| Steps |
Activity |
| Status of problem |
Measles was an endemic problem in Guangxi, particularly in the rural areas. Achieving the measles elimination by the national targeted date is not feasible with the existing EPI system, in particular, the current level of government inputs. |
| Understanding the setting |
|
- General physical, social, economic situation
|
In addition to high birth rates and high percentage of minority population, the underdeveloped economic, the mountainous terrain and subtropical climate create various conditions unfavorable to measles control/elimination program. |
- Type and organization of political system
|
The local government leaders are appointed by the provincial government. They enjoy unchallenged power over resources appropriation, and also face political consequences for failure to address the issues identified by provincial government. |
- Type and organization of health care system
|
County public health agencies came under the leadership of the local government, while the provincial public health authority has only a technical assistance role. |
- The weakness of the existing system
|
Limited financial and human resource, high staff turnover, insufficient Infrastructure, and short of communications between health staff and politicians. |
| Clarify the purpose of the surveillance system |
(1) Secure political and financial commitments to immunization service
(2) Monitor the performance of immunization service, and the trend of vaccine coverage and population immunity, and
(3) Achieve sustainable mortality and morbidity reduction and reduce the burden of measles and other vaccine-preventable diseases. |
| Formulate the topic and content |
(1)The cases of measles including demographic and geographic information for identifying the high-risk areas for intervention.
(2)Information on strategies and processes for improving immunization service, and capacity and resources for implementing these strategies. |
| Define the scope |
Entire population with focuses on rural and minority-populated areas. |
| Determine how quickly information is needed |
Case should be reported within 12 hours of onset. The outbreak, if more than 7 cases reported within a well-defined area, should be investigated within 48 hours of reporting. All other information is collected on needed base. |
| Select source of information and the method of collection |
Mandatory reporting from physicians, vital-event registration, regular and periodic surveys, and focuses group discussion. |
| Collect the data |
Data were collected by the counties public health department with assistance from provincial center for disease control. |
| Process and analyze the data |
Case-based information was analyzed monthly (March-June) or quarterly by county EPI staff, and the summary was reported to provincial center. Other data were processed and analyzed by the provincial center on needed bases. |
| Interpret the data |
Cases-based data should be interpreted by local staff for prompt response. Other data were interpreted by provincial staff with assistance from county’s. |
| Write report and disseminate findings |
The report with the rankings of county in order of scores was formulated by the provincial staff, and was endowed by provincial leaders, including governor. |
| Ensure that those who need the information receive it |
Newsletters with updated epidemiological reports were circulated within the government leaders and health care professionals province-wide. |
| Evaluate the usefulness of data that is collected to those who use it |
Political and technical authority from province periodically inspected the counties whose overall EPI performance score below 85. Official warning documents (yellow warning card) endowed by provincial political leaders will be re-sent to the county’s leaders whose EPI score remained unimproved. |
