The implementation of Integrated Disease Surveillance and Response in Uganda: a review of progress and challenges between 2001 and 2007.
BACKGROUND
In 2000 Uganda adopted the Integrated Disease Surveillance and Response (IDSR) strategy, which aims to create a co-ordinated approach to the collection, analysis, interpretation, use and dissemination of surveillance data for guiding decision making on public health actions.


METHODS
We used a monitoring framework recommended by World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC)-Atlanta to evaluate performance of the IDSR core indicators at the national level from 2001 to 2007. To determine the performance of IDSR at district and health facility levels over a 5-year period, we compared the evaluation results of a 2004 surveillance survey with findings from a baseline assessment in 2000. We also examined national-level funding for IDSR implementation during 2000-07.


RESULTS
Our findings show improvements in the performance of IDSR, including: (1) improved reporting at the district level (49% in 2001; 85% in 2007); (2) an increase and then decrease in timeliness of reporting from districts to central level; and (3) an increase in analysed data at the local level (from 10% to 47% analysing at least one target disease, P < 0.01). The case fatality rate (CFR) for two target priority diseases (cholera and meningococcal meningitis) decreased during IDSR implementation (cholera: from 7% to 2%; meningitis: from 16% to 4%), most likely due to improved outbreak response. A comparison before and after implementation showed increased funding for IDSR from government and development partners. However, funding support decreased ten-fold from the government budget of 2000/01 through to 2007/08. Per capita input for disease surveillance activities increased from US$0.0046 in 1996-99 to US$0.0215 in 2000-07.


CONCLUSIONS
Implementation of IDSR was associated with improved surveillance and response efforts. However, decreased budgetary support from the government may be eroding these gains. Renewed efforts from government and other stakeholders are necessary to sustain and expand progress achieved through implementation of IDSR.
Uganda Ministry of Health, Kampala, Uganda. luswal@yahoo.com
Luswa
L
Lukwago
Miriam
M
Nanyunja
Nestor
N
Ndayimirije
Joseph
J
Wamala
Mugaga
M
Malimbo
William
W
Mbabazi
Anne
A
Gasasira
Immaculate N
IN
Nabukenya
Monica
M
Musenero
Wondimagegnehu
W
Alemu
Helen
H
Perry
Peter
P
Nsubuga
Ambrose
A
Talisuna
D003140:Communicable Disease Control / Q000191:economics / Q000379:methods / Q000458:organization & administration; D003365:Costs and Cost Analysis; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D006801:Humans; D011159:Population Surveillance / Q000379:methods*; D016730:Program Development; D014454:Uganda / Q000453:epidemiology