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WHO
Collaborative Programme
Evidence
and Information for Policy
A. Health Situation and Trend Assessment
Situation Analysis:
Since the end of the civil war, the Ministry of Public Health with continuing support of WHO, had made important efforts to rebuild the national health statistical information system (NHSIS). In addition to considerable efforts to strengthening the routine part of NHSIS (through the introduction of the ICD-10 in hospital level, the update and adoption of nomenclature of medical, laboratory, radiological, pathological and nuclear medicine acts, the computerization of admission authorization to private hospital as well as the discharge summary, the issue of Quarterly Epidemiological Surveillance Bulletin and Statistical Report or Immunization coverage and the initiation of Health District Information sub-system development), important progress has been made during the last three decades in carrying out national health surveys to satisfy the unmet information needs through the routine component of
NHSIS.
The following important national surveys were implemented or are ongoing:
- Pan Arab Project for children development (PAPCHILD Survey, 1995-1996)
- National Household Health Expenditure and Utilization Survey (1999)
- National Health Accounts Study (2000)
In the last biennium, Lebanon also engaged in the Burden of Disease study, as part of the Health Financing Reform project, and in the Health and Health Systems Responsiveness study. Data from all the above studies will be used for the Health System Performance analysis, a global exercise conducted by WHO HQ
Efforts are underway to improve data by developing the District Health Information System.
In order to obtain information on Mortality and Morbidity, WHO supported computerization of the Deaths Certificates at the Ministry of Interior, for three years (1997-1999).
Efforts to introduce ICD-10 started in 1997, with the support of WHO, selected hospitals were trained on ICD-10, but its application remained very limited. In September 2000, the MOH issued a decree mandating ICD-10 coding on all discharge summaries of patients admitted at the expenses of the MOH. There is need to diffuse the standardized discharge summaries to all hospitals (private and public), and to train hospitals staff and MDs on proper ICD-10 coding.
A project for district health information system development was put on track in selected 7 districts. The software has been developed, and training on its use has been done. It remains to test the system, the information flow, and explore the possibility of expanding the project to more districts.
Achievements:
During 2000-2001 focus was made on the following:
- Reinforcing the health district information and sub-system development.
- Use of available data in decision making process, particularly at health district level
- Enhancement of cause of deaths data collection, data processing and analysis.
- Completion of Burden of Diseases assessment exercise and strengthening of national capacity building on the subject.
Objectives:
- To take advantage of available data use to improve decision making at health district system.
- To develop the causes of death statistics.
- To complete the burden of diseases assessment exercise at country level.
- To strengthen the health district information sub-system development.
B. Disease Surveillance and Control
1. Epidemiological Surveillance
Situation analysis:
The epidemiological Surveillance Unit (ESU) at the MOH was established in 1995, with the support of WHO. Since then, many efforts to develop a functional effective communicable diseases surveillance system were deployed. Although the unit was reinforced with human resources, it remains severely understaffed. In 1995, when the ESU was launched, it had two personnel from the World Bank. Nowadays, the ESU includes: 3 personnel from the MOH, one personnel from the World Bank and 8 health inspectors.
Each person has its won specific projects:
- Afp surveillance
- Measles surveillance,
- Meningitis surveillance
- Ambulatory sentinel system
- Qada physician reports system
- Mortality and natatily reports system
- Health centers and dispensaries reports system
- Water monitoring and database
- Descriptive statistics
- Analytic statistics
- And during outbreaks and food poisoning, all the team is activated.
Although case definitions and national guidelines have been developed, their diffusion and use remains suboptimal.
Despite efforts to increase the compliance and voluntary participation of the Private Sector, reporting from this sector remains insufficient, erratic and subject to the own willingness of the physicians.
Routine reporting is not systematic, except for AFP where sentinel sites have been selected, and active weekly data collection is done by MOH.
Reporting of outbreaks is often delayed, and the capacity of the MOH , be it in human resources or in laboratory capacity, remains very limited, although the MOH usually reacts promptly.
Efforts were made to prioritize diseases to be reported, but no consensus was reached, although there is an updated list of reportable diseases (immediate or routine).
WHO supported in the year 2000, a Short Term Consultant on Emergency Preparedness,, where recommendations for epidemic preparedness were proposed.
The issue of new health inspectors - Since 1999, more than 50 health inspectors are available. Yet the government did not hire them. Waiting for these long procedures, the ESU is trying to incorporate them in its different surveillance activities.
The most pressing needs, however, remain the reinforcement of the operational capacity of the ESU, and supporting the development of a data collection/ reporting system.
For 2001, the two objectives are:
- Strengthen the capacity of surveillance personnel at the central level
- Establish the web pages of the ESU
Objectives:
- Strengthen the capacity of surveillance personnel at the provincial (Mohafazat) level.
- Develop a national plan for epidemic preparedness.
2. Control of Emergency Disease and Drug Resistance
Situation analysis:
Use of antimicrobials is widely used, without any restrictions, and antibiotics are used adlib, without medical control or supervision. Information on antimicrobial resistance is not available.
Efforts to initiate a national antimicrobial resistance surveillance (AMRS) network has faced many difficulties in the past few years, mainly in issues related to compliance of the private sector and leadership of the Central Public Health Laboratory (CPHL). The project was finally launched at the end of 2000, in selected private and public laboratories. During the past biennium, WHO supported the development of the system of surveillance for Antimicrobial resistance, by supporting the recruitment of needed staff and purchasing the equipment and training the personnel on the WHONet program for Antimicrobial Resistance Surveillance and Control software.
Priority actions need to be oriented toward sustaining the achievements of the CPHL and supporting the expansion of the AMRS network
Objectives:
- To reduce the risk of morbidity and mortality from communicable diseases
- To continue support to the Antimicrobial Resistance Surveillance System
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