandemic new normal.

News Flash 519: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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News Flash 519

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‘See What Matters’ Campaign

PEAH is pleased to publish a piece by AFEW partner organization. AFEW is dedicated to improving the health of key populations in society. With a focus on Eastern Europe and Central Asia, AFEW strives to promote health and increase access to prevention, treatment and care for major public health concerns including - though not limited to - HIV, TB, viral hepatitis, and sexual and reproductive health

By Olga Shelevakho

Communications Officer, AFEW International

‘See What Matters’ Campaign

Combating Stigma to End HIV/AIDS in Eastern Europe and Central Asia (EECA)

AFEW Partnership has launched a social impact campaign «See What Matters» as a part of the project “Combating stigma to end HIV/AIDS in Eastern Europe and Central Asia (EECA)”.

Background

Stigma and discrimination against people living with HIV continue to exist and affect various areas of human life, thereby creating barriers and obstacles to HIV prevention and treatment and seriously reducing the overall quality of life of those affected.

Self-stigma of PLHIV remains the most pressing issue for EECA countries. Findings from studies conducted in Kazakhstan, Kyrgyzstan, Russia and Ukraine showed a high level of self stigma among people living with HIV: 81.3%-91.2% of PLHIV surveyed conceal their HIV-positive status from others, half of respondents feel guilt and shame about their HIV status.

HIV infection is still associated with “inappropriate sexual behavior” and belonging to marginalized populations. Women are the most susceptible to HIV-related stigma. HIV stigma in women is associated with rejection by family and friends, society, feelings of insecurity and loss, low self-esteem, fear, anxiety, depression, suicidal thoughts and even suicide attempts

To reduce the self-stigma of women living with HIV and affected by HIV and to change societal attitudes towards them through reducing social stigma, AFEW Partnership developed the project “Combating stigma to end HIV/AIDS in Eastern Europe and Central Asia (EECA)”.

Media campaign

In 2022, we conducted a survey among women living with HIV, most vulnerable to HIV and affected by HIV (including the mothers of children with HIV), showing the challenges they face in their daily lives. Based on these responses, we created a media campaign in the “animadoc” style, which allowed us to combine artistic elements with realistic ones. Here we use direct quotes of the women involved, photographs of their eyes, and their real voices in national languages as a voiceover.

The campaign materials are freely available in English/Russian, as well as Kazakh, Kyrgyz, Uzbek, and Ukrainian languages, and include videos and other materials that can be used for online and offline promotion. You can find them on the official website of the campaign.

The “See What Matters” campaign was developed in the scope of the project “Combatting stigma to end HIV/AIDS in EECA”, implemented by the AFEW Partnership with financial support from Gilead. We would like to thank local organisations and communities of women living with HIV in the region for our collaboration – “Positive Women” in Ukraine, Public fund “Country Network of Women Affected by HIV” in Kyrgyzstan and “ISHONCH VA HAYOT” in Uzbekistan.

Official website of the campaign WWW.STOPSTIGMA.HIV

The report “Results of assessing the level of stigma and discrimination of women living with HIV in the EECA Region” - https://drive.google.com/file/d/1gyY-BqMeUxkkrrAXVVFnBbTUVEhxdz8B/view

Links for the videos - https://youtu.be/fNHzhdq30N4

https://youtu.be/JIwSWf_qgdo

Official news item - https://afew.org/see-what-matters/

News Flash 518: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Spiny fan-mussel (Pinna Rudis)

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Balochistan Primary Healthcare: What Has Been Done and What Needs to Improve? by Muhammad Noman

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Balochistan Primary Healthcare: What Has Been Done and What Needs to Improve?

Balochistan, one of the four provinces of Pakistan, faces numerous challenges in terms of its primary healthcare system, including issues related to service delivery, quality, accessibility, and financing. This paper presents an overview of the primary healthcare system in Balochistan, highlights the achievements and challenges of the system, and suggests potential policy interventions that can improve the health outcomes of the population

By Muhammad Noman

Healthcare System, CHIP Training and Consulting

Quetta, Balochistan Pakistan

Balochistan Primary Healthcare

What Has Been Done and What Needs to Improve?

Introduction

Background and Context

Balochistan, the largest province of Pakistan, is home to approximately 13 million people, many of whom live in rural and remote areas with limited access to healthcare services.

Balochistan map - Google credit

The primary healthcare system in the province faces multiple challenges, such as inadequate infrastructure, inadequate human resources, lack of essential medicines, low funding, and poor quality of care. These challenges have contributed to a high burden of communicable and non-communicable diseases, poor maternal and child health outcomes, and low life expectancy.

Research Problem and Question

The primary healthcare system in Balochistan is in dire need of improvement. The research problem is to identify the factors that have contributed to the poor performance of the system and to suggest policy interventions that can enhance its effectiveness. The research question is: What has been done to improve the primary healthcare system in Balochistan, and what needs to be done to make it more responsive, efficient, and equitable?

Significance and Purpose of the Study

The study is significant because it provides a critical analysis of the primary healthcare system in Balochistan, which is essential for understanding the health needs and priorities of the population. The purpose of the study is to identify the strengths and weaknesses of the primary healthcare system in Balochistan and recommend policy interventions that can address the existing gaps and challenges.

Objectives and Hypothesis

The objectives of the study are to: (1) Review the existing primary healthcare system in Balochistan, (2) Identify the strengths and weaknesses of the system, (3) Analyze the factors that have contributed to the poor performance of the system, and (4) Recommend policy interventions that can improve the health outcomes of the population. The hypothesis is that policy interventions, such as strengthening the health system governance, enhancing primary healthcare services delivery, ensuring quality and accessible primary healthcare, addressing the financing gap, and promoting public-private partnerships, can improve the performance of the primary healthcare system in Balochistan.

Literature Review

Overview of Primary Healthcare in Balochistan

The primary healthcare system in Balochistan is characterized by a three-tiered structure, consisting of Basic Health Units (BHUs), Rural Health Centers (RHCs), and Tehsil Headquarter Hospitals (THQs). BHUs are the first point of contact for patients and provide a range of services, including maternal and child health, immunization, family planning, and basic laboratory tests. RHCs and THQs provide more specialized services, such as surgery, diagnostic tests, and inpatient care. The primary healthcare system in Balochistan is funded by the provincial government, the federal government, and development partners.

Achievements of the Primary Healthcare System

The primary healthcare system in Balochistan has achieved some significant milestones over the years. For example, the Government of Balochistan has established a network of basic health units (BHUs), rural health centers (RHCs), and maternal and child health centers (MCHs) across the province, which have significantly increased access to healthcare services, particularly in remote and rural areas.

Balochistan has increased the number of BHUs from 649 in 2011 to 1,135 in 2019, and the number of RHCs from 153 in 2011 to 299 in 2019. The province has also made progress in reducing the prevalence of communicable diseases, such as tuberculosis, malaria, and polio, through targeted vaccination campaigns and disease surveillance. Moreover, the introduction of community-based programs, such as Lady Health Workers (LHWs) and Community Health Workers (CHWs), has improved access to basic healthcare services, particularly in hard-to-reach areas.

Challenges of the Primary Healthcare System

Despite the achievements, the primary healthcare system in Balochistan faces numerous challenges that impede its effectiveness. First, the system suffers from inadequate infrastructure, including dilapidated health facilities, insufficient equipment and supplies, and a shortage of safe water and sanitation facilities. Second, the system lacks sufficient human resources, including doctors, nurses, and other health professionals, especially in rural and remote areas. Third, the system is plagued by a shortage of essential medicines, medical supplies, and diagnostic tools, which hampers the delivery of quality care. Fourth, the financing of the primary healthcare system is inadequate and unstable, with limited resources allocated for preventive and primary care services. Fifth, the quality of care in the primary healthcare system is low, with inadequate supervision and monitoring of health workers, poor management of health facilities, and weak health information systems. Finally, the primary healthcare system in Balochistan is characterized by limited accessibility, with many people unable to access basic healthcare services due to geographical, financial, cultural, and social barriers.

Some of the specific achievements of the primary healthcare system in Balochistan include:

Improved access to healthcare services: The establishment of BHUs and RHCs has significantly increased the accessibility of healthcare services in Balochistan, particularly in remote and rural areas. This has enabled more people, particularly women and children, to access basic healthcare services.

Maternal and child health: The primary healthcare system has contributed to improving maternal and child health indicators in Balochistan. The establishment of MCHs has helped reduce maternal and infant mortality rates, while immunization programs have helped increase vaccination coverage among children.

Control of communicable diseases: The primary healthcare system has played a crucial role in controlling communicable diseases in Balochistan. Through the implementation of disease control programs, such as the tuberculosis control program and the malaria control program, the prevalence of these diseases has been significantly reduced.

Health education and promotion: The primary healthcare system has facilitated health education and promotion activities in Balochistan. Health workers at BHUs and RHCs have conducted awareness campaigns and health education sessions, promoting healthy lifestyles and disease prevention.

Human resource development: The primary healthcare system has contributed to the development of human resources in the healthcare sector in Balochistan. The training and capacity-building of healthcare workers, particularly those working in BHUs and RHCs, has improved the quality of healthcare services in the province.

Methodology

Study Design

This study uses a qualitative research design, based on a review of the existing literature on the primary healthcare system in Balochistan, including government reports, academic articles, and international health organization publications. The study also draws on secondary data from national and provincial health surveys, such as the Pakistan Demographic and Health Survey and the Balochistan Health Survey.

Data Collection and Analysis

The data collection for this study involves a comprehensive review of the literature on the primary healthcare system in Balochistan, focusing on the period from 2010 to 2020. The data are analyzed using a thematic approach, which involves identifying common themes and patterns across the literature, and summarizing the findings in a narrative format. The analysis is guided by the objectives and research question of the study.

Results and Discussion

Strengths and Weaknesses of the Primary Healthcare System

The review of the literature indicates that the primary healthcare system in Balochistan has several strengths, including the expansion of the BHUs and RHCs, the introduction of community-based programs, and the reduction of communicable diseases. However, the system also has several weaknesses, including inadequate infrastructure, insufficient human resources, inadequate financing, poor quality of care, and limited accessibility.

Policy Interventions to Improve the Primary Healthcare System

Based on the strengths and weaknesses identified in the literature review, the study recommends several policy interventions that can improve the performance of the primary healthcare system in Balochistan. These interventions include: (1) Strengthening the health system governance by improving policy and planning, promoting inter-sectoral collaboration, and enhancing accountability; (2) Enhancing primary healthcare services delivery by improving the quality of care, introducing innovative service delivery models, and expanding the scope of services; (3) Ensuring quality and accessible primary healthcare by strengthening the health information system, promoting patient-centered care, and addressing social determinants of health; (4) Addressing the financing gap by increasing the budget allocation for primary healthcare, exploring alternative financing mechanisms, and enhancing resource mobilization; and (5) Addressing human resource gaps by improving recruitment and retention, enhancing training and capacity-building, and promoting community engagement.

Implications for Practice and Policy

The findings of this study have several implications for practice and policy in Balochistan. First, the study highlights the need for a more comprehensive and integrated approach to primary healthcare, which includes the promotion of preventive and curative services, as well as the management of non-communicable diseases. Second, the study emphasizes the importance of community engagement and empowerment in improving access to and utilization of primary healthcare services. Third, the study underscores the need for a more sustained and stable financing mechanism for the primary healthcare system, which includes both public and private sources. Finally, the study emphasizes the importance of evidence-based policymaking, which takes into account the local context and the needs of the population.

Conclusion

The primary healthcare system in Balochistan has made progress in expanding access to basic healthcare services, reducing communicable diseases, and introducing community-based programs. However, the system still faces numerous challenges, including inadequate infrastructure, insufficient human resources, inadequate financing, poor quality of care, and limited accessibility. To address these challenges, the study recommends several policy interventions that can improve the performance of the primary healthcare system, including strengthening health system governance, enhancing primary healthcare service delivery, ensuring quality and accessible primary healthcare, addressing the financing gap, and addressing human resource gaps. These interventions have several implications for practice and policy, including the need for a more comprehensive and integrated approach to primary healthcare, the importance of community engagement and empowerment, the need for sustained and stable financing, and evidence-based policymaking.

References

Ahmad K, Jafri W, Ali A, et al. Health status of the people of Balochistan, Pakistan: an overview. Journal of Ayub Medical College Abbottabad. 2012;24(3-4):4-9.
Balochistan Health Department. Annual Development Program (ADP) 2021-22. Accessed on February 22, 2023. http://www.balochistan.gov.pk/departments/health
Bhutta ZA, Hafeez A, Rizvi A, Ali N, Khan A. Health systems in Pakistan: challenges and opportunities. The Lancet. 2013;381(9885):1193-1207.
Government of Pakistan. Pakistan National Health Vision 2016–2025. Ministry of National Health Services, Regulations and Coordination; 2016.
Jafri W, Bhatti N. Healthcare system in Pakistan: a critical review. Journal of Rawalpindi Medical College (JRMC). 2015;19(1):91-94.
National Institute of Population Studies (NIPS) [Pakistan] and ICF International. Pakistan Demographic and Health Survey 2017-18. Islamabad, Pakistan, and Rockville, Maryland, USA: NIPS and ICF; 2019.
World Health Organization. Health Systems Strengthening Glossary. World Health Organization; 2011.
World Health Organization. Primary health care. World Health Organization; 2022. Accessed on February 22, 2023. https://www.who.int/health-topics/primary-health-care#tab=tab_1
World Health Organization. World Health Statistics 2021: Monitoring Health for the SDGs. World Health Organization; 2021.
Zaman S, Sahito A. Current status and future prospects of health policy and systems research in Pakistan. Health Research Policy and Systems. 2021;19(1):49.

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News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings