The lessons of COVID-19 pandemic for communicable diseases surveillance system in Kurdistan Region of Iraq.

Objectives: This study aimed to determine the opportunities of and barriers to communicable diseases surveillance system (CDSS) during the COVID-19 pandemic and the extent to which the disease integrated into the CDSS in the Kurdistan region of Iraq. Study design: A descriptive qualitative approach was applied. Methods: We conducted seven semi-structured interviews and seven interviewee in a focus group discussion (FGD) with purposefully identified Key Informants (KI) from June to December 2020. All interviews were digitally recorded and transcribed verbatim. We adopted a mixed deductive-inductive approach for thematic data analysis, facilitated by using MAXQDA20 software for data management. Results: Although the CDSS was considered appropriate and flexible, the COVID-19 was interpreted not to be integrated into the system due to political influence. The main concerns regarding core and support activities were the lack of epidemic preparedness, timeliness, and partial cessation of training and supervision during the pandemic. The existence of reasonable surveillance infrastructure, i.e., trained staff, was identified as an opportunity for improvement. The main challenges include staff deficiency, absence of motivation and financial support for present staff, scarce logistics, managerial and administrative issues, and lack of cooperation, particularly among stakeholders and surveillance staff. Conclusion: Our findings revealed that the CDSS in the Kurdistan region requires substantial enhancement in epidemic preparedness, strengthening human resources, and logistics. the system can be developed by fostering meaningful intersectoral collaboration. We advocate that the health authorities and policy-makers prioritise the surveillance and effective management of communicable diseases.

Assessment of core and support functions of the communicable disease surveillance system in the Kurdistan Region of Iraq.

Early detection and prompt response are crucial measures to prevent and control outbreaks. Public health agencies, therefore, designed the Communicable Disease Surveillance System (CDSS) to obtain essential data instantaneously to be used for appropriate action. However, a periodic evaluation of CDSS is indispensable to ensure the functionality of the system. For this reason, this study aims to assess the performance of the core and support functions of the CDSS in the Kurdistan Region of Iraq. A descriptive cross-sectional study was used. From a total of 291 health facilities HFs (Primary health care centers and Hospitals) in the Kurdistan region of Iraq that have surveillance activities, 74 HFs were selected using a random stratified sampling approach. The World Health Organization (WHO) generic questionnaire has been used to interview the surveillance staff, together with direct collection of the data. Our analysis shows a lack of surveillance guiding manual in the HFs. Even at the district level, where a surveillance manual existed, case definitions, thresholds, and control measures were still missing. To note, more than 93% of HFs had organized and comprehensive patients registers for the collection of their clinical and secondary data. Also, all HFs had functioning laboratories. The majority of them (almost 93%) were equipped to collect, process, and store blood, stool, and urine specimens. About 72% of these laboratories were also able to transport timely the specimens to more specialized laboratories. At all levels, data reporting to the higher level exceeded the recommended minimum rate of 80%. The reporting system at the district level was based on emails, while in the periphery on hand-delivered in paper-based formats (50%), telephone (22%), and social media (22%). Furthermore, our analysis highlights the lack of data analysis: only 3.8% of Primary Health Care Centers conduct simple data analysis regularly, while hospitals do not do any sort of analysis. Also, only a few HFs investigated an outbreak, though using system routine sources to capture these public health events. Our findings show a lack in epidemic preparedness (3%), in feedback (53%), in standard guidelines, training, supervision, and resource allocations in HFs (0%). Taken together, our data show the importance of strengthening the CDSS in the Kurdistan region of Iraq, by reinforcing the surveillance system with continuous feedback, supervision, well-trained and motivated staff, technical support, and coordination between researchers and physicians.

An Assessment of Timeliness and Quality of Communicable Disease Surveillance System in the Kurdistan Region of Iraq.

BACKGROUND: The quality of the surveillance system can be defined by attributes such as completeness, timeliness, usefulness, simplicity, flexibility, acceptability, and reliability. This study aims to assess these quality features of the communicable disease surveillance system (CDSS) in the Kurdistan Region of Iraq. METHODS: This study was conducted using a retrospective review of records and documents, and the interviews with the surveillance staff (n = 82) of the Kurdistan governorates during 2018, 2019, and 2020. The World Health Organization (WHO) guideline 2006 indicators were used for evaluation and monitoring the quality of the communicable disease surveillance system. The data analyzed and showed as frequencies and percentages using Statistical Package for the Social Sciences (SPSS) version 26 software. RESULTS: The reporting timeliness declined from 98% in 2019 to 69% in 2020. At the same time, there was an improvement in completeness of reporting from 83% in 2018 to 99% in 2020. The total scores of other surveillance quality attributes, simplicity, usefulness, flexibility, acceptability, and reliability, were 75%, 72%, 67%, 72%, and 69%, respectively. CONCLUSION: Current findings demonstrate that the CDSS is still facing significant challenges in timeliness simplicity, usefulness, flexibility, acceptability, and reliability. Further studies to assess the system's quality, particularly the system's timeliness of outbreak response, sensitivity, and specificity, are recommended.