WHAT IS PUBLIC HEALTH SURVEILLANCE?
1. Establish objectives
2. Develop case definitions
3. Determine data sources data-collection mechanism (type of system)
4. Determine data-collection instruments
5. Field-test methods
6. Develop and test analytic approach
7. Develop dissemination mechanism
8. Assure use of analysis and interpretation
Source: excerpted from Teutsch S, Thacker S: Planning a public health surveillance system. Epidemiological Bulletin 1995, 16(1), pgs.1-6)
Example: In Belize, Guatemala, and Panama, a single registration system has been developed that is intended to be used by professionals from all sectors that come into contact with violence victims, such as the Ministries of Health, law enforcement, the court system, and non-governmental organizations. The system also applies to reports by forensic doctors. In Belize, the Ministry of Health is responsible for consolidating, processing, and analyzing the information from these sectors and then afterwards reporting it to the other pertinent ministries. In Panama, the information is sent to the Legal Medicine Institute for analysis.
Lessons learned from this approach are that information and surveillance systems are an essential part of the integrated approach to gender-based violence and should not function independently from the development of services. For the reporting system to work, and before it is implemented, it is important to develop norms and protocols for the detection and care of the affected women and to train providers in their appropriate use. Untrained personnel can actually cause harm to women by asking about violence in insensitive or victim-blaming ways.
Furthermore, information systems are only valid if the data are used to improve services. Not only is it a waste of resources, but also it is unethical to collect information or carry out active screening for violence with the sole purpose of information-gathering, if no services are offered in return
Source: Excerpted from Velzeboer, M., Ellsberg, M., Arcas, C., and Garcia-Moreno, C., 2003. Violence against Women: The Health Sector Responds. Washington, DC: PAHO, pgs. 55-57.
Example: The province of Valle, Colombia created a domestic surveillance system with the support of the Secretary of Health of Valle. This was done using resources from the basic health plan allocated for strengthening the municipal reporting system and response to domestic violence. By creating an active surveillance system, a municipality with 185,000 inhabitants increased the documented cases of violence against women and girls from 192 in 2002 to 1,059 in 2004 – a fivefold increase in reported cases over a three-year period. Reliability and validity of data also improved. Strategies included: implementation of a standard digitalized reporting and analysis system along with advocacy with community decision makers; strengthening inter-institutional attention networks; consulting for constructing internal flow charts; sensitizing and training network teams in charge of providing health care in cases of domestic violence and supporting improved public policy prevention initiatives. The system was useful for improving survivor services. The project was phased in, with sites added in over a three-year period. The system created geographic references and plotted where reported cases of violence against women and girls occurred; developed a prevention strategy for early detection of violence against women and girls; constructed charts for decision making for each institution; and constructed a common protocol and flow chart for referral of survivors within a network of inter-institutional prevention and treatment. Standardized information gathering in a common software programme became an epidemiological surveillance system including all cases within a defined population, with active collection, consolidation and verification procedures.
Domestic Violence Surveillance System: A Model (Espinosa, R., Gutierrez, M., Mena-Munoz, J. and Cordoba, P. 2008). Salud Publica de Mexico 50 (Issue Supplement 1): S12-S18. Available in English.
Data Collection System for Domestic Violence (The United Nations Economic Commission for Latin America and the Caribbean, 2002). Available in English.
Sexual Violence Surveillance: Uniform Definitions and Recommended Data Elements (Centres for Disease Control and Prevention, 2002). Available in English.
Administrative Data Collection on Domestic Violence in Council of Europe Member States (Council of Europe. 2008). Available in English.
Gender-based Violence Information Management System Project Tools. The GBVIMS is a multi-faceted initiative being undertaken in humanitarian settings to enable humanitarian actors to safely collect, store, and analyze reported GBV incident data. The GBVIMS includes: a workbook that outlines the critical steps agencies and inter-agency GBV coordination bodies must take in order to implement the system; an Excel database (the “Incident Recorder”) for data compilation and trends analysis; and a global team of GBV and database experts from UNFPA, UNHCR and the International Rescue Committee for on-site and remote technical support. For more information about the tools, see the information brief and the website.