Page 27 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

communication, provision of guidance for professionals and surveillance, how- ever no indicators are provided (26). In the JEE the impact of emergency pre- paredness is defined as ‘multi-sectoral actors at national and subnational (local and intermediate) levels have a common understanding of the priority risks and ready for timely, effective and efficient emergency response operations for out- breaks and other emergencies’ (10).
Although the JEE includes for each indicator the desired impact and targets, quantitative measurable thresholds for performance of the system are scarce. According to the WHO Monitoring & Evaluation Framework, the After Action Reviews (AAR) and Simulation Exercises (SimEx) focus on the functionality of capacities of a country’s response during real or non-real events, and serve as qualitative instruments (22, 55). The ECDC Best practice recommendations for conducting after-action reviews to enhance public health preparedness is a valuable review on AAR methodology but performance indicators for timeliness are not included (56). In the WHO Country Implementation Guidance, evalua- tion objectives include timely laboratory testing and availability of supplies as personal protective equipment (PPE) as examples, however they lack thresh- olds or performance indicators as well (22, 57). Interestingly, the Epidemic Preparedness Index ranking methodology (EPI) developed by Oppenheim et al, timeliness of reporting at WHO Disease Outbreak News (DON) to evaluate the country’s capacity for detection and reporting as determined in the EPI methodology. To evaluate the EPI outcome of a country’s response capacity, the vaccination coverage during the 2009 influenza A(H1N1) pandemic was used, however no timeliness component was involved (27).
Performance indicators, or ‘metrics’, have been developed by the Food- borne Diseases Centers for the Outbreak Response Enhancement (FoodCORE) project in the United States, a project that aims at enhanced outbreak detection and investigation (58). Indicators involve, amongst others, timeliness of labora- tory and epidemiological activities. Not thresholds or targets, but comparison of performance metrics over the years is used to evaluate the impact and effec- tiveness of the program.
To summarize, capacities for surveillance and response have been inter- nationally defined. Performance indicators for evaluation of timeliness are scarce however. For evaluation of infectious disease notification systems, main- ly timeliness according to national legal timeframes is used. For response sys- tems, standardized performance indicators for timeliness are hardly available. Furthermore, thresholds for performance of timeliness of notification and re- sponse systems are lacking.
General introduction 25
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