Building Capacity to Improve Disease Surveillance in Ghana

PHRplus and the Ministry of Health and Ghana Health Services (MoH/GHS) have developed a comprehensive training program to give front line health workers the necessary skills to play a key role in improving infectious disease surveillance.

Despite recognition of the important role of these workers, efforts to improve surveillance system performance typically have focused on building the capacity of regional and district staff to analyze, report, and respond to data from the field. Little if any attention has been paid to building the necessary skills of the front line health worker.

Health workers who see and treat patients are the backbone of not just the service delivery system, but also of disease surveillance: correctly diagnosing, reporting, and responding to myriad public health threats. Surveillance systems that cannot count on the rigorous application of standards and protocols by health workers at the front lines cannot produce reliable information to guide decision makers as to how to best respond to identified problems. The success of the system is truly based upon this “bottom-up” structure.

In summer 2003, PHRplus and MoH/GHS successfully trained 450 health personnel in eight of the 24 districts that comprise Ghana’s three northernmost regions. The training focuses on providing not only technical knowledge and skills, but also understanding job responsibilities, why tasks are important, and problem solving related to operational barriers participants face at their duty stations.

All of these elements are intended to improve health worker motivation and performance. The training is part of Ghana’s overall strategy to improve infectious disease surveillance by adopting the Integrated Disease Surveillance and Response (IDSR) strategy.

Design of the training plan/curriculum was based on a mapping exercise that clearly identified the surveillance tasks performed at the health facility level, a training needs assessment, and selected training material on IDSR for Ghana district health teams. A number of tools to accompany the curriculum were developed and modified based upon initial training experiences. They are being edited and finalized based on the current training experience for dissemination to partners in Ghana and the region.

The training needs assessment and facility level trainings have also been part of the continuous learning and assessment strategy of PHRplus. A single training event or meeting does not ensure implementation of IDSR at facility and district levels. Thus, in addition to training/capacity building, IDSR includes continuous assessment and problem solving to help ensure that skills and knowledge acquired in training can be effectively implemented at the participants’ duty stations. Constraints and enablers to successful IDSR implementation at the facility level have begun to be identified and addressed. PHRplus is working closely with MoH/GHS partners to develop methods and tools to inculcate this continuous problem solving approach to surveillance system improvement at all levels of the system.

The training of 450 health personnel has been well received to date and evaluations have shown improvements in front line worker’s knowledge and implementation of system changes. It is clear that workers must be supported by district and regional staff through supervision and continued problem identification and solving.

IDSR implementation and PHRplus support do not, however, end there. Plans are underway to build the capacity of district and regional staff to enhance their role in effective disease surveillance as well. A curriculum is under development and initial training is planned for the fall.

For further information, contact jim_setzer@abtassoc.com.