A framework for improving quality and economic impacts in surveillance systems

Health surveillance systems are crucial to make sure that health threats are detected, monitored, and dealt with. The quality of such a system ensures that it can provide continuous diagnostic services, clinical guidance, and inform adequate interventions to health professionals; track, investigate, and report disease outbreaks; promote communication activities; test the efficacy of interventions against threats; and develop new methods for detection of health threats.

In this presentation we discuss a proposed adaption of a framework for health quality assessment of public health systems based on the 9 Public Health Aims for Quality, to the specific assessment of health surveillance systems using multi-criteria decision analysis. The evaluation of quality in this context is necessarily multi-dimensional, taking into account both quantitative criteria (such as the sensitivity of the system in detecting a disease outbreak) and qualitative criteria (such as the transparency level in which the system is run). It also involves determining trade-offs between these quality criteria, for instance between efficiency versus equity concerns, which can provide an overall index of quality for health surveillance systems.

Multi-criteria decision analysis has been increasingly, and effectively, employed in other types of health-related assessments, for example in supporting the prioritization of health threats, the assessment of benefits of new drugs, and the evaluation of capabilities against diseases. The framework we suggest here will enable the evaluation of quality of health surveillance systems, the identification of quality gaps, the assessment of quality-improvement actions, and the temporal monitoring of quality levels of these systems. We illustrate this multi-criteria framework analyzing a surveillance system.