Strengthening disease surveillance capacity at national level across five countries: a qualitative study.

OBJECTIVES: Disease surveillance is an essential component of public health and a core function of National Public Health Institutes (NPHIs), including to better prepare and respond to infectious diseases outbreaks. Strengthening NPHIs in their efforts to establish and maintain efficient surveillance systems is an opportunity to ensure future outbreak preparedness and response; yet, guidance on how to increase and prioritise capacity building efforts is limited. This study sought to investigate approaches to capacity building and training for disease surveillance at national level and understand the potential role of NPHIs. STUDY DESIGN: Qualitative study. METHODS: This is a qualitative study, based on a literature review and interviews undertaken between June and November 2022. Fifty seven in-depth interviews were conducted in five countries: Côte d'Ivoire, Ecuador, Madagascar, Namibia, and the Kingdom of Saudi Arabia. Participants included a range of professionals from government, NPHIs, academic institutions and the private sector. Interviews were thematically analysed. RESULTS: Selected countries varied in terms of their disease surveillance capacities, as well as in the structure of their surveillance systems and decision-making. Research identified shared priority areas for action at national level, identifying common challenges and opportunities: 1) capacity building, here specifically the need for a training agenda at national level to ensure sustainability and guide donor funded training offers; 2) data tools and technology-to help decision-makers select the best software tool to address countries' identified need; 3) data sharing-the need for clear data sharing standards and norms for national to international data sharing; and 4) genomic sequencing-the need for national genomic surveillance strategies and reporting guidelines. CONCLUSION: Addressing challenges and using opportunities to strengthen disease surveillance at national level is an important step to build capacity in this area and to help prevent future epidemic and pandemics globally. The findings of this study help decision-makers to identify priority areas for capacity building and understand the potential role and significance of NPHIs.

Approaches, challenges, and opportunities to strengthen the epidemic intelligence workforce: a scoping review.

BACKGROUND: Weak surveillance systems have limited countries' ability to adequately respond to public health emergencies. Strengthening the human workforce in this field is considered an important opportunity to ensure the future response to infectious diseases outbreaks globally. A scoping review of the academic literature and relevant documents was conducted to identify approaches, challenges, and opportunities to strengthen the epidemic intelligence (EI) workforce. METHODS: Five peer-reviewed databases were systematically searched, as well as Google as a grey literature source. English language articles and documents published between 2014 and 2022 were included. No geographical restrictions were set. RESULTS: 37 articles and 20 documents were included in the review. Professional training, the acknowledgement of including a broad variety of disciplines into the workforce, the inclusion of communities, the pursuit of a One Health approach and the use of digital tools were identified as impeding and/or facilitating the EI workforce. The review shows that the field epidemiology training programme is a prominent approach for strengthening the EI workforce and that little evidence exists on how non-traditional disciplines (e.g., disciplines besides medicine, laboratory science, or epidemiology) contributing to surveillance may support the future EI workforce. CONCLUSION: The identification of approaches, challenges, and opportunities of EI can inform future policy and practice on strengthening the EI workforce. The conduct of more high-quality studies is needed to guide this process. The potential benefits of integrating a wider range of disciplines than currently found in the surveillance workforce and of involving communities in disease surveillance needs to be further researched.

Why do medical tourists travel to where they do? The role of networks in determining medical travel.

Evidence on medical tourism, including patient motivation, is increasing. Existing studies have focused on identifying push and pull factors across different types of treatment, for example cosmetic or bariatric surgery, or on groups, such as diaspora patients returning 'home' for treatment. Less attention has been on why individuals travel to specific locations or providers and on how this decision is made. The paper focused on the role of networks, defined as linkages - formal and informal - between individual providers, patients and facilitators to explain why and where patients travel. Findings are based on a recently completed, two year research project, which examined the effects of medical tourism on the UK NHS. Research included in-depth interviews with 77 returning medical tourists and over sixty managers, medical travel facilitators, clinicians and providers of medical tourism in recipient countries to understand the medical tourism industry. Interviews were conducted between 2011 and 2012, recorded and transcribed, or documented through note taking. Authors undertook a thematic analysis of interviews to identify treatment pathways by patients, and professional linkages between clinicians and facilitators to understand choice of treatment destination. The results highlight that across a large sample of patients travelling for a variety of conditions from dental treatment, cosmetic and bariatric surgery, through to specialist care the role of networks is critical to understand choice of treatment, provider and destination. While distance, costs, expertise and availability of treatment all were factors influencing patients' decision to travel, choice of destination and provider was largely the result of informal networks, including web fora, personal recommendations and support groups. Where patients were referred by UK clinicians or facilitators these followed informal networks. In conclusion, investigating medical travel through focus on networks of patients and providers opens up novel conception of medical tourism, deepening understanding of patterns of travel by combining investigation of industry with patient motivation.