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In a decentralized health system where public health services are mostly provided by LGUs, there is a need for timely and accurate epidemiologic information from the field in order to identify problems e.g. disease outbreak, monitor implementation of health programs and guide health policy making. Such information will help the DOH-RHO in extending the appropriate technical assistance to LGUs. Local health personnel also need assistance in developing their own epidemiologic expertise, particularly in the areas of public health surveillance and disease prevention and control. To coordinate DOH efforts in these activities, Regional Epidemiology and Surveillance Units (RESUs) were created. RESUs serve as a crucial link between the central office and devolved health units. They can serve as “information services nodes” and can be platform for capacity building in the field epidemiology.
SURVEILLANCE SYSTEMS OF RESU:
 A. Philippine Integrated Disease Surveillance and Response (PIDSR)
            On May 2005, the World Health Organization adopted the revised Integrated Health Regulations (IHR) to strengthen disease surveillance and response system in the Philippines. To strengthen the surveillance and response systems, they developed policies and strategies that would make the system more efficient and effective. In order to achieve this, the Philippine Department of Health is adopting an integrated approach to surveillance of priority communicable diseases and conditions. This approach aims at coordinating and streamlining all surveillance activities and ensuring timely provision of surveillance information action. 
            Disease Surveillance is recognized as the cornerstone of public health decision-making and practice. Surveillance data provide information which can be used for priority setting, policy decisions, planning, implementation, resource mobilization and allocation, prediction and early detection of epidemics. A surveillance system can also be used for monitoring, evaluation and improvement of disease prevention and control programs.
            Administrative Order Number 2000-0036, “Guidelines on the Philippines Integrated Disease Surveillance and Response (PIDSR) Framework”. This administrative order provides the framework for PIDSR to guide its implementation at all levels of the health care delivery system as well as both the public and private sector.
B. Vaccine Preventable Disease Surveillance (VPD)
            Vaccine preventable disease (VPD) surveillance under the umbrella of the Philippine Integrated Disease Surveillance and Response (PIDSR) that was established in 2007 has an objective of improving the quality of disease surveillance nationwide, thus, assist in the disease prevention and control programs of the Department of Health. The goal is to improve the capacity of health system through timely detection and appropriate response to disease and conditions with high level of morbidity, disability, and mortality.
            The Philippines has been certified polio-free in October 29, 2000. However, despite polio-free certification, the risk of wild poliovirus importation remains until poliovirus is eradicated throughout the world. According to the World Health Organization (WHO), at the beginning of 2006 only four countries remained polio-endemic: Nigeria, India, Pakistan and Afghanistan. Many other countries have experienced outbreaks and re-established transmission of wild poliovirus because of imported poliovirus originating from northern Nigeria or Northern India. Fortunately, virtually all countries with polio outbreaks following importation have been successful in interrupting wild poliovirus transmission a second time. In 2012, India has successfully interrupted wild poliovirus transmission and was certified Polio-free. Until global eradication is achieved, a threat of wild poliovirus importation always exists.
            The country also aims to eliminate Measles and Neonatal Tetanus. The same AFP Surveillance Network, which has been proven to be effective, shall be used for Measles and Neonatal Tetanus surveillance. Case-based surveillance is important to accurately identify high risk areas and populations to achieve elimination goals.
C. Event-based Surveillance and Response (ESR)
            Event-based Surveillance and Response (ESR) shall complement the existing indicator-based disease surveillance in detecting IHR events with the added advantage of rapid reporting because it does not support data aggregation by morbidity week, with a wider scope (since PIDSR is limited to a set number of reportable diseases and syndromes), greater geographic spread (as reports will not be coming from predetermined sentinel sites although PIDSR was envisioned to have a universal coverage) and most importantly, initially at a relatively low cost.
            The ESR has unique characteristics that will define its purpose. ESR is the organized, unstructured capture of information on new events that are not included in indicator-based surveillance, events that occur in populations which do not access health care through formal channels, rare, unusual or unexpected events to distinguish it from indicator-based surveillance, which employs a systematic collection of variables to characterize specific illnesses.
            Furthermore, ESR describes illnesses or deaths occurring in individuals or clusters or those related to potential exposures that threaten public health. Clearly, ESR may detect similarly PIDSR-listed diseases and syndromes or others not from this list. Then, information is filtered to require only those that need further assessment and for which, finally, some actions are intended. Such actions from indicator-based surveillance are triggered following pre-defined thresholds. No such thresholds exist for event-based surveillance. Instead, an assessment is made on pertinent findings about each event having a potential or even an actual risk to public health that ultimately leads to a timely and appropriate response.
            Thus, Epidemiology Bureau shall build, develop and maintain its capacity for disease surveillance and ensure that assessments of these events will lead to timely, relevant intervention, alone or with other stakeholders as well. Assessments should comply with provisions contained in Annex 2 of the revised IHR. Response may involve domestic or international representatives, or individual or multi-disciplinary teams.
D. STI and HIV Surveillance
            The Philippines still remains to be one of nine countries globally that had a greater than 25% increase in HIV incidence rate in the past decade. Particularly, the rise in HIV epidemic is seen among key affected populations at greater risk for HIV, including males or transgender who have sex with males (M/TSM), people who inject drugs (PWID) and female sex workers (FSW). Continuous surveillance activities are vital in monitoring the magnitude of this HIV epidemic. These will provide evidence-based and strategic information to guide prevention and control efforts including treatment, care and support needs in specific population groups. To fight the epidemic, one core strategy is to strengthen STI and HIV prevention and control. The Epidemiology Bureau is committed to monitor the HIV situation in the Philippines and improve the country’s response to the HIV epidemic.
The STI and HIV Surveillance shall be promoted at all levels in order to create well-informed groups with increased sense of responsibility, urgency and ownership and to ensure maximum cooperation. This can be done through consultative meetings, expert panel meetings, trainings or workshops, actual conduct of surveillance [HIV and STI surveillance, HIV Inventory, Mapping of at-risk populations, Areas and Current HIV services, (HIV IMPAC), rapid assessment of HIV vulnerability, epidemic investigations, risk assessment], geographic mapping of Key Populations (KP), operation/intervention researches and advocacy campaigns (local dissemination forum).
 
 
 
 
 
 VISION 
 
 
 
 
MISSION
 
 
 
 
OBJECTIVES
SURVEILLANCE SYSTEMS OF RESU: 
 A. Philippine Integrated Disease Surveillance and Response (PIDSR) 
  1. To increase the number of LGUs able to perform disease surveillance and response.
  2. To enhance capacities at the national and regional levels to efficiently and effectively manage and support local capacity development for disease surveillance and response.
  3. To increase utilization of disease surveillance data for decision making, policy-making, program management, planning and evaluation at all levels. 
B. Vaccine Preventable Disease Surveillance (VPD) 
  1. To sustain polio-free status until polio is eliminated in the world;
  2. To eliminate measles;
  3. To eliminate Maternal and Neonatal tetanus. 
C. Event-based Surveillance and Response (ESR) 
1. To capture all types of health events with potential public health risk including rare and new events; 
2. To immediately assess and respond to all captured health events in order to decrease morbidity, mortality and disability to minimize economic impact; 
3. To immediately disseminate available information regarding ongoing health events to relevant or concerned agencies for proper coordination of response and support activities; 
4. To provide information for IHR notification; 
5. To enhance data quality and real time reporting of health events through application of electronic web-based technologies.
 
D. STI and HIV Surveillance 
  1. Quantifying the magnitude of HIV infection;
  2. Assisting in HIV and AIDS program planning;
  3. Advocating for intervention and care services;
  4. Aiding program evaluation.
 
 
 
 
PROGRAM COMPONENTS
 
 
 
 
 
TARGET POPULATION/CLIENT
 
 
 
 
 
AREA OF COVERAGE
 
 
 
 
 
PARTNER INSTITUTIONS
 
 
 
 
 
POLICIES AND LAWS
DEPARTMENT CIRCULAR NO. 293 S. 1997 
In line with the devolution of health services to local government units (LGUs) and the need for strengthening the technical capacity of Regional Health Offices (RHOs), Dept. Circular No. 11, s. 1993 mandated the creation of Regional Epidemiology Units (REUs). Since among the functions of such units are the conducts of disease surveillance, these units have subsequently been referred to as Regional Epidemiology and Surveillance Units (RESUs). This circular clarifies the mandate, functions, manpower and logistics requirements of such units.
 
 
 
 
 
STRATEGIES, ACTION POINTS, AND TIMELINE
 
 
 
 
 
 
PROGRAM ACCOMPLISHMENTS/STATUS 
A. Outbreak investigations conducted 2016: 
  • AGE OUTBREAK (Zamboanga City)
- Total No. of Cases: 3,870
- Total No. of Deaths: 21
- Technical assistance provided:
  1. FETP Team for investigation
  2. Facilitated the collection and transport of stool specimens
  3. Facilitated the collection and transport of water samples
  • AGE OUTBREAK (Zamboanga City Jail)
- Total No. of Cases: 274
-Total No. of Deaths: 1
- Technical assistance provided:
  1. Case investigation together with CHO
  2. Facilitated the collection and transport of stool specimens
  • Increasing AGE cases in Isabela City
- Total No. of Cases: 1,638
- Total No. of Deaths: 4
- Technical assistance provided:
  1. Case investigation with FETP Fellow
  2. Facilitated the collection and transport of stool specimens
 
B. Vaccine Preventable Disease Accomplishment and Target:
2016
ACUTE FLACCID PARALYSIS
 
TARGET
ACCOMPLISHED
Zamboanga del Sur
6
0
Zamboanga del Norte
6
0
Zamboanga Sibugay
5
2
Pagadian City
2
0
Zamboanga City
7
8
Dipolog City
1
0
Dapitan City
1
0
Isabela City
1
0
Total
29
10
 
MEASLES
 
TARGET
ACCOMPLISHED
Zamboanga del Sur
16
15
Zamboanga del Norte
16
15
Zamboanga Sibugay
13
114
Pagadian City
4
10
Zamboanga City
19
147
Dipolog City
3
0
Dapitan City
2
1
Isabela City
2
6
Total
75
308
 
NEONATAL TETANUS
 
TARGET
ACCOMPLISHED
Zamboanga del Sur
1 per 1,000 live births
0
Zamboanga del Norte
0
Zamboanga Sibugay
2
Pagadian City
0
Zamboanga City
2
Dipolog City
0
Dapitan City
0
Isabela City
0
Total
4
 
C. Health events monitored under ESR (January – December 2016)
RESU Program
 
 
D. Summary of Morbidities and Mortalities, January-December Region IX, 2015 vs 2016
2015
2016
DISEASES/ SYNDROMES
Cases
Deaths
DISEASES/ SYNDROMES
Cases
Deaths
CATEGORY I
AEFI
4
1
AEFI
4
2
AFP
6
0
AFP (Suspect)
10
0
RABIES
8
8
RABIES
10
10
MEASLES
287
0
MEASLES
72
0
MENINGO DSE
10
6
MENINGO DSE
10
7
NT
0
0
NT
3
0
ANTHRAX
0
0
ANTHRAX
0
0
PSP
0
0
PSP
26
1
SARS
0
0
SARS
0
0
ZIKA
0
0
ZIKA
0
0
MALARIA
12
0
MALARIA
8
0
MERS-COV
0
0
MERS-COV (PUI)
3
0
 
2015
2016
DISEASES/ SYNDROMES
Cases
Deaths
DISEASES/ SYNDROMES
Cases
Deaths
CATEGORY II
ABD
1,069
3
ABD
858
1
AHF
1
0
AHF
0
0
AES
7
1
AES
0
0
CHIKV
49
0
CHIKV
14
0
CHOLERA
14
0
CHOLERA (Suspect)
9
0
DENGUE FEVER
7,079
25
DENGUE FEVER
7,298
39
DIPTHERIA
4
0
DIPTHERIA
0
0
HFMD
14
0
HFMD
15
0
HEPA
337
5
HEPA
297
0
ILI
1,177
0
ILI
882
0
LEPTOSPIROSIS
37
5
LEPTOSPIROSIS
18
1
MENINGITIS
102
15
MENINGITIS
88
24
NNT
51
9
NNT
45
14
PERTUSSIS
0
0
PERTUSSIS
1
0
ROTA VIRUS
0
0
ROTA VIRUS
62
0
TYPHOID
2,248
5
TYPHOID
1,675
11
 
E.  Trainings Conducted and Attended January – December 2016
 
 
Activities
Date
Venue
No. of Pax
Local Strategic Information and Response Planning Workshop (STIR UP)
March 7 – 12, 2016
Hotel Centro, Puerto Princesa City, Palawan
1 RESU Staff
 Infection Control Training for DSCs (public and private hospitals) in Zamboanga Peninsula
April 12 – 14, 2016
Grand Astoria Hotel, Zamboanga City
101 Nurses and Medtechs
 Online Document Tracking Information Systems
May 18 – 20, 2016
Grand Astoria Hotel, Zamboanga City
2 RESU Staff
 Health Research Methodology Training
May 24 – 27, 2016
University of Manila, Ermita, Manila
1 RESU Staff
 Rapid Response Team Training
June 28 – July 1, 2016
Crimson Hotel, Alabang, Muntinlupa City
1 RESU Staff
 IHBSS Local Dissemination Forum (Partners Meeting)
June 30, 2016
Grand Astoria Hotel, Zamboanga City
100 pax
Multi-sectoral
 Health System and Program Actions based on Data Analysis and Evidence – Informed Strategies (Health SPADE)
July 11 – 15, 2016
Citystate Tower Hotel, Ermita, Manila
2 RESU Staff
HIV IMPAC (2 Sites)
August 2 – 7, 2016
Roderics Hotel, Zamboanga Sibugay and Chandlier Suites, Zamboanga del Sur
30 pax Multi-sectoral
 RESU Annual Scientific Conference
August 2 – 5, 2016
Grand Astoria Hotel, Zamboanga City
90 DSCs
 FETP Annual Scientific Conference
August 16 – 19, 2016
Days Hotel, Tagaytay City
1 RESU Staff
 ISO Awareness and Orientation Seminar: Understanding and Appreciating ISO 9001:2015
September 6 – 7, 2016
Grand Astoria Hotel, Zamboanga City
2 RESU Staff
 Review of Event-based Surveillance and Response (ESR) Policies and Implementation of Processes
September 13 – 16, 2016
Hotel St. Ellis, Legazpi City, Albay
3 RESU Staff
 Online ESR Training for selected LGUs
September 20 – 22, 2016
Cityinn Hotel, Zamboanga City
45 PHNs and Midwives
 VPD Advocacy for DEPED Nurses (Private and Public Schools), Zamboanga City
September 23, 2016
Grand Astoria Hotel, Zamboanga City
100 Nurses
 Basic Epidemiology Training for ESR Staff (BEES)
October 18 – 21, 2016
Grand Astoria Hotel, Zamboanga City
50 Physicians and Nurses
 Online ESR Surveillance Updates
October 25 – 27, 2016
Grand Astoria Hotel, Zamboanga City
50 DSCs
 Workshop on Root Cause Analysis Relative to the Stage 2 Audit Findings
November 9 – 12, 2016
Citystate Tower Hotel, Ermita, Manila
1 RESU Staff
 HIV Updates
November 28 – 29, 2016
Grand Astoria Hotel, Zamboanga City
50 Medtechs
 PIDSR Training for New DSCs
December 7 – 9, 2016
Roderic’s Hotel, Ipil, ZSP
40 Nurses and IT encoder
 
 
 
CALENDAR OF ACTIVITIES
 
 
 
 
STATISTICS
 
 
 
PROGRAM MANAGER CONTACT INFORMATION