In Tanzania, the PHRplus project, in collaboration with the Tanzania National Institute of Medical Research (NIMR), the Tanzania Ministry of Health (MoH), the CHANGE project, and the Centers for Disease Control and Prevention (CDC), developed and tested a set of training materials and tools designed to strengthen the Integrated Disease Surveillance and Response (IDSR) system. All of the tools were implemented in twelve project districts in eight regions of the country. They were designed to adhere to the disease surveillance functions stipulated in the Tanzania National Guidelines for Integrated Disease Surveillance as well as the World Health Organization African Region (WHO/AFRO) IDSR technical guidelines. These key functions are shown in table below:
Application and Results
An essential first step in strengthening IDSR is to ensure that key health facility staff and district staff involved in surveillance understand their roles and responsibilities and have the knowledge and skills to perform their IDSR duties. Therefore, the project developed training materials and held trainings for district health management teams and health facility staff. In addition, to make the training sustainable, the project developed training of trainers materials used to train district, regional, and national level staff to conduct district and facility trainings.
The 12 PHRplus project districts (Babati, Mbulu, Dodoma Rural, Mpwapwa, Masasi, Tunduru, Nkasi, Sumbawanga Rural, Igunga, Tabora Urban, Muleba, and Mwanza Urban) were grouped into three sets of four for training, using an approximately 6-week plan for each set of districts, as follows:
- Week 1: District level training of trainers
- Week 2: Training of council (district) health management team members – half of team members
- Week 3: Training of council (district) health management team members – other half of team members
- Week 4: Facility level training of trainers
- Weeks 5-6 (carried out in districts following a planning period): Training of health facility personnel
The district level training of trainers was facilitated by PHRplus and NIMR staff and focused on developing the skills of regional health personnel and zonal training center staff. Using a cascade model, these individuals then trained the district level staff, who were in turn trained in facilitation methods and trained facility level staff upon return to their districts.
Trainings were conducted beginning in March 2004 and ending in January 2005. A total of 41 IDSR trainers from the MOH, National Institute of Medical Research (NIMR), Zonal Training Centers, and Regional Health Management teams were trained. They in turn trained a total of 96 Council (District) Health Management Team members. Thirty-two of these district staff were trained to become IDSR trainers for the facilities in their districts. A total of 787 health workers from 591 health facilities were trained in IDSR.
While each tool can be used separately, the PHRplus experience in Tanzania has demonstrated that activities aimed at strengthening the IDSR system are strongly inter-connected and should ideally be implemented in a coordinated and comprehensive fashion. The district and facility training formats and materials provide a springboard for working with health workers to improve IDSR. However, it is important to note that the training format and approach, which is highly interactive and based on adult learning principles, requires strong trainers to conduct the initial training of trainers and to build a core group of trainers for the districts and the facilities. The additional tools and job aids can be introduced gradually as part of a series of ongoing follow-up visits to districts after training has been conducted. The PHRplus experience revealed that regular reinforcement through follow-up visits and activities is essential for developing and sustaining a strong IDSR system at the district level.
Some of the regions involved in the PHRplus activities have started using the tools in non-project districts to supplement their existing IDSR strengthening strategies. The laboratory confirmation job aids have been officially adopted by the MOH, and the process for MOH adoption of the other materials will begin soon.