A Short Note on Diseases Surveillance in Nepal

In 1996, the Government of Nepal, Ministry of Health (GoN, MoH) first launched Early Warning and Reporting System (in short EWARS) for hospital-based sentinel surveillance of six diseases: three vaccine-preventable diseases or VPDs (polio, measles and neonatal tetanus or NNT) and three vector-borne diseases - malaria, kala-azar (KA), and Japanese Encephalitis (JE). For which the implementing agency is the Epidemiology and Disease Control Division (EDCD) of the MOH. The primary goal as any surveillance system was designed to provide more timely information to the decision makers to facilitate early response. All hospitals that comes under EWARS are expected to report every week on the number of cases and/or deaths (including “zero” reports) of the six priority diseases (1). However, there remain various challenges which hinder the completeness and timeliness of the reports. We can discuss on this further.

 

The major milestone in the history of public health arena in Nepal would be the introduction of acute flaccid paralysis (AFP) for the eradication of poliomyelitis since 1996. As Nepal was signatory in the Global Polio Eradication Initiative (GPEI), Polio Eradication Nepal (PEN) - surveillance and support team was established in June 1998 by the Ministry of Health and Population in collaboration with technical support from World Health Organization, Nepal. PEN was later re-named Program for Immunization Preventable Diseases (IPD) because activities were expanded to include surveillance for other vaccine preventable diseases such as measles, neonatal tetanus, and Japanese Encephalitis(2). Currently, along with these Vaccine Preventable Diseases (VPDs), are added other infectious diseases of public health importance e.g., rubella.
In addition, there also exists system of data collection known as Health Management Information Reporting System (HMIS). In this reporting system, various illnesses as well as utilization of health services are reported from every village to districts and then to the central level on monthly basis.
Having said that there exist disease surveillance structure in place, there are astronomical challenges to be solved and taken it in right course.

• Leadership / Ownership: Unstable political situation, frequent changes in the state government leadership and reshuffling of government key position in parallel, and their changing priority affects public health system as a whole.
• Policy: Though disease surveillance recognized an important component of public health system at policy level, there are weakness in its implementation due to various reasons like
  • Leadership - weakness
  • Advocacy - weakness
  • Too much dependent on external funding, lacking government ownership
  • Lack of trained human resource
  • Poor infrastructure and network to carry out laboratory surveillance
  • Sample transportation problems (esp. a tremendous challenge in Nepal)

References:

1. Pyle DF, Nath LM, Shrestha BL, Sharma A, Koirala S. Assessment of Early Warning and Reporting Systems (EWARS) in NEPAL. 2004; Available from: http://www.ehproject.org/PDF/Activity_Reports/AR-126%20EWARS-ASSESS....
2. Field Guide for Surveillance of Vaccine Preventable Diseases (VPDs). 2010; Available from: http://www.nep.searo.who.int/LinkFiles/Guidelines_VPD_Field_Guide_2....