It is as a key point in all health policy makings in different countries. The first law approved for diseases reporting system came back to many years ago. The fine that parliament has considered for this program is too small, so, the legislation and revising debate have specific sensitivity. Attraction the support of policy makers and chief managers of treatment sector and their positive attitude will have key role in the successful implementation of the program.
This is done correctly, if it is imparted by deputy of treatment for implementation in hospitals obligatorily. Hospitals in medical university level are under treatment deputy of the university. Performing of the program in hospitals faced with some challenges such as gaps between different Deputies.
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Because of that, compilation plan for surveillance system is necessary. Strategic planning of university which carried out under direct supervision of the President of the University should require all deputies primary health, treatment, education and research development to support the program and it will be the concern of the whole system.
Respectively, the amount of responsibility and accountability, as well as interaction and cooperation will permeate to lower levels. As a result, they practiced the responsibility that diverse sectors must have to this issue. Most of participants believed that payment to employees in fee for service form of surveillance system program has impacts on promote motivation, increased commitment, and improved of performance. On the other hand, operation of surveillance system to pay for physicians, nurses and other involved forces can affect the program.
In the absence of cooperation in the program, it should be considered this in paying for them. Performance-based incentive system will be particularly important in the program. In WHO standards, when a certain guideline is introduced, the first thing to be considered is an incentive system for employees.
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Human resource was the main factor that most participants stated. Human education and training was one of the frequent codes in interviews. Many participants believed that, the deputy of education should change educational Curriculum of medical and nursing students in regards to program carrying out. In their internship, Communicable diseases surveillance system emphasizes more. In addition to academic education, training at the beginning of employment, training during work years, holding educational workshops to change attitudes and insights of employees and enhance their knowledge and skills is crucial.
I was a medical student. Something was thought us, we study and take a test, but there are other things that you need to practice. Surveillance system is one of those needs to have a special position in internship. Experts and managers in the study believed that, one of the weaknesses of the program in hospitals is unavailability of comprehensive networking system.
Unfortunately, despite the hospitals have health information system HIS ; the surveillance system is not included on HIS. A comprehensive network is needed in health surveillance system which includes Communicable Diseases Surveillance program too. On the other hand, this software should be designed based on the early warning system and be able to report outbreaks and epidemics in smart way to related authorities. This theme includes two main categories; appropriate organizational structure and meetings and committees of the coordination in Surveillance system.
This study showed that, the structure of health surveillance system in the country contributes to the implementation of the program. In some provinces and cities of Iran, the hospitals according to the organizational and official hierarchy are separated from health system structure and placed directly under the Deputy of treatment It should be noted that in the capitals of provinces, because there are no primary health network, health centers are under deputy of primary health and hospitals are under deputy of treatment.
Therefore, in these cases, the level of cooperation and coordination seems lower than provinces and cities that hospitals and health centers are under health network and they have integrated and have unique management. Other factor related to the organizational structure which mentioned frequently by participants was the structure of human resource. The main mission of the hospital is treating patients and their satisfaction.
It is inconsistent with the facts, and this causes a lack of employees in our hospitals.
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Communicable disease surveillance program in hospitals is the multi-sectorial joint activity in the health system. One is that, the primary health services are not coordinated with treatment part. Coordination in higher level should be taken. If the departments were close to each other, it was better and I think the productivity became much better.
Another factor that was important in point of participants in the research is holding and strengthens cooperation and communication between primary health and treatment in different levels of Ministry of Health, Universities and operating.
Participation of health experts in direction and guidance of hospitals in this field is undeniable. Since the program has the common components and points between the primary health and treatment sectors, there are differences of opinions and styles between these two sectors according to the results.
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One reasons has been stressed by participants was lack of knowledge and awareness of primary health workers about the problems and challenges of treatment area and hospitals. But what clear is that, with respect and mutual understanding can be achieved to an agreement and empathy in this area. They think that problems are only for them, while we have our own limitations. These thoughts must be eliminated.
According to the results, the first step of surveillance system is timely and correct diagnosis of physicians. We can implement the program according to their diagnosis. They have not been trained for this program. Another important component of the surveillance process is properly registration of information related to the program.
One of duties of hospitals in surveillance system is reporting cases require follow-up to health center of city.
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Selection of responsible person for the reporting and the way of reporting are effective factors. In fact, nobody report cases or the reporting done with delay. Reporting is not upright, and some reports are also very incomplete. Providing feedback to the hospitals is very effective. Some participants in the study stressed that the expectations and goals of the surveillance system should be defined in terms of performance indicators.
And these expected indicators are sent to all parts of the hospital.
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Interviewees stated that, in order to implement the guidelines and protocols of surveillance system, identifying problems and challenges of the program, and reforming of the processes in order to improve program performance, it needs deputy of primary health and deputy of treatment jointly monitor hospital performance at the Ministry and the university level. Performance indicators of the surveillance system should be considered in hospital accreditation process and rated high degree that hospital managers and staff understand the importance of the program.
For example, it is considered in hospital accreditation program and assigned high score to have influence. It is necessary to be included in the accreditation of hospitals and allocate good score for that. Most participants noted that, the surveillance system needs to have an incentive system based on reward and punishment arrangement. Strengthen the motivation of interested people and dealing with those who fail in their duties, can become suitable tools for better implementation of the program.
Incentives have important role that can be defined rewards in financially mode. If we can design a type of motivation system, it can be effective in the implementation of the program. The results of this study showed that, for having effective communicable diseases surveillance system in hospitals, some of the areas must be noticed such as policy making and planning, resource development, organization, collaboration and participation, monitoring process and evaluation of surveillance programs.
Reporting system and diseases surveillance system has fragile infrastructure and laws in most countries. Because of that, governments should revise the laws, regulations and policies which relate to this program and create inter-sectorial and multi-sectorial collaboration to management of the program, in which, all private and public sectors involve. Using appropriate technologies for this program, governments reinforce disease surveillance systems Perry et al. In this study, the absence of macro policy-making in the field of communicable diseases surveillance, no revision in old rules, a lack of collaboration between two deputies of the Ministry of Health, and the lack of comprehensive surveillance programs in the universities from the points of experts, mentioned as problems and shortcomings of the surveillance system in Iran.
Therefore, an effective and efficient surveillance system in hospitals requires macro policy-making and planning in the Ministry of Health and the university level.
Development of information infrastructure and human resources is another factor that can influence the performance of a communicable disease surveillance system. The best communicable disease surveillance system and reporting must identify incidence and prevalence of diseases quickly and respond to disease outbreaks timely and appropriately. Because of resources lack, the problems of using paper based methods and conquer on inefficiencies in information transformation, the need to utilization of electronic, simple and efficient methods to surveillance and reporting of communicable diseases is felt Rajeev et al.
Development of electronic systems can be used as quick, efficient, effective and affordable tools for this purpose Hanafusa et al. In this study, the expert believed that, one of the weaknesses of the hospital surveillance system is the unavailability of a comprehensive electronic network in health system.
However, the application of an electronic system for this purpose needs funding resources and budget to establish the system, inter-sectorial cooperation, personnel training and efforts to maintain the confidentiality of patient information Faensen et al.
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