Philippines

With ADB Support, NEC is Ready to Head Off Next Disease Outbreak
by Rita Festin, ADB National Officer

In February, when there was an outbreak of about 2,400 typhoid fever cases in Calamba, Laguna, just outside of Metro Manila, it took three weeks before health authorities could send a team to investigate. Calamba did not have its own disease surveillance system and could not immediately act and resolve the problem. By the time the information finally reached the central office in Manila, they could not immediately dispatch personnel to the area to investigate since they were short-handed, causing further delay. It was almost end-March when the outbreak was effectively contained. Under a new decentralized disease surveillance and response system being implemented by the Department of Health’s National Epidemiological Center (NEC), local health authorities no longer have to rely on the central office since they can detect, analyze, and quickly resolve an outbreak on their own.

The system is called Philippine Integrated Disease Surveillance and Response or PIDSR funded by a $200,000 grant from the Asian Development Bank (ADB). It is an Internet-based system that captures data from the all over the country and directly transmits it to the central office in Manila. A trend can be simultaneously tracked so that the problem can be resolved at the local level right away. In the case of the Calamba typhoid fever outbreak, the root cause was traced to contaminated water and a lack of chlorine which authorities could have easily resolved had they immediately recognized that there was an alarming rise in typhoid fever cases right in their own backyard.

The PIDSR is supported by an ADB regional technical assistance grant for Communicable Diseases being implemented in Indonesia, Malaysia, and the Philippines to improve epidemiological surveillance and more effectively respond to threats of emerging infectious diseases. The PIDSR software and an online data management system were developed so that data encoding can be done anytime and anywhere in the country and then transmitted to the provincial, regional and succeeding levels until it reaches the NEC. A series of trainings all over the country is being undertaken so that ultimately, the system will have a nationwide reach. To date, regional health authorities from Regions IV-B, VII, and XIII and selected provinces have already been trained to re-echo the training in the provincial and rural health units. The full impact of the project will be felt after a year, when all hardware and software shall have been delivered and all the trainings have been conducted.

Brand-new high-end computers with licensed operating systems have been installed in the regional levels. At the provincial levels, LGUs will procure their own computers based on NEC specifications. For 2008, 37 provinces have been prioritized under the ADB-supported Health Sector Reform and will be trained under PIDSR. Thereafter, capacity building at the local level and establishing laboratories at the regional level will also be implemented.

Dr. Enrique A. Tayag, NEC Director, says the PIDSR system is simple but has revolutionized the way disease surveillance and response is conducted in the country. “The surveillance and response in this country will never be the same again because this is a total revamp of the framework of what we had. In fact, this Project surprised us, because with a little amount, we were able to accomplish so much.” He acknowledged the dedication and professionalism of NEC staff and Pacific Rim Innovation and Management Exponents Inc., Philippines (PRIMEX), the project consultant.

Previously, if a Laguna-based patient is hospitalized in Metro Manila, that will be recorded as a Metro Manila statistic even if he caught the disease in the province. Laguna health authorities would have been clueless that they had a problem. It is only when the data reaches the NEC central office in Manila where all other cases in Laguna are recorded that they will realize the problem. By that time, it may be too late and the disease would have further spread.

In addition, the reporting process was a routine task that had no meaningful end-result. A survey form was manually completed and submitted weekly to the NEC. From the municipal level, it is submitted in hard copy to the provincial level, then to the regional level and to the central office. Sometimes, data is only gathered from hospitals, which is just the tip of the iceberg, not at the barangay level. Local government units are unable to immediately see a trend at their level so that they can make decisions on the spot. As a result, detection of an outbreak is very much delayed.

The coverage of the new surveillance system is wider and there are more disease reporting advocates. Cases are reported simultaneously within 24 hours of detection through the fastest means possible, either through phone, fax or email on a case-based form in standard PIDSR format. Data from the lowest reporting unit at the barangay/community level can now be uploaded online within 24 hours and the system alerts the provincial or regional health units if there is an outbreak. They can investigate and respond right away. They do not have to rely nor wait for the NEC.

The diseases covered under the surveillance are epidemic-prone diseases such as Acute Bloody Diarrhea, Acute Encephalitis Syndrome, Acute Hemorrhagic Fever Syndrome, Acute Viral Hepatitis, Anthrax, Cholera, Dengue, Human Avian Influenza, Influenza-like Illness, Leptospirosis, Malaria, Meningococcal Disease, Paralytic Shellfish Poisoning, Severe Acute Respiratory Syndrome or SARS and Typhoid and Paratyphoid Fever. Also covered are diseases targeted for eradication or elimination such as Poliomyelities (Acute Flaccid Paralysis), Measles and Neonatal Tetanus. Other diseases or conditions of public health importance also covered Adverse events following immunization, Diphtheria, Non-neonatal tetanus, Pertussis, and Rabies.

The project also produced a step-by-step Manual of Procedures produced by PRIMEX in a record three months’ time. The manual is “the Bible” of all disease surveillance coordinators who will implement, monitor, and support the PIDSR from hospitals, clinics, rural health units, city health offices, and health authorities at the provincial, regional and national levels. The manual has been widely distributed down to the municipal level all over the country.

At the central office, it is Edna Lopez who receives all the encoded information as national coordinator of the NEC’s National Epidemic Sentinel Surveillance System. She says the new system is very user-friendly, easy to update, and can instantly be sorted alphabetically. It is also less prone to typographical errors and there is no need to manually encode the data. She stresses the importance of having an effective surveillance system. “Diseases are easily detected and stopped from further spreading,” she said. Last year alone, there were 55,000 dengue cases nationwide which would have been significantly minimized had the new system been in place.

The website of the PIDSR is open to the public for viewing: www.pidsr.net.ph.* Only encoders can access the system to input data.

NEC provides critical support to the DOH in the prevention and control of diseases through surveillance and response. As Dr. Tayag puts it, “without NEC support, the head may fall”. With a strengthened NEC, the DOH can easily head off the next epidemic.