الفهرس 
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Abstract
Integrated Disease Surveillance and Response (IDSR) system is one world health strategy promotes the integration and coordination within and across sectors for disease surveillance, outbreak investigation and response activities undertaken by professionals from various fields. It is a strategy that ensures the strengthening of each sector and enhances intersectoral linkages to facilitate efficient utilization of scarce resources, effective and prompt leveraging of various sectors capabilities for a better disease prevention and control. The objectives of the IDSR system are to conduct effective surveillance activities, to integrate multiple surveillance systems. In addition to use resources more efficiently, to improve the use of information for detecting, investigating and responding to public health threats, and to improve the flow of surveillance information throughout the healthcare system through each health facility level.
Objective of study:
Assessment of the core activities and support functions of IDSR system in all health facilities in Thamar Governorate, Yemen.
Materials and methods:
For the purpose of the present cross-sectional study and after obtaining the official approval of the MOHP to carry out the study, the researcher visited the Public Health and Population Office in Thamar Governorate and the general administration for disease control and Surveillance, all district RRTs and all public health facilities with health personnel responsible for IDSR (47 health units, 58 health centers, 21 hospital,4 clinic and11 dispensary).
The target was persons responsible for the surveillance in all the study settings and components of the IDSR system.
The data collection methods and tools included:
• Questionnaire for studying IDSR core activities and support functions in Thamar Governorate completed from responsible workers in all levels.
This tool included structure of IDSR, case conformation, data reporting, data analysis, outbreak investigation, epidemic preparedness, epidemic responses, feedback, supervision, training, co-ordination, logistics and human resources.
• IDSR records review (available in the governorate and districts levels) of the preceding year.
The collected data was entered, after coding, to the computer using the SPSS package version 21 and descriptive statistics including frequency distribution and percentage were calculated.
Results:
1. Assessment of IDSR core activities revealed that distribution of health facilities according to type and classification. As regards classification of health facility, it indicates that 76.6% of health facilities were public health facilities, while23.4% were private facilities. As regards the type of health facility operating in IDSR program, health centers represented the highest percentage (41.2%), of the total health facilities, followed by health units (33.3%) while hospitals represented only (14.9%).
According to the availability of manual IDSR program guidelines, they were not percent in all three levels. On the other hand availability of a mandatory surveillance for any diseases was present in all three levels.
The capacity of specimens transport to a higher level lab occurred in (100%) at both governorate and district level, while health facilities lacked the capacity of specimens transfer. All governorate managers, all district level RRT and (86.5%) of focal persons working in health facilities confirmed availability of guidelines for specimen collection, handling and transportation to the next level. Follow up of specimen’s results occurred in 100% of both governorate and district levels while occurred in (28.4%) of health facility level. All managers in governorate level, (91.7%) of RRT in district level and (46.1%) of focal persons at health facility level reported lack of recommended IDSR forms. The main reason for this lack is non-availability of these forms at the national level.
The study revealed the data analysis was described by person age, sex, place and time according to 100% of governorate’s managers and RRTs district while this was not applicable in health facility level.
2. Assessment of support functions of IDSR program revealed that the great preparation of managers at governorate level (72.7%) producing of IDSR feedback report routinely and distributed copies to staff at this level and to higher and lower level. IDSR feedback reports were received from higher levels at governorate, district and health facility levels completely. Lesser proportion of focal persons at health facility level (24.1%), greater proportion of RRT members at district level (75%) and all managers at governorate level stated that there were regular supervision visits from higher levels. Further than more, all managers at governorate level, the majority of RRT members at district level (95%) and greater proportion of focal persons at health facility level (80.1%) received post basic training in IDSR program.
More than half of health workers at health facility level stated that there are enough staff available at their level while all managers at governorate level and all rapid response teams at district level stated that there are not enough staff available at their level. All participants at all levels reported that there was not available budget in IDSR program. The only resource that was available at all levels was telephone (cellphone for data reporting)