epidemiological surveillance & control of cds in turkey european commission. republic of turkey,...

Ep

idemiological S

urveillance & C

ontrol of CD

s in T

urkey

European Commission. Republic of Turkey, Ministry of Health. WHO Regional Office for Europe1

Strengthening PH Strengthening PH Surveillance & ControlSurveillance & Control

Dr Robert Hartley Stevens WHO Country Office, Turkey

WHO European Region

Ep

idemiological S

urveillance & C

ontrol of CD

s in T

urkey


InternationalInternationalPolicy ContextPolicy Context

Ep

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The UN FamilyThe UN Family

UNO WHO FAO UNESCO ILO

Specialised Agencies

Implementing bodies

•UNICEF•UNDP•UNHCR•Etc.

Self-Governing Agencies

•IMF•WB•WTO•Etc.

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urveillance & C

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urkey


Health For AllHealth For All

Secure and Supportive Society

Nu

trition

Ed

ucation

Incom

e

Health

Services

Pu

blic H

ealth

Hou

sing

Individuals fulfill their health potential

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The Health For All approachThe Health For All approach

Improve Health and Reduce Health Inequalities through:

Multi-Sectoral Working

Evidence Based Practice

Partnership and Participation

Health Systems Development

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urveillance & C

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The Health Gap in WHO EuroThe Health Gap in WHO Euro

55y 57y 59y 61y 63y 65y 67y 69y 71y 73y 75y

Disability Adjusted Life Years (DALYs)Disability Adjusted Life Years (DALYs)

Commonwealth of Independent States

Republic of Turkey

EU 10 joining May 2004

EU 15 before May 2004

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Health versus WealthHealth versus Wealth

1

10

100

1000

0 5 10 15 20 25 30 35 40Dea

ths

/ 100

,000

live

bi

rths

GDP per cap PPP USD 000s

Maternal Mortality Rate versus Gross Domestic ProductMaternal Mortality Rate versus Gross Domestic Product42 / 52 Euro states, 2002, HFA Database 200542 / 52 Euro states, 2002, HFA Database 2005

Turkey Reported

Turkey Actual

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Health Spending as a National PriorityHealth Spending as a National Priority

Health Expenditure as a % of GDP versus log GDPHealth Expenditure as a % of GDP versus log GDP42 / 52 Euro states, 2002, HFA Database 200542 / 52 Euro states, 2002, HFA Database 2005

0

2

4

6

8

10

12

14

1 10 100

Hea

lth E

xp a

s a

% o

f G

DP

GDP per cap PPP USD 000s

Turkey

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Health Systems DevelopmentHealth Systems Development

Turkey is spending an above average %GDP on health

But MMR is still average to high because of organisational factors

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Old Int Health Reg 1969Old Int Health Reg 1969Limited scope (Cholera, Yellow fever, Plague)

Only official reports and information considered

Notification by MS only after confirmation

WHO involved only after official notification

Border controls

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New IHR 2005New IHR 2005All PH Emergencies of International Concern

Containment in-country

WHO acts on all information sources

Adapted responses according to risks

WHO / ECDC / GOARN support from the start

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idemiological S

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EC CD LegislationEC CD LegislationList of 46 diseases brought progressively under surveillance

Contribution to Community networks

Comparable and compatible data

Early warning and response

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EC CD LegislationEC CD Legislation

Legal Framework

ECDC

Norms + Systems = NPoA WHO

Guidelines SoPs

Performance

Audit

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Technical Issues:Technical Issues:Surveillance Surveillance

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Public Health Emergency of Public Health Emergency of International Concern (PHEIC)International Concern (PHEIC)

Any two of:– Serious public health impact of the event– Event is unusual or unexpected– Significant risk of international spread– Significant risk of international travel or

trade restrictions

‘an extraordinary event which constitutes a public health risk to other States through the international spread of disease and potentially require a coordinated international response’

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Examples of PHEICsExamples of PHEICsSudden increase in IMD in pilgrims returning from the Haj

Cholera with high risk of international spread

Cases of a novel strain of influenza

Natural disasters with potential impact on other countries

Serious chemical contamination of rivers crossing international boundaries

Serious chemical or radioactive air pollution following an industrial accident

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CD Surveillance and ControlCD Surveillance and ControlEvent detection, warning and early responseEstimating burden and trend in diseaseChanges in severity, clinical pictureMonitoring disease control incl. VPIGenerating research hypotheses

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Event DetectionEvent Detection

Baseline

Alert threshold

Action threshold

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Signals and NoiseSignals and Noise

Typo

Year-on-year trend

Noise

Seasonality

Outbreak

Rep

ortin

g V

ariation

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Turkey MeningitisTurkey MeningitisAnnual Average Case Rate

0

2

4

6

8

10

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79

Province

Rat

e per

100

,000

....

Source: MoH routine notifications 1996 to 2006

Includes all causes of probable cases of meningitis 30-fold variation due to reporting bias

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Turkey MeningitisTurkey MeningitisYear-on-year trend

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

2.00

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Rep

ort

Rat

e,Turk

ey.... EU 25

average


Rapid decrease in baseline

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Turkey MeningitisTurkey MeningitisYear-on-year trend

0.00

0.50

1.00

1.50

2.00

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Rep

ort

Rat

e, T

urk

ey.....

EU Median 2005


Reports are 1/5 of EU average, lower than any of EU 25

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idemiological S

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Surveillance Surveillance System System

StrengtheningStrengthening

Ep

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s in T

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Main Achievements to DateMain Achievements to Date EPIET-like 3 week epidemiology course (30 Fellows) 4 / 5 x 1-week modules in more specialized public health

topics (30 Fellows) Adult education Preparatory of study protocols Data analysis of study results Health Mapping

6 / 6 x 2-week ToTs (180 CD Department staff). 30 / 81 Provinces x 2-day Basic Training (3000 GPs) Strategic management training to a national planning group

(20 core Working Group members) Laboratory management training

2-week ToT (40) 3-day (450 microbiologists) SoPs for PH microbiology Launching a pilot laboratory sentinel surveillance network

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idemiological S

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Strategic 5 year plan

Yearly action plans

Monitoring progress

Evaluating outcomes and impact

Assessing risks; prioritising public health threats; assessing existing systems

IHR: Planning and Management CycleIHR: Planning and Management Cycle

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urkey


Primary Health

MoHNRL

PHDs

Medical Universities and Sate Hospitals

Integrated Surveillance - 1Integrated Surveillance - 1

Food and Water Safety Animal

Health

Vital Registration

Nosocomial Infections

MoHNRL

TB Dispens.

NRL

Group D

Other systems…?

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idemiological S

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Primary Health Care and Hospitals

Provincial Health Directorates

Intermediate level

MoHNRL

National Focal Point

Rep

ortin

g Feedback

Integrated Surveillance - 2Integrated Surveillance - 2

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Evidence Based Policy /

Critical Appraisal of Literature

Operational Research (OR)

Monitoring & Evaluation (M&E)

Surveillance & Lab Guidelines Management & Organisational

Development

(M&OD)

CDS&C System Development ModelCDS&C System Development Model

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idemiological S

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Next StepsNext StepsBuilding on the broad base of ESCCDS I: ESCCDS II – Development of National Electronic Surveillance– Bench laboratory training– 20 Cohort II surveillance and control Fellows– National Conference

EC 2008 funding– IHR integrated surveillance strengthening– ? Turkish Field Epidemiology Training Programme

Ep

idemiological S

urveillance & C

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s in T

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Thank youThank you

Robert Hartley StevensProject [email protected]

epidemiological surveillance & control of cds in turkey european commission. republic of turkey,...

Documents

ministry of health

turkey european commission

health spending

health inequalities

health gap

s turkey slide

health potential slide

turkey actual slide