Capacity Evaluation Of Village Health Clinics For The Strategies Of Implementing Syndromic Surveillance In Jiangxi Province

Since2003SARS outbreak, a web-based, daily infectious diseases case reporting system was instituted in2004in China, which has greatly improved the timeliness of infectious disease notification. The current surveillance system is majorly based on case diagnosis. However in rural China, village clinics are unable to carry out laboratory tests for disease diagnosis, as they are equipped with very simple instruments. Village doctors also lack the necessary experience and knowledge for the identification of infectious diseases. It would be very difficult for the current surveillance system to early detect an epidemic occurred in villages.Thus besides the conventional diseases surveillance system, a new surveillance system-syndromic surveillance, has become a great concern of public health policy makers. Syndromic surveillance system, which collects non-specific syndromes in the early stages of disease development, has great advantages in promoting the early detection of epidemics and reducing the necessity of disease confirmation. It is especially effective for surveillance in resource-poor settings, where laboratory confirmation is not possible or practical.Since resources for surveillance are scarce in villages, syndromic surveillance systems in low resourced settings need to be simple and build on the existing public health service infrastructure. Technological resources and human capacity building should be considered during the implementation of syndromic surveillance. In2010, European Commission started to fund a FP7project on developing a syndromic surveillance system in rural China. This study aims to explore the feasibility and the problems to implement syndromic surveillance in rural areas and evaluate the capacity of village health agencies and village health workers in two counties of Jiangxi province. Part Ⅰ Feasibility study of developing syndromic surveillance in village health clinics of Jiangxi province Objective To explore the feasibility of developing syndromic surveillance in village clinics. Methods Totally355village doctors from37townships of2counties were investigated by self-designed questionnaires and2focus group discussions (FGD) were conducted to collect information about basic conditions of village clinics and doctors’ perceptions towards the acceptability of syndromic surveillance as well as data collection and transfer methods. Results79.6%of the village doctors recorded outpatient logs while2.0%never recorded;74.8%recorded required information for syndromic surveillance. The completeness of outpatients’information (χ2=22.036, P <0.0001) and surveillance information (χ2=7.794, P<0.0001) in the logs of doctors in the standard management system of village clinics were better than those not in.56.4%considered internet as the top choice of reporting surveillance information.60.6%of the village doctors could record and report surveillance information every day, while45.7%perceived the workload as heavy; The doctors’average knowledge score of symptoms of20infectious diseases was40.60±19.32points. Conclusions Establishing syndromic surveillance system in village health clinics is feasible, but the management of outpatient logs should be standardized and patients’information should be transformed into electronic surveillance data source. Data collection and reporting process should be simplified to reduce the workload of village doctors and their knowledge of syndromic surveillance need to be improved.Part II Research on the capacity and resources of village health clinics in Jiangxi province for the implementation of syndromic surveillance.Objective To analyze the health service infrastructure of village health clinics and explore available resources for the establishment of syndromic surveillance. Methods15townships in2counties were selected as study field by stratified cluster sampling. A total of155village health clinics were investigated using self-designed questionnaires to collect information about health service infrastructure and resources for syndromic surveillance. Results The average service population of village health clinics was1657persons. The average time for the furthest residents walking to village clinics was37.6minutes.91.0%of the village health clinics operated daily without weekends. The operating status of village clinics in standard management system is more stable than those not in (P<0.05). Village clinics in standard management system had more stethoscopes, thermometers, blood pressure monitors, outcalls cases and UV lamps than those not in (P<0.01).95.5%of the clinics were equipped with computers and86.5%of them had internet access, but35.5%had a slow speed of network,17.4%usually had network failure and26.5%sometimes had power cut. Conclusions The basic health service infrastructure of village clinics could provide available resources to build syndromic surveillance. The surveillance information could be collected and reported daily due to the operating time of village clinics. Village health clinics in standard management system are more suitable for syndromic surveillance, as the hardware configuration and operating conditions were better than those not in.Part III Capacity evaluation of village health workers in Jiangxi province for the implementation of syndromic surveillance.Objective To evaluate the capacity of village health workers in Jiangxi province for the implementation of syndromic surveillance. Methods Totally253village doctors from15townships in2counties were investigated. Self-designed questionnaires were used to collect information about doctors’capacity and willingness of implementing syndromic surveillance. Results The average age of village doctors was44.56±11.92years old.12.5%of the directors of the village clinics were unable to use computers. Upper respiratory infection, acute gastrointestinal infections, chronic gastrointestinal infections, hypertension and diabetes were the most common diseases in villages. Village doctors in standard management system had more patients than those not in (Z=-8.105, P<0.0001). Influenza, infectious diarrhea, mumps, chicken pox and dysentery were the most common infectious diseases in rural villages.75.9%of the village doctors tended to report infected patients to township hospitals. The willingness to provide public health service((x2=4.827, P=0.028) and subsidies (Z=83.863, P<0.0001) of village doctors in standard management system were lower than those not in. Conclusions Village doctors’health service ability and infectious disease control capabilities could meet the requirements of implementing syndromic surveillance. Fever, sore throat, cough, diarrhea and rash should be prioritized as targeted symptoms for surveillance. The capacity of village doctors in standard management system was better than those not in, but the economic driving factors would affect the compliance in implementing syndromic surveillance.