title: Survey of the perceptions of key stakeholders on the attributes of the South African Notifiable Diseases Surveillance System.
abstract: An effective and efficient notifiable diseases surveillance system (NDSS) is essential for a rapid response to disease outbreaks, and the identification of priority diseases that may cause national, regional or public health emergencies of international concern (PHEICs). Regular assessments of country-based surveillance system are needed to enable countries to respond to outbreaks before they become PHEICs. As part of a broader evaluation of the NDSS in South Africa, the aim of the study was to determine the perceptions of key stakeholders on the national NDSS attributes of acceptability, flexibility, simplicity, timeliness and usefulness.
  
  
  
  During 2015, we conducted a nationally representative cross-sectional survey of communicable diseases coordinators and surveillance officers, as well as members of NDSS committees. Individuals with less than 1 year experience of the NDSS were excluded. Consenting participants completed a self-administered questionnaire. The questionnaire elicited information on demographic information and perceptions of the NDSS attributes. Data were analysed using descriptive statistics and the unconditional logistic regression model.
  
  
  
  Most stakeholders interviewed (53 %, 60/114) were involved in disease control and response. The median number of years of experience with the NDSS was 11 years (inter-quartile range (IQR): 5 to 20 years). Regarding the NDSS attributes, 25 % of the stakeholders perceived the system to be acceptable, 51 % to be flexible, 45 % to be timely, 61 % to be useful, and 74 % to be simple. Health management stakeholders perceived the system to be more useful and timely compared to the other stakeholders. Those with more years of experience were less likely to perceive the NDSS system as acceptable (OR 0.91, 95 % CI: 0.84-1.00, p = 0.041); those in disease detection were less likely to perceive it as timely (OR 0.10, 95 % CI: 0.01-0.96, p = 0.046) and those participating in National Outbreak Response Team were less likely to perceive it as useful (OR 0.38, 95 % CI: 0.16-0.93, p = 0.034).
  
  
  
  The overall poor perceptions of key stakeholder on the system attributes are a cause for concern. The study findings should inform the revitalisation and reform of the NDSS in South Africa, done in consultation and partnership with the key stakeholders.
authors: National Department of Health, Private Bag X828, Pretoria, 0001, South Africa. frewbenson@gmail.com.|School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193, South Africa. frewbenson@gmail.com.
authors: F G
authors: FG
authors: Benson
authors: Division of Global Health Protection, United States Centers for Diseases Control and Prevention (CDC), PO Box 9536, Pretoria, 0001, South Africa.
authors: A
authors: A
authors: Musekiwa
authors: School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193, South Africa.|National Institute of Communicable Diseases, Private Bag X4, Sandringham, Johannesburg, 2131, South Africa.
authors: L
authors: L
authors: Blumberg
authors: Centre for Health Policy & DST/NRF SARChI Chair on the Health Workforce, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193, South Africa.
authors: L C
authors: LC
authors: Rispel
mesh_terms: D000328:Adult; D000368:Aged; D003140:Communicable Disease Control / Q000379:methods*; D003141:Communicable Diseases / Q000453:epidemiology / Q000523:psychology; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D062486:Public Health Surveillance / Q000379:methods*; D013019:South Africa; D011795:Surveys and Questionnaires
keywords: Acceptability; Flexibility; Notifiable diseases; Simplicity; Surveillance system; Timeliness; Usefulness