Sixty-two participants were recruited in the first round of the survey and a response rate of 81% was obtained. The final sample size was 50 participants following exclusion of those who did not consent (n = 5) and those who were unavailable (n = 7) to participate in the study. The median number of years of work experience for participants in their current designation was 10 years (IQR: 8–12 years). Majority (64%) of participants were members of the county health management committee with 36% being part of the sub-county health management committee. The second round of the Delphi survey involved 45 participants translating to a response rate of 90% since five out of the 50 participants in the previous round were unavailable to participate in the second round. The stakeholders were grouped into various areas of work including health management (county directors of health); disease surveillance (county and sub-county disease surveillance and response coordinators and NTDs coordinators); public health (sub county public health personnel) and health information (county and sub-county health records and information personnel) (Table 1). The preponderance of participants reached agreement on the significance and practicability of implementing recommendations to improve surveillance and response to PC-NTDs at the sub-national level. Out of the 60 statements in 12 sub-domains in the first round of the survey, stakeholders reached consensus on importance of 56 (93%) recommendation statements (Table 2). Furthermore, in the second round, participants reached consensus on the feasibility of implementing 46 (77%) of the recommendation statements (Table 3).
Table 1
Socio-demographic characteristics of participants
Characteristic
|
n (%)
|
Regions
|
|
Coast (Kwale and Kilifi)
|
20 (40%)
|
Rift Valley (Baringo, West Pokot and Narok)
|
18 (36%)
|
Eastern (Kitui and Embu)
|
12 (24%)
|
Age of participants
|
|
31–40 years
|
20 (40%)
|
41–50 years
|
21 (42%)
|
> 50 years
|
9 (18%)
|
Gender of participants
|
|
Female
|
14 (28%)
|
Male
|
36 (72%)
|
Areas of work responsibility
|
|
Health management
|
3 (6%)
|
Disease surveillance
|
19 (38%)
|
Public health
|
14 (28%)
|
Health information
|
14 (28%)
|
Health management committee level
|
|
Sub county
|
18 (36%)
|
County
|
32 (64%)
|
Table 2
Participants’ consensus status on the importance of recommendation statements (N = 50)
Domains
|
Sub-domains
|
Statements
|
Consensus
|
Non-consensus
|
Neutral
|
|
|
|
n (%)
|
n (%)
|
n (%)
|
Core Functions
|
Case detection, registration and confirmation
|
Need to update surveillance guidelines currently in use at the sub-national level
|
49 (98)
|
-
|
1 (2)
|
|
|
Need to update the available PC-NTDs case definitions currently in use at the sub-national level
|
41 (82)
|
3 (6)
|
6 (12)
|
|
|
Training is required on practical application of the available PC-NTDs case definitions
|
50 (100)
|
-
|
-
|
|
|
Availing case registers specific for registering PC-NTD cases is necessary
|
35 (70)*
|
4 (8)
|
11 (22)
|
|
|
All PC-NTDs need confirmation at the lower surveillance levels
|
33 (66)*
|
4 (8)
|
13 (26)
|
|
|
Increased number of laboratories at lower surveillance levels to improve PC-NTDs case confirmation capacity
|
45 (90)
|
2 (4)
|
3 (6)
|
|
|
Need to properly equip laboratories at the health facility level to improve PC-NTDs case confirmation
|
49 (98)
|
-
|
1 (2)
|
|
Need to provide an adequate number of skilled laboratory health personnel for effective confirmation of PC-NTDs
|
50 (100)
|
-
|
-
|
Reporting
|
Need to ensure reporting forms are always readily available in all surveillance levels
|
50 (100)
|
-
|
-
|
|
Need to avail updated reporting guidelines at the sub-national level
|
49 (98)
|
-
|
1 (2)
|
|
Need to list all PC-NTDs in the existing reporting forms to improve surveillance data capture
|
45 (90)
|
-
|
5 (10)
|
|
Immediate reporting of PC-NTD cases is required to improve planned response actions
|
44 (88)
|
2 (4)
|
4 (8)
|
|
Need to adopt electronic reporting tools to improve transmission of PC-NTDs surveillance data to the next level
|
50 (100)
|
-
|
-
|
|
Frequent training on reporting PC-NTDs using existing reporting forms is required
|
50 (100)
|
-
|
-
|
|
Need to allocate adequate time for surveillance reports preparation and submission to the next levels
|
49 (98)
|
-
|
1 (2)
|
Data Analysis
|
Need to prioritise PC-NTDs surveillance data analysis at the sub-national level
|
49 (98)
|
-
|
1 (2)
|
|
Analysis of PC-NTDs surveillance data should be conducted on a routine-basis
|
42 (84)
|
4 (8)
|
4 (8)
|
|
Trend analysis of PC-NTDs reported cases should be undertaken periodically
|
45 (90)
|
-
|
5 (10)
|
|
Enhanced training on PC-NTDs surveillance data analysis is required
|
50 (100)
|
-
|
-
|
|
Clearly formulated PC-NTDs action thresholds are required
|
50 (100)
|
-
|
-
|
|
Need to provide adequate data analysis tools and equipment
|
50 (100)
|
-
|
-
|
Feedback
|
Need to prioritise feedback specifically regarding PC-NTDs surveillance data
|
50 (100)
|
-
|
-
|
|
Need for timely feedback on PC-NTDs surveillance data reported to the next level
|
50 (100)
|
-
|
-
|
|
Regular feedback on reported PC-NTDs surveillance data is required
|
47 (94)
|
-
|
3 (6)
|
|
Need to adapt improved electronic feedback mechanisms
|
49 (98)
|
-
|
1 (2)
|
|
Increased feedback on PC-NTDs to lower surveillance levels is required
|
46 (92)
|
-
|
4 (8)
|
Epidemic preparedness and response
|
Updated PC-NTDs outbreak preparedness and response protocols are required
|
50 (100)
|
-
|
-
|
|
Need for outbreak response teams to be well-constituted to respond to probable PC-NTDs outbreaks
|
47 (94)
|
1 (2)
|
2 (4)
|
|
Need for emergency supplies to adequately respond to probable PC-NTDs outbreaks
|
50 (100)
|
-
|
-
|
|
Regular training on PC-NTDs outbreak preparedness and response is required
|
50 (100)
|
-
|
-
|
Support Functions
|
Supervision
|
Need to prioritise supervision of PC-NTDs surveillance activities at the sub-national level
|
50 (100)
|
-
|
-
|
|
|
Regular supervision of PC-NTDs surveillance activities undertaken at the lower levels is required
|
46 (92)
|
-
|
4 (8)
|
|
|
Formulation of supervisory schedules for PC-NTDs surveillance activities is necessary
|
45 (90)
|
-
|
5 (10)
|
|
|
Increased frequency of supervisory visits at the lower surveillance levels is required
|
42 (84)
|
1 (2)
|
7 (14)
|
|
|
Training and sensitisation of all health workers regarding supervisory activities is required
|
46 (92)
|
2 (4)
|
2 (4)
|
|
|
Need for properly constituted supervisory teams to adequately supervise PC-NTDs surveillance activities
|
50 (100)
|
-
|
-
|
|
Need for adequate resource provision to support supervision of PC-NTDs surveillance activities
|
49 (98)
|
-
|
1 (2)
|
|
Need for increased participation of the community levels to support supervision of PC-NTDs surveillance activities
|
49 (98)
|
-
|
1 (2)
|
Training
|
Need to prioritise PC-NTDs in surveillance trainings conducted at the sub-national level
|
49 (98)
|
-
|
1 (2)
|
|
Regular training specifically on PC-NTDs surveillance activities is necessary
|
50 (100)
|
-
|
-
|
|
All health workers need to be involved in training on PC-NTDs surveillance activities
|
35 (70)*
|
3 (6)
|
12 (24)
|
|
Availing adequate training materials and equipment is necessary across all surveillance levels
|
50 (100)
|
-
|
-
|
|
Need to retain trained surveillance staff across all surveillance levels
|
50 (100)
|
-
|
-
|
Resources
|
Increased funding is required to support PC-NTDs surveillance activities
|
50 (100)
|
-
|
-
|
|
Availing electronic communication equipment for transmission of PC-NTDs surveillance data is required
|
50 (100)
|
-
|
-
|
|
Improved transport and logistical support is necessary to facilitate PC-NTDs surveillance activities
|
50 (100)
|
-
|
-
|
|
Increasing the number of health workers involved in PC-NTDs surveillance activities is necessary
|
41 (82)
|
5 (10)
|
4 (8)
|
|
Increasing the number of designated surveillance focal persons is required
|
33 (66)*
|
6 (12)
|
11 (22)
|
|
Need for to improve telecommunication channels to support transmission of surveillance data
|
49 (98)
|
1 (2)
|
-
|
|
Need for improved means of transportation to facilitate surveillance activities
|
50 (100)
|
-
|
-
|
Attribute Functions
|
Simplicity
|
Simplification of existing guidelines for completing reporting forms is required
|
46 (92)
|
-
|
4 (8)
|
|
|
Need to simplify available forms to ease reporting of PC-NTDs
|
36 (72)
|
-
|
14 (28)
|
|
Need to simplify PC-NTDs case definitions to ease application
|
42 (84)
|
-
|
8 (16)
|
|
Need to simplify methods for PC-NTDs surveillance data collection and analysis
|
44 (88)
|
-
|
6 (12)
|
Acceptability
|
Need for the health managers to support PC-NTDs surveillance activities in the region
|
50 (100)
|
-
|
-
|
|
PC-NTDs need to be considered of public health importance in the region
|
50 (100)
|
-
|
-
|
Stability
|
Need for challenges facing PC-NTDs surveillance activities to be addressed with minimal delays
|
50 (100)
|
-
|
-
|
|
Sufficient resources to support PC-NTDs surveillance activities are required
|
50 (100)
|
-
|
-
|
Flexibility
|
Need for existing surveillance systems to be well adapted to reporting all PC-NTDs in the region
|
50 (100)
|
-
|
-
|
|
|
Existing surveillance systems need to adapt easily to changes in PC-NTDs information needs
|
50 (100)
|
-
|
-
|
* - statements not achieving the > 70% consensus threshold |
Table 3
Participants’ consensus status on the feasibility of implementing recommendation statements (N = 50)
Domain
|
Sub-domains
|
Statements
|
Consensus
|
Non-consensus
|
Neutral
|
|
|
|
n (%)
|
n (%)
|
n (%)
|
Core Functions
|
Case detection, registration and confirmation
|
It is feasible update surveillance guidelines currently in use at the sub-national level
|
50 (100)
|
-
|
-
|
|
|
It is feasible to update the available PC-NTDs case definitions currently in use at the sub-national level
|
37 (82)
|
-
|
8 (18)
|
|
It is practical to train all health workers on the application of available PC-NTDs case definitions
|
31 (69)*
|
4 (9)
|
10 (22)
|
|
It is feasible to avail case registers specific for registering PC-NTD cases
|
19 (42)*
|
22 (49)
|
4 (9)
|
|
It is feasible to confirm all PC-NTDs at the lower surveillance levels
|
13 (29)*
|
23 (51)
|
9 (20)
|
|
It is practical to increase the number of laboratories at lower surveillance levels to improve PC-NTDs case confirmation capacity
|
16 (35)*
|
3 (7)
|
26 (58)
|
|
It is feasible to fully equip laboratories at the health facility level to improve PC-NTDs case confirmation
|
32 (71)
|
3 (7)
|
10 (22)
|
|
It is feasible to provide an adequate number of skilled laboratory health personnel for effective confirmation of PC-NTDs
|
39 (87)
|
-
|
6 (13)
|
Reporting
|
It is feasible to ensure reporting forms are always readily available in all surveillance levels
|
45 (100)
|
-
|
-
|
|
It is feasible to avail updated reporting guidelines at the sub-national level
|
44 (98)
|
-
|
1 (2)
|
|
It is feasible to list all PC-NTDs in the existing reporting forms to improve surveillance data capture
|
25 (55)*
|
3 (7)
|
17 (38)
|
|
It is feasible to ensure immediate reporting of PC-NTD cases to improve planned response actions
|
30 (66)*
|
2 (4)
|
13 (29)
|
|
It is feasible to adopt electronic reporting tools to improve transmission of PC-NTDs surveillance data to the next level
|
45 (100)
|
-
|
-
|
|
It is feasible to offer frequent training on reporting PC-NTDs using existing reporting forms
|
44 (98)
|
1 (2)
|
-
|
|
It is feasible to allocate adequate time for surveillance reports preparation and submission to the next levels
|
45 (100)
|
-
|
-
|
Data Analysis
|
It is feasible to prioritise PC-NTDs surveillance data analysis at the sub-national level
|
42 (93)
|
-
|
3 (7)
|
|
It is practical for analysis of PC-NTDs surveillance data to be conducted on a routine-basis
|
14 (31)*
|
22 (49)
|
9 (20)
|
|
It is practical to undertake trend analysis of PC-
NTDs reported cases periodically
|
27 (60)*
|
3 (7)
|
15 (33)
|
|
It feasible to enhance training on PC-NTDs surveillance data analysis
|
45 (100)
|
-
|
-
|
|
It is feasible to have clearly formulated PC-NTDs action thresholds
|
43 (95)
|
-
|
2 (4)
|
|
It is practical to provide adequate data analysis tools and equipment to all surveillance levels
|
44 (98)
|
-
|
1 (2)
|
Feedback
|
It is feasible to prioritise feedback specifically regarding PC-NTDs surveillance data
|
41 (91)
|
-
|
4 (9)
|
|
It is feasible to provide timely feedback on PC-NTDs surveillance data reported to the next level
|
44 (97)
|
-
|
1 (2)
|
|
It is feasible to provide regular feedback on reported PC-NTDs surveillance data
|
42 (93)
|
-
|
3 (7)
|
|
It is feasible to adapt improved electronic feedback mechanisms
|
45 (100)
|
-
|
-
|
|
It is practical to increase feedback on PC-NTDs to lower surveillance levels
|
41 (91)
|
-
|
4 (9)
|
Epidemic preparedness and response
|
It is feasible to provide all surveillance levels with updated PC-NTDs outbreak preparedness and response protocols
|
45 (100)
|
-
|
-
|
|
It is feasible to have well constituted outbreak response teams to respond to probable PC-NTDs outbreaks
|
43 (95)
|
-
|
2 (4)
|
|
It is feasible to provide adequate emergency supplies to respond to probable PC-NTDs outbreaks
|
41 (91)
|
-
|
4 (9)
|
|
It is feasible to provide regular training on PC-NTDs outbreak preparedness and response
|
45 (100)
|
-
|
-
|
Support Functions
|
Supervision
|
It is feasible to prioritise supervision of PC-NTDs surveillance activities at the sub-national level
|
41 (91)
|
-
|
4 (9)
|
|
|
It is feasible to provide regular supervision of PC-NTDs surveillance activities undertaken at the lower levels
|
23 (51)*
|
2 (4)
|
20 (44)
|
|
It is feasible to formulate supervisory schedules for PC-NTDs surveillance activities
|
45 (100)
|
-
|
-
|
|
It is feasible to increase the frequency of supervisory visits to the lower surveillance levels
|
10 (22)*
|
20 (45)
|
15 (33)
|
|
It is practical to train and sensitise all health workers regarding supervisory activities
|
43 (95)
|
1 (2)
|
1 (2)
|
|
It is feasible to properly constitute supervisory teams to adequately supervise PC-NTDs surveillance activities
|
45 (100)
|
-
|
-
|
|
It is feasible to ensure there is adequate resource provision to support supervision of PC-NTDs surveillance activities
|
44 (98)
|
-
|
1 (2)
|
|
It is practical to increase community participation to support supervision of PC-NTDs surveillance activities
|
44 (98)
|
-
|
1 (2)
|
Training
|
It is feasible to prioritise PC-NTDs in surveillance trainings conducted at the sub-national level
|
44 (97)
|
-
|
1 (2)
|
|
It is feasible to provide regular training specifically on PC-NTDs surveillance activities
|
39 (87)
|
-
|
6 (13)
|
|
It is feasible to involve all health workers in training on PC-NTDs surveillance activities
|
7 (16)*
|
22 (48)
|
16 (35)
|
|
It is practical to avail adequate training materials and equipment across all surveillance levels
|
45 (100)
|
-
|
-
|
|
It is feasible to retain trained surveillance staff across all surveillance levels
|
12 (27)*
|
24 (53)
|
9 (20)
|
Resources
|
It is feasible to increase funding to support PC-NTDs surveillance activities
|
34 (75)
|
-
|
11 (24)
|
|
It is feasible to provide electronic communication equipment for transmission of PC-NTDs surveillance data
|
45 (100)
|
-
|
-
|
|
It is feasible to improve transport and logistical support to facilitate PC-NTDs surveillance activities
|
45 (100)
|
-
|
-
|
|
It is practical to increase the number of health workers involved in PC-NTDs surveillance activities
|
18 (40)*
|
2 (4)
|
25 (56)
|
|
It is feasible to increase the number of designated surveillance focal persons
|
17 (38)*
|
18 (40)
|
10 (22)
|
|
It is feasible to improve telecommunication channels to support transmission of surveillance data
|
45 (100)
|
-
|
-
|
|
|
It is feasible to improve means of transportation to facilitate surveillance activities
|
45 (100)
|
-
|
-
|
Attribute Functions
|
Simplicity
|
It is feasible to simplify existing guidelines for completing reporting forms
|
45 (100)
|
-
|
-
|
|
|
It is practical to simplify available forms to ease reporting of PC-NTDs
|
45 (100)
|
-
|
-
|
|
|
It is practical to simplify PC-NTDs case definitions to ease application
|
37 (82)
|
-
|
8 (18)
|
|
|
It is feasible to simplify methods for PC-NTDs surveillance data collection and analysis
|
45 (100)
|
-
|
-
|
|
Acceptability
|
It is feasible for the health managers to support PC-NTDs surveillance activities in the region
|
45 (100)
|
-
|
-
|
|
|
It is feasible to influence health workers’ perceptions on the public health importance of PC-NTDs in the region
|
43 (96)
|
-
|
2 (4)
|
|
Stability
|
It is feasible to address challenges facing PC-NTDs surveillance activities with minimal delays
|
36 (80)
|
3 (7)
|
6 (13)
|
|
|
It is feasible to avail sufficient resources to support PC-NTDs surveillance activities
|
44 (98)
|
1 (2)
|
-
|
|
Flexibility
|
It is feasible for the existing surveillance systems to be well adapted to reporting all PC-NTDs in the region
|
32 (71)
|
2 (4)
|
11 (24)
|
|
|
It is feasible for the existing surveillance systems to adapt easily to changes in PC-NTDs information needs
|
33 (73)
|
3 (7)
|
9 (20)
|
* - statements not achieving the > 70% consensus threshold |
Surveillance core activities
Stakeholders agreed on the importance and feasibility of updating surveillance guidelines currently in use at the sub-national levels and were further in consensus on the need to update the available standard case definitions for PC-NTDs. Further, participants agreed on the importance of training health workers on practical use of the standard case definitions. However, there was non-consensus on the feasibility of training all health workers on use of PC-NTDs standard case definitions. There was further non-consensus on the importance (70%) and feasibility (42%) of providing case registers specific for registration of PC-NTDs cases.
“Having in place case registers for registering PC-NTDs only may not be practical and cost effective since we have many other conditions to be registered and it would be easier to do this using one common register” (Participant 5)
“It is only feasible to issue facilities designated as treatment sites with the registers since they receive NTD patients more often compared to the other facilities” (Participant 16)
“Providing registers specific for NTDs to all levels might require additional resources which are currently unavailable” (Participant 32)
Furthermore, participants disagreed on the need and feasibility of confirming all the PC-NTDs cases at the lower surveillance levels. Nonetheless, participants reached consensus (90%) on the importance of increasing the number laboratory facilities at the peripheral levels to confirm PC-NTDs, although there was non-consensus on the practicability of having additional laboratories at lower surveillance levels.
“It will not be quite possible to always confirm all the NTDs due to low capacity of the lower levels to undertake case confirmation due to unavailability of laboratory facilities” (Participant 4)
“Confirmation of all PC-NTDs at the lower levels would require increased provision of laboratory facilities and equipment in the region to achieve this target” (Participant 8)
“Confirming all cases requires adequate supply of laboratory reagents and supplies that may not be the case for most of the lower levels” (Participant 29)
There was agreement among stakeholders on the importance and feasibility of adequately equipping existing laboratories at the facility level and providing sufficient number of skilled laboratory personnel to enhance PC-NTDs case confirmation.
Further findings showed agreement on the importance and feasibility of ensuring reporting forms are always readily available and on providing updated reporting guidelines across all surveillance levels. Stakeholders were also in consensus on the importance (90%) of listing all the PC-NTDs in the reporting forms but there was non-consensus on the feasibility of including all the diseases in the existing report forms. Further, participants agreed (88%) on the need to ensure immediate reporting of PC-NTD cases to improve planned response actions. However, there was non-consensus on the achievability of immediate case reporting on first detection. There was unanimity among stakeholders on the importance and feasibility of adopting electronic reporting tools to improve transmission of PC-NTDs surveillance data. Participants further reached consensus on the significance and practicality of providing regular training on PC-NTDs reporting and allocating ample time for preparation and submission of surveillance reports.
Stakeholders had a converging opinion on the importance (98%) and feasibility (93%) of prioritising analysis of PC-NTD surveillance data. Participants also agreed on the need to conduct routine data analysis and undertake periodic trend analysis for PC-NTDs. However, there was lack of consensus on the practicability of conducting regular data analysis and periodic assessment of PC-NTDs trends.
“Analysis of PC-NTDs data may not be routinely done due to other competing activities but can be done whenever there is an increased number of cases in the region” (Participant 5)
“We first need to improve the quality and quantity of data collected on PC-NTDs to be able to undertake routine analysis of these data” (Participant 9)
Moreover, participants were in consensus on the importance and practicality of enhancing training on data analysis, formulation of coherent action thresholds and provision of sufficient data analysis tools and equipment considering PC-NTDs.
There was consensus among stakeholders on the importance and feasibility of prioritising feedback specific to PC-NTDs and providing timely and regular feedback across all surveillance levels. In addition, participants agreed on the need and practicality of adopting electronic feedback mechanisms and enhancing feedback on PC-NTDs to lower surveillance levels. Agreement was also reached on the importance and possibilities of updating outbreak preparedness and response protocols for all PC-NTDs and having well-constituted outbreak response teams at the sub-national level to adequately respond to PC-NTDs outbreaks. Participants further reached consensus on the need and feasibility of provision of sufficient emergency supplies in anticipation of probable outbreaks and providing frequent training on PC-NTDs epidemic preparedness and response.
Surveillance support activities
Stakeholders reached consensus on the importance (100%) and feasibility (91%) of prioritising supervision of PC-NTDs surveillance activities at the sub-national levels. There was further agreement on the need to undertake regular supervision of surveillance activities concerning PC-NTDs and heightening the frequency of supervisory visits at the peripheral levels. However, participants disagreed on the feasibility (51%) of consistently conducting supervision of surveillance activities and there was lack of consensus (22%) on the possibility of increasing the frequency of supervisory visits at the lower levels.
“Conducting regular supervision of surveillance activities requires resources for transportation and purchase of other materials which may not be feasible at this time due to other priority activities” (Participant 12)
“Due to the nature of the region which has very poor terrain, this pose a challenge to accessing some of the remote regions and conducting frequent supervision at the peripheral levels may not be practical” (Participant 16)
Participants were in consensus on the necessity and feasibility to formulate supervisory schedules, train all health personnel on supervisory activities and establish supervisory teams capable of providing support supervision for PC-NTDs surveillance activities. Moreover, stakeholders agreed on the importance and practicality of resource provision to support supervisory activities and involvement of the community levels to support supervision of PC-NTDs surveillance activities.
“Support supervision should be strengthened especially at the peripheral levels with the involvement of the community units throughout the process” (Participant 13)
“Supervision of surveillance activities at the peripheral level requires the involvement of community health workers working within a functional community health unit” (Participant 21)
Stakeholders had converging points of view on the importance and practicality of prioritising and providing regular training on PC-NTDs surveillance activities. Participants further agreed on the need and feasibility of availing sufficient training materials and tools across all surveillance levels. However, participants ruled out consensus on the importance (70%) and possibilities (16%) of involving all health workers in training concerning surveillance activities for PC-NTDs.
“Involving all the health workers in the region in surveillance training might not be cost effective and practical given the scarcity of resources set aside for conducting training” (Participant 2)
“This may not be feasible but we only need to ensure that an adequate number of staff are trained on surveillance of NTDs that are common in the region then they can pass on the knowledge gained to other health workers in their area of work” (Participant 39)
There was unanimity on the importance of limiting high turnover of surveillance staff. However, stakeholders disagreed (53%) on the feasibility of retaining trained surveillance personnel across all surveillance levels.
“Retention of health workers across surveillance levels may not be feasible since health workers are frequently transferred whenever there is need to adjust to given work circumstances” (Participant 3)
“This might not be feasible since staff progression and transfers normally happen regularly so it is better to train other staff to replace the ones transferred” (Participant 37)
The stakeholders concurred on the need and feasibility of increased funding provision and logistical support for PC-NTDs surveillance activities and provision of electronic communication equipment for transmission of surveillance data. There was also consensus (82%) on the importance of involving more health personnel in PC-NTDs surveillance activities but from a practical perspective, there was lack of consensus (40%) among stakeholders on providing additional staff to be engaged in the surveillance activities. There was further lack of consensus on the importance (66%) and feasibility (38%) of increasing the number of designated surveillance focal persons.
“This may not be feasible due to lack of adequate resources to have additional staff and since we already have enough surveillance coordinators in the region” (Participant 30)
“This might lead to duplication of roles of the surveillance staff already in post, so the available staff should be able to handle all surveillance issues efficiently” (Participant 38)
Additionally, stakeholders concurred on the need and feasibility of improving the surveillance data transmission and communication channels and providing reliable means of transport to facilitate surveillance activities.
Surveillance attributes
Recommendation statements on improving simplicity, acceptability, stability and flexibility of the surveillance system concerning PC-NTDs were assessed in the two rounds. Findings showed that participants reached consensus regarding the importance and feasibility of simplifying existing reporting guidelines and forms, simplifying PC-NTDs case definitions for ease of application by health workers and simplifying methods of data collection and analysis of surveillance data. Further, there was unanimity among stakeholders on the need and practicability for health managers across all levels to support PC-NTDs surveillance activities and for all health workers to consider PC-NTDs of public health importance in the endemic regions. In addition, participants agreed on the need and feasibility of promptly addressing challenges facing PC-NTDs surveillance activities and provision of adequate resources to support surveillance of the neglected tropical conditions. Stakeholders also reached consensus on the importance and feasibility of the existing surveillance system to adapt to reporting all PC-NTDs and for the system to adapt to changes in information needs regarding the diseases.
Sensitivity analysis was undertaken with the assumption that participants with neutral responses were in agreement with the recommendation statements on both perspectives of importance and feasibility (Tables 4 & 5). Considering this scenario, findings indicated that stakeholders reached consensus on the importance of availing case registers specific for PC-NTDs but all the same disagreed (51%) on the feasibility of providing the case registers. Furthermore, there was consensus on the importance of confirming the cases but there was still lack of consensus (49%) on the feasibility of confirming all PC-NTDs cases at the lower surveillance levels. Stakeholders further reached consensus on the importance of involving all health personnel in training on PC-NTDs surveillance activities and increasing the number of health workers involved in surveillance activities having assumed that those with neutral responses were in agreement with the statements. Further sensitivity analysis indicated that participants were in consensus on the feasibility of training all health workers on applying the available standard case definitions for PC-NTDs, increasing the number of laboratories at the lower levels, including all PC-NTDs in the existing reporting forms, ensuring immediate reporting and undertaking periodic trend analysis concerning PC-NTDs. However, further findings showed that stakeholders still lacked consensus on the feasibility of conducting routine data analysis for PC-NTDs surveillance data, increasing the frequency of supervisory visits at the lower surveillance levels, involving all health workers in surveillance training, retaining trained surveillance staff and increasing the number designated surveillance focal persons.
Table 4
Sensitivity analysis of non-consensus statements in the first round (N = 50)
Statements
|
Scenario 1: ‘Neither agree nor disagree’ excluded in analysis
|
Scenario 2: ‘Neither agree nor disagree’ included in analysis
|
|
Consensus
|
Non-consensus
|
Neutral
|
Consensus
|
Non-consensus
|
Availing case registers specific for registering PC-NTD cases is necessary
|
35 (70)*
|
4 (8)
|
11 (22)
|
46 (92)
|
4 (8)
|
All PC-NTDs need confirmation at the lower surveillance levels
|
33 (66)*
|
4 (8)
|
13 (26)
|
46 (92)
|
4 (8)
|
All health workers need to be involved in training on PC-NTDs surveillance activities
|
35 (70)*
|
3 (6)
|
12 (24)
|
47 (94)
|
3 (6)
|
Increasing the number of designated surveillance focal persons is required
|
33 (66)*
|
6 (12)
|
11 (22)
|
44 (88)
|
6 (12)
|
* - statements not achieving the > 70% consensus threshold |
Table 5
Sensitivity analysis of non-consensus statements in the second round (N = 50)
Statements
|
Scenario 1: ‘Neither agree nor disagree’ excluded in analysis
|
Scenario 2: ‘Neither agree nor disagree’ included in analysis
|
|
Consensus
|
Non-consensus
|
Neutral
|
Consensus
|
Non-consensus
|
It is practical to train all health workers on the application of available PC-NTDs case definitions
|
31 (69)*
|
4 (9)
|
10 (22)
|
41 (91)
|
4 (9)
|
It is feasible to avail case registers specific for registering PC-NTD cases
|
19 (42)*
|
22 (49)
|
4 (9)
|
23 (51)*
|
22 (49
|
It is feasible to confirm all PC-NTDs at the lower surveillance levels
|
13 (29)*
|
23 (51)
|
9 (20)
|
22 (49)*
|
23 (51)
|
It is practical to increase the number of laboratories at lower surveillance levels to improve PC-NTDs case confirmation capacity
|
16 (35)*
|
3 (7)
|
26 (58)
|
42 (93)
|
3 (7)
|
It is feasible to list all PC-NTDs in the existing reporting forms to improve surveillance data capture
|
25 (55)*
|
3 (7)
|
17 (38)
|
42 (93)
|
3 (7)
|
It is feasible to ensure immediate reporting of PC-NTD cases to improve planned response actions
|
30 (66)*
|
2 (4)
|
13 (29)
|
43 (95)
|
2 (4)
|
It is practical for analysis of PC-NTDs surveillance data to be conducted on a routine-basis
|
14 (31)*
|
22 (49)
|
9 (20)
|
23 (51)*
|
22 (49)
|
It is practical to undertake trend analysis of PC-NTDs reported cases periodically
|
27 (60)*
|
3 (7)
|
15 (33)
|
42 (93)
|
3 (7)
|
It is feasible to provide regular supervision of PC-NTDs surveillance activities undertaken at the lower levels
|
23 (51)*
|
2 (4)
|
20 (44)
|
43 (95)
|
2 (4)
|
It is feasible to increase the frequency of supervisory visits to the lower surveillance levels
|
10 (22)*
|
20 (45)
|
15 (33)
|
25 (55)*
|
20 (45)
|
It is feasible to involve all health workers in training on PC-NTDs surveillance activities
|
7 (16)*
|
22 (48)
|
16 (35)
|
23 (51)*
|
22 (48)
|
It is feasible to retain trained surveillance staff across all surveillance levels
|
12 (27)*
|
24 (53)
|
9 (20)
|
21 (47)*
|
24 (53)
|
It is practical to increase the number of health workers involved in PC-NTDs surveillance activities
|
18 (40)*
|
2 (4)
|
25 (56)
|
43 (96)
|
2 (4)
|
It is feasible to increase the number of designated surveillance focal persons
|
17 (38)*
|
18 (40)
|
10 (22)
|
27 (60)*
|
18 (40)
|
* - statements not achieving the > 70% consensus threshold |