title: The integrated disease surveillance and response system in northern Ghana: challenges to the core and support functions.
abstract: BACKGROUND
  The integrated disease surveillance and response (IDSR) strategy was adopted in Ghana over a decade ago, yet gaps still remain in its proper functioning. The objective of this study was to assess the core and support functions of the IDSR system at the periphery level of the health system in northern Ghana.
  
  
  METHODS
  A qualitative study has been conducted among 18 key informants in two districts of Upper East Region. The respondents were from 9 health facilities considered representative of the health system (public, private and mission). A semi-structured questionnaire with focus on core and support functions (e.g. case detection, confirmation, reporting, analysis, investigation, response, training, supervision and resources) of the IDSR system was administered to the respondents. The responses were recorded according to specific themes.
  
  
  RESULTS
  The majority (7/9) of health facilities had designated disease surveillance officers. Some informants were of the opinion that the core and support functions of the IDSR system had improved over time. In particular, mobile phone reporting was mentioned to have made IDSR report submission easier. However, none of the health facilities had copies of the IDSR Technical Guidelines for standard case definitions, laboratories were ill-equipped, supervision was largely absent and feedback occurred rather irregular. Informants also reported, that the community perceived diagnostic testing at the health facilities to be unreliable (e.g. tuberculosis, Human Immunodeficiency Virus). In addition, disease surveillance activities were of low priority for nurses, doctors, administrators and laboratory workers.
  
  
  CONCLUSIONS
  Although the IDSR system was associated with some benefits to the system such as reporting and accessibility of surveillance reports, there remain major challenges to the functioning and the quality of IDSR in Ghana. Disease surveillance needs to be much strengthened in West Africa to cope with outbreaks such as the recent Ebola epidemic.
authors.affiliation: Institute of Public Health, University of Heidelberg, INF 324, D-69120, Heidelberg, Germany. nyaaba1979@yahoo.com.|School of Medicine & Health Sciences, University for Development Studies, Box TL 1350, Tamale, Ghana. nyaaba1979@yahoo.com.
authors.forename: Martin N
authors.initials: MN
authors.lastname: Adokiya
authors.affiliation: Regional Health Directorate, Ghana Health Service, Upper East Region, Bolgatanga, Ghana, Swiss Tropical and Public Health Institute, Switzerland, and University of Basel, Basel, Switzerland. kawoonor@gmail.com.
authors.forename: John K
authors.initials: JK
authors.lastname: Awoonor-Williams
authors.affiliation: Institute of Public Health, University of Heidelberg, INF 324, D-69120, Heidelberg, Germany. beiersmann@uni-heidelberg.de.
authors.forename: Claudia
authors.initials: C
authors.lastname: Beiersmann
authors.affiliation: Institute of Public Health, University of Heidelberg, INF 324, D-69120, Heidelberg, Germany. olaf.mueller@urz.uni-heidelberg.de.
authors.forename: Olaf
authors.initials: O
authors.lastname: Müller
mesh_terms: D003140:Communicable Disease Control; D004196:Disease Outbreaks; D005260:Female; D005869:Ghana; D063005:Health Information Systems; D019142:Hemorrhagic Fever, Ebola; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011159:Population Surveillance; D036301:Qualitative Research; D011795:Surveys and Questionnaires