As many as 15 Disease Surveillance Systems set up in the National Institute of Health (NIH) have become ‘white elephants’ for the Federal Government as the number of sufferers of the diseases they are working on, such as polio, diarrhea, TB, malaria hepatitis etc, are going by unrecorded due to fragmentation in the system, leading to inaccurate data being compiled.
Disease surveillance is an epidemiological practice by which the spread of disease is monitored in order to establish patterns of progression. The main role of disease surveillance is to predict, observe, and minimize the harm caused by outbreak, epidemic, and pandemic situations, as well as to increase knowledge as to what factors contribute to these circumstances.
On the one hand, it seems it is quite easy to evaluate the performance of these surveillance systems as, according to the Economic Survey of Pakistan, during the last year 47,948 cases of tuberculosis, 18 million cases of hepatitis, over 1.6 million cases of malaria and 143 cases of polio were reported in the country. Over 7,000 patients were infected with the dengue virus and 31 people died of the disease. 114,000 patients of swine flu were reported in 2010 and 97,400 HIV/AIDS cases had been diagnosed, while only 5,000 AIDS patients had been registered.
However, Dr Sania Nishtar, president of Heartfile, an NGO working on the health sector told Pakistan Today that there are currently around 15 disease information collection systems in place, inclusive of surveillance systems for the following diseases: Acute Respiratory Infections, AFP/Polio, Bacterial Meningitis, Diarrhea, Hepatitis, HIV/AIDS, Malaria, Measles and Tuberculosis. She pointed out that “Many of these surveillance systems are discrete, fragmented and are dependent upon external donor support. Pakistan lacks an integrated disease surveillance system.”
She was of the opinion that in addition to this fragmentation, some surveillance systems are also antiquated and have not benefited adequately from technology. For example HMIS, a nationwide system of collecting data from public first level facilities, has not been fully automated. “Therefore, the potential that which exists to tap Pakistan’s telecommunication boom and create a central computing facility for the public and private sector to report to remains unused,” she said.
She further added that “There is no agency clearly mandated for collecting, collating and consolidating and relaying information and data. Now that a new role for the Ministry of Health is being crafted in the post-18th Amendment scenario, due attention should be accorded to health information as one of its mandates. The cost of inattention could be enormous in the event of another outbreak of avian influenza in Asia.”
An official in the ministry of health, seeking anonymity, told Pakistan Today that the data of these disease surveillance systems is not reliable as there is no mechanism to monitor, cross check or evaluate this data. Regarding the credibility of the data produced by these surveillance systems he cited the following example, “According to the data 20 million people were affected by the floods in Pakistan while only 1 million people, amounting to 0.5% of the total, consulted health units in the flood-affected areas over the time period of two months. When we compare this data with previous data, it shows that only 0.03 percent people visited health units in the two month prior to the floods, this data show a 100 times increase in people visiting health units in this duration.”
He said that a hundred fold increase in only two months is a confusing figure which clearly indicates the lax performance and unreliability of the disease surveillance systems working in Pakistan. The official went on to say that there should be a unified disease surveillance system in Pakistan, which is cumulatively representative of the public and private health sector so that the disease occurrences in the private sector do not go unrecorded.
