Reporting Chain, continued

Dissemination of Information

At the national level, each country is responsible for the dissemination of the following feedback within its own country and to other key stakeholders:

• 
  feedback from communicable disease surveillance
  
• 
  HIV/AIDS/STI annual report.
  

At the national level, each country is also responsible for disseminating relevant Health Alerts within its own country, and for contributing information to Carisurvnet, a secure listserv that serves as an electronic communication tool for member countries.

• 
  weekly updates on syndromes (including EPI) posted on the CAREC website
  
• 
  CSR: quarterly reports on specific diseases, TB updates, outbreaks, articles and regional news and announcements
  
• 
  CSR supplements: two annually with detailed reports on specific issues
  
• 
  CAREC annual report, containing details of the work of the Centre for the period, including a summary of outbreaks for the year and an HIV/AIDS/STIs update
  
• 
  CAREC alerts: public health alerts and regional and international information of interest, produced as necessary.
  

These documents are available on the CAREC website (www.carec.org).

Use of Data and Information

Nationally, countries should use data and information for:

• 
  direct action for prevention and control (for example, therapy, prophylaxis, outbreak control)
  
• 
  programme planning
  
• 
  priority setting and resource allocation
  
• 
  evaluation and monitoring
  
• 
  research.
  

Regionally, CAREC should use data and information for:

• 
  initiating appropriate activities (for example, outbreak investigations, control activities, development of guidelines)
  
• 
  evaluation and monitoring
  
• 
  supporting the planning, monitoring and evaluation of CAREC’s five regional communicable disease programmes, namely:
  

• 
  EPI programme
  

• 
  Special programme on STIs
  

• 
  TB programme
  

• 
  Leprosy programme
  

• 
  Food-borne disease programme
  

• 
  research.
  

CAREC is also responsible for working with countries to appropriately package information for different audiences, such as the media, politicians and the general public, as well as for presentation in the scientific literature.

Monitoring and Evaluation

WHO definitions of monitoring and evaluation are as follows:

• 
  Monitoring is the routine (continuous) tracking of the performance of surveillance and response systems.
  
• 
  Evaluation is the periodic assessment of changes in targeted results (objectives) that can be attributed to a surveillance and response system.
  

National and regional communicable disease surveillance systems must be routinely monitored using appropriate indicators. The regional surveillance indicators and data are listed in Appendix F: Regional Indicators. Laboratory indicators are listed in the CAREC Laboratory User Manual and programme-specific indictors are listed in the respective programme manuals. It is essential to monitor all components of the system (as indicated in Figure 3.2), namely:

• 
  surveillance structure
  
• 
  surveillance quality (as per Unit 5, it is essential to monitor at least timeliness and completeness)
  
• 
  core functions
  
• 
  support functions.
  

Routine system monitoring may require minor or major system adjustments or indicate the need for an evaluation.

The regional communicable disease surveillance system should be evaluated every three years by a group consisting of representatives from CAREC, member countries and other appropriate stakeholders and/or partners. This evaluation will include a review and rationalisation of the syndromes and diseases under surveillance.
Each national communicable disease surveillance system should be evaluated every six to seven years. CAREC is responsible for co-ordinating these evaluations and they should be conducted in collaboration with countries and other relevant partners. All evaluations should aim to describe the system and assess four major components: Surveillance structure, core functions, support functions, and surveillance quality. CAREC is responsible for the development of standard evaluation tools and indicators for the region.

Summary
Surveillance is the collection of data relevant to public health, which can be analysed to guide prevention and treatment programmes. Sentinel surveillance involves the collection of more detailed data from a smaller sample of sites, while laboratory-based reporting occurs when case reports come from laboratories instead of health facilities. Prevalence is the proportion or number of persons in a certain population who have a particular disease, while incidence measures new infections during a specific time period.
The Caribbean Epidemiology Centre (CAREC) maintains and provides norms and forms for the reporting, monitoring and investigation of diseases and outbreaks. Regular feedback and exchange of information is facilitated by an internet-based, secure listserv (Carisurvnet), weekly surveillance updates, quarterly CAREC Surveillance Reports (CSRs), surveillance summaries and supplements and public health alerts. Training in surveillance and outbreak investigation is used to develop national capacity. Laboratory support for surveillance and response is provided in a variety of ways, including early identification of changing disease trends and outbreaks, the provision of reference testing services and antimicrobial resistance monitoring. Within the limits of resources available, the Centre sometimes provides information technology (IT) support, such as training and computers.
CAREC conducts advocacy with national and regional policymakers on the importance of surveillance and resources needed for it. Finally, periodic evaluations of the quality of national surveillance systems are conducted, and feedback and technical assistance are provided to aid revision and strengthening.

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