RT Journal Article
SR Electronic
T1 Exploring stakeholders’ experiences and perceptions regarding barriers to effective surveillance of communicable diseases in a rural district of Pakistan: a qualitative study
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e067031
DO 10.1136/bmjopen-2022-067031
VO 12
IS 11
A1 Imran Naeem
A1 Sameen Siddiqi
A1 Amna Rehana Siddiqui
A1 Rumina Hasan
YR 2022
UL http://bmjopen.bmj.com/content/12/11/e067031.abstract
AB Objective To explore the experiences and perceptions of health system stakeholders of a rural district of Sindh, Pakistan regarding the barriers to effective surveillance of communicable diseases.Design This qualitative descriptive exploratory design comprised in-depth interviews. Both inductive and deductive thematic analysis was applied to identify key themes from the data.Settings The study was conducted in public sector healthcare facilities and the district health office of the rural district of Thatta, in Sindh province, Pakistan.Participants Fifteen healthcare managers and healthcare providers working in the eight public sector primary and secondary healthcare facilities were interviewed using an open-ended in-depth interview guide.Results Key themes that emerged from the data were: poor governance and absence of surveillance policy framework; fragmentation in the health system leading to lack of uniform reporting; inadequate (human) resources that weakened the infrastructure for disease surveillance; hospital-based reporting of cases that led to a predominantly passive surveillance system; paper-based surveillance system as the key determinant of delayed reporting; non-utilisation of surveillance data for decision making; absence of local laboratory capacity to complement the detection of disease outbreaks and lack of private sector integration in disease surveillance.Conclusions Poor governance and lack of policy framework were perceived to be responsible for weak surveillance infrastructure. Resource deficiencies including inadequate human resource, paper-based reporting and the absence of local laboratory capacity were considered to result in delayed, poor quality and incomplete reporting. The lack of private sector engagement was identified as a major gap.All data relevant to the study are included in the article or uploaded as online supplemental information. All the data collected as part of this research study are reported in the manuscript.