[Evaluation of the tuberculosis control program through tuberculosis surveillance].
Tuberculosis (TB) surveillance has involved three main functions: (1) data collection, (2) data analysis, and (3) feedback. There is now one more important function: (4) a new action plan based on the results of feedback. If all four functions are operating smoothly, the result will be effective so-called "program surveillance". In Japan, the first nationwide computerized TB surveillance system was established in 1987 and it was revised in 1992, 1998 and 2007. Treatment outcomes have been decided automatically in this system since 1998, based on data concerning treatment status, bacteriological test results and so on. Two optional systems, the recording of DOTS and managing of contact tracing, were added to this system in 2007. Since we can thus obtain and use a large amount of surveillance data, we have developed assessment indicators and methods of evaluating the national or regional TB control programs (Fig. 1). However, the accuracy of surveillance data entered into computers at public health centers has been inadequate. Therefore, one of the objectives of evaluating regional TB control program activities is to improve the quality of surveillance data. As regional governments have responsibility for TB control programs in Japan, TB control is generally evaluated at the regional level; i.e. prefecture and designated city. This evaluation process should be done in the cycle of "Plan-Do-See" (planning, execution, evaluation). However, the priority of "See" in this cycle seems to be low, because of the heavy workload of TB control activities. Nevertheless, the evaluation of TB control is very important, so I have introduced some examples of evaluation methods in WHO and Osaka city, and propose the optimum approach to evaluating TB control programs at the regional level. This approach is: (1) to observe the correct epidemiological situation, (2) to set a clear goal, (3) to announce the strategy, and (4) to carry out an annual evaluation. It might also be possible to evaluate the national TB control program by the same process. However, unfortunately there is no national organization such as a TB surveillance committee. I therefore propose setting up a TB surveillance committee in Japan as soon as possible. Since the number of TB specialists has been decreasing in Japan, advice and support for regional TB control will become increasingly important. An organization such as a TB surveillance committee would serve as supervisor.
Ohmori
Masako
M
Research Institute of Tuberculosis, JATA, 3-1-24, Matsuyama, Kiyose-shi, Tokyo 204-8533, Japan. ohmori@jata.or.jp
D026683:Advisory Committees / Q000458:organization & administration; D003140:Communicable Disease Control / Q000379:methods* / Q000458:organization & administration; D016358:Contact Tracing; D023801:Directly Observed Therapy; D006306:Health Surveys; D006801:Humans; D007564:Japan; D015397:Program Evaluation / Q000379:methods*; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*