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标题：Evaluation and Reform of Mexican National Epidemiological Surveillance System
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作者：Roberto Tapia-Conyer ; Pablo Kuri-Morales ; Luis González-Urbán 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2001
卷号：91
期号：11
页码：1758-1760
语种：English
出版社：American Public Health Association
摘要：To generate timely and reliable information for decision making in local health centers, Mexico's National Epidemiological Surveillance System (SINAVE) was evaluated and reformed. The reform was achieved by consensus through national meetings of epidemiologists, using a conceptual model of requirements, leadership, participation, and motivation. The new SINAVE is run by committees that use data from 16 468 local health centers that generate homogeneous information from all health institutions. Indicators, flowcharts, and standardized instruments were created. The reforms modernized SINAVE and strengthened epidemiologists' leadership, consolidated local decision making, and assessed control actions needed to improve the health of the Mexican population. THE REFORM BEGAN WITH AN evaluation of SINAVE by means of a qualitative interview, with a guideline to detect potential solutions to several perceived problems at the first national meeting of 150 state epidemiologists (Table 1 ▶ ). 1 TABLE 1 —SINAVE Problems and Solutions Detected During First National Epidemiological Meeting Problem Solutions Decision making Institute compulsory notification Facilitate immediate and prompt decision making, based on real needs, analysis, and priorities Analysis of information Implement single recording system Standardize programs for recording and processing information Train personnel in system analysis to integrate multidirectional network information Excess work Eliminate useless formats and simplify notification network Integrate information in local health systems Standardize formats Communication within institutions Implement single, constant, bidirectional, and prompt morbidity and mortality feedback system and with other institutions Integrate interinstitutional surveillance group Feedback Generate reports and bulletins Frequently update interinstitutional agreements at every operational level Unify normative and technical documents and periodical revisions according to epidemiological behavior and program impact SINAVE organization manual Prepare manual for SINAVE, including case definition Technology Provide equipment to every operational level Standardize computer programs for recording, processing, and analyzing information Promptness of information Redefine channels to allow better information flow Disseminate information to allow updates and advice at other levels Quality of information Improve veracity, promptness, integrity, and agreement through technical support and interinstitutional collaboration System flexibility Maintain flexibility to allow integration and elimination of diseases, based on experience in a particular state and according to technological and scientific advances Staff mobilization Promote agreements by academic institutions to include epidemiological surveys in their curricula Encourage long-term appointment of physicians Promote better salaries Training Implement continuous personnel training Provide epidemiological educational programs Information, decision, action Define range and characteristics of decisions and actions at each level Provide prompt and reliable information to focus actions toward specific problems Have qualified technical personnel Implement communication network with “state-of-the-art” technology (fax, modem, etc.) Supervision Unify supervision criteria Periodical and permanent supervision Private sector Incorporate participation by law Parallel information systems Create single information system Human resources Define expenditure structure for SINAVE Dissemination of information Elaborate periodical bulletin Promulgate official procedures at all operational levels Carry out events with interinstitutional participation Open in a separate window A second national meeting defined diseases of epidemiological interest, the frequency of epidemiological reports, and technical levels where analysis should be conducted to verify the data for decision making. 2 Work teams were given a list of 389 diseases, which they rated for impact, relevance, and vulnerability; they then selected the diseases to be included for national and regional epidemiological surveillance. A cutoff point was defined (μ ± 2SD) so that each professional continued the exercises only with events selected above the cutoff. Participants also considered which diseases should be reported immediately or weekly and whether a case study should be conducted. Listings were subjected to a frequency analysis, and three standardized formats were defined: a Weekly Report of New Cases of Disease (EPI-1-95), a Case Study (EPI-2-95), and an Outbreak Study (EPI-3-95). A pilot test was conducted for a 2-month period. Problems were discussed, and errors were detected and corrected. At a third national meeting, the simple conceptual model of SINAVE reform, formats, manuals, and training program was presented. A Single Information System for Epidemiological Surveillance (SUIVE) was created to generate efficient homogeneous data to improve the quality and timeliness of epidemiological information. 3 An Automated Epidemiological Surveillance System (SUAVE) also was designed, using up-to-date technology. 4 SUAVE was created to install, input, process, and analyze data about the diseases included in EPI-1-95 generated in 16 468 local health centers, 2428 municipalities, and 234 health jurisdictions in Mexico. 5 SINAVE leaders held weekly meetings to develop case definitions, morbidity manuals, an epidemiology bulletin, and a training plan. A National Committee for Epidemiological Surveillance (CONAVE) was created through ministerial agreement to make surveillance statutory and compulsory in the National Health System. 6 CONAVE was conceived and designed according to the model of academic committees. With Mexico's complex health system, CONAVE has a unique value, because, for the first time, all organizations had been actively involved at SINAVE, and the Official Mexican Norm for Epidemiology Surveillance mandates that involvement (Figure 1 ▶ ). 7 Open in a separate window Open in a separate window FIGURE 1 —National Epidemiological Surveillance System (SINAVE). To assess a SUIVE's performance, 4 indicators were designed: compliance in delivering information, distribution of total versus expected diagnoses reported, coverage of local health centers reporting on time and with delays, and consistency (a measure of the homogeneity of diagnoses reported). These indicators could be analyzed on a weekly or an institution basis, or both, from the national level to the reporting center. A 2-year training plan was established. Five courses—on leadership, teamwork, total quality, data for decision making, and verbal and written communication—were offered to SINAVE reform leaders. 8 Together these courses constituted a special curriculum on leadership in epidemiology for all epidemiologists. To keep the epidemiology leadership in local health centers, annual national meetings were held; since 1995, every epidemiologist in the country has been assured of receiving comprehensive training at least once a year. To establish a feedback system, the lead team met to determine the contents, periodicity, users, and design of weekly feedback instruments to improve communication. The official newsletter, Boletín Epidemiología, is distributed to 3500 users and through an Internet web page. 9 The states also established their own bulletins, which are distributed to all LHCs (dedicated to primary health assistance and members of the local public health system).