Evaluation of School Health Surveillance System in Baghdad Governorate

Objective(s) : A descriptive evaluation study is conducted on primary health care centers, primary health sectors, health directorates in Baghdad Governorate and General Health Directorate/ Ministry of Health from November 27 th 2011 to June30 th 2012. Methodology: A probability multistage


INTRODUCTION
Public health surveillance is the ongoing systematic collection, analysis, and interpretation of data, closely integrated with the timely dissemination of these data to those responsible for preventing and controlling disease and injury . (1, 2, 3)Surveillance has been around a long time.Surveillance has historically focused on close observation of individuals exposed to a communicable disease such that early manifestation of the disease could be detected and prompt isolation and control measures imposed.This form of surveillance is referred to as medical surveillance.A more recent form of surveillance involves continuous monitoring of healthrelated status or events within a population. (4)Because surveillance systems vary widely in methodology, scope, and objectives, characteristics that are important to one system may be less important to another.Efforts to improve certain attributes--such as the ability of a system to detect a health event (sensitivity)-may detract from other attributes, such as simplicity or timeliness.Thus, the success of an individual surveillance system depends on the proper balance of characteristics, and the strength of an evaluation depends on the ability of the evaluator to assess these characteristics with respect to the system's requirements.In an effort to accommodate to these objectives, any approach to evaluation must be flexible.With this in mind, the guidelines that follow describe many measures that can be applied to surveillance systems, with the clear understanding that all measures will not be appropriate for all systems . (5)

IMPORTANCE OF THE STUDY
To identify surveillance system parameters, a specification profile can be developed; this will include scientific, operational and resource considerations, and compliance issues.The specification profile will help 'ground' the scope of an evaluation in the context and stage of development of the surveillance system. (6)

OBJECTIVES OF THE STUDY:
1) Evaluation of school health surveillance system.
2) Indicate the level of usefulness of surveillance system in the school health.
3) Describe the school health surveillance system.

METHODOLOGY Design of the Study:
A descriptive evaluation study is conducted on primary health care centers, primary health sectors, health directorates and general health directorate in Baghdad governorate.The study is carried out to evaluate the school health surveillance system from November 27 th 2011 to October 15 th 2012.

Setting of the Study:
The study is carried throughout Baghdad Governorate at the General Health Directorate, Al-russafa and Al-karkh Health Directorates, 16 Primary Health Sectors, 168 Primary Health Centers; as being divided into 135 major, 28 ideal, 5 training centers A total of (43) primary health centers; 28major,12 ideal, and 3 training ones and 8 health sectors with two health directorates and the General Health Directorate are selected for the purpose of the study Sample of the Study: A multistage sample of (54) subject, which is selected throughout the use of probability sampling approach.The sample of study is divided into three stages which include; First stage: health directorates, Second stage: health sectors, Third stage: primary health centers (major, ideal, and training) Study Instrument: An evaluation tool is developed depending on the updated guidelines for evaluating public health surveillance system (5) with some modification to be adopted with our situation.It comprises three questionnaires and overall items included in these questionnaires are (47) item.Each of questionnaire deals with the basic components of the evaluation tool; structure, process, and outcome Surveillance System Score All scores were computed for the total score of each of its components 1. Adequate score The score is treated as adequate of (122-130), average adequacy of (131-139), and inadequate of (140-150).

Flexibility score
The score is treated as flexible system of (5-6), average flexibility system of (7-8), and inflexible system of (9).

Utilization score
The score is treated as high utility system of (13-14), moderate utility system of (15-16), and low utility system of (17-19).

Methods of Data Collection
Data are collected through the utilization of the developed questionnaire and interview technique as means of data collection and keeping records of all available contacts that facilitate the access to the study sample from the period 1/10/2010 to 1/10/2011.Interviews are conducted with the chief of the school health unit in each stage level.Each interview takes approximately (15-20) minutes.The data collection is carried out from February 1 st 2012 to March 30 th 2012.

Pilot Study
A pilot study is initiated from February 1 st 2012 to February 16 th 2012 in order to accomplish the following objectives: 1.To evaluate the evaluation tool contents clarity, relevancy and adequacy.2. To estimate the time that each interview may need to be done.3. To identify barriers which may be experienced throughout the study.4. To determine the reliability and validity of the study instrument.

Validity of the Questionnaire
In order to test the validity of the questionnaire, the instrument is presented to (13) experts in different fields for this purpose.Few items were excluded and other were added and removed according to experts' notes, then the final draft is ready to be administrated.Experts had mean of years of experience (25.615) and standard Deviation (S.D) (6.156).

Reliability of the Questionnaire
A purposive sample of (10) subjects involved in the surveillance system is interviewed on individual basis.Interobservor reliability technique is employed for the determination of the instrument reliability.Cronbach alpha correlation coefficient is computed for such determination the following equation is used: Reliability coefficient for the interview questionnaire Questionnaire (A) = 0.75, Questionnaire (B) = 0.82, Questionnaire (C) = 0.89

Data Analysis
Data are analyzed through the application of descriptive statistical data measurements (frequency and percentage) and inferential data analysis of SPSS (Statistical Package for the Social Sciences).The table (1) shows that the average adequacy surveillance system (39.5%) in primary health centers and inadequate surveillance system in both health sectors and health directorate(45.45%).The table (3) presents that the moderate flexible system is (58.10%),(54.54%) in both primary health centers, health sectors and health directorate.

Table 4.Used Scoring to Evaluate the Acceptance of the Surveillance System in Primary Health Centers
The table (4) presents that the acceptance of the surveillance system; It is highly acceptance system (90.7%).The table (5) shows the system of school health surveillance as being representative ones (74.40%).The table (6) presents that the utility of the system; it is clear the low utility system (44.10%) in the primary health center and high utility system (54.54%) in the health sectors and health directorate.

DISCUSSION
The system attributes are determined through evaluation of each characteristic component as being statistically examined.The analysis of the results indicate average adequacy of school health surveillance system in primary health centers and health sectors, while inadequate system in health directorate.
For priority diseases already under surveillance, the adequacy of the existing system to fulfill surveillance and response needs should be reviewed.Laboratory capacity for confirmation, whether it is within or outside the country, should be discussed for each of the priority diseases.Training needs, and guidelines and standards that require improvement or updating, should be identified.Feasible, cost-effective ways to improve the capacity for surveillance and control should be proposed (7).
The analysis of the results indicates the low utilization of system in primary health care centers, but high utilization of the system is in both health sectors and directorate.
The public health importance of a health-related event and the need to have that event under surveillance can be described in several ways.Health-related events that affect many persons or that require large expenditures of resources are of public health importance.However, healthrelated events that affect few persons might also be important, especially if the events cluster in time and place (e.g., a limited outbreak of a severe disease).In other instances, public concerns might focus attention on a particular health-related event, creating or heightening the importance of an evaluation.Diseases that are now rare because of successful control measures might be perceived as unimportant, but their level of importance should be assessed as a possible sentinel health-related event or for their potential to reemerge.Finally, the public health importance of a health-related event is influenced by its level of preventability (8).
The analysis of the result indicates simple system in primary health centers, health sectors, and health directorate.

Table 2 . Used Scoring to Evaluate the Simplicity of the Surveillance System in Primary Health Centers The
(2)le(2)It is obvious from this table that simple surveillance system in primary health center is (48.8%) and health sectors and health directorate is (72.72%).