Evaluation of Measles Surveillance Systems in Ginnir District, Bale Zone, Southeast Ethiopia: A Concurrent Embedded Mixed Quantitative/Qualitative Study

BACKGROUND: Public health surveillance systems should be evaluated periodically to ensure the problems of public health importance are being monitored efficiently and effectively. Despite the widespread measles outbreak in Ginnir district of Ethiopia in 2019, an evaluation of measles surveillance systems has not been conducted. Therefore, we evaluated the performance of measles surveillance systems and key attributes in Ginnir district, Southeast Ethiopia. METHODS: We conducted a concurrent embedded mixed quantitative/qualitative study in August 2019 among 15 health facilities/study units in Ginnir district. The qualitative study involved a purposively selected 15 key-informants. Data were collected using updated guidelines for evaluating surveillance systems based on CDC’s Framework. RESULTS: Records of 15 study units were reviewed and 15 key informants participated. The structure of surveillance data flow was from the community to the respective upper level. Emergency preparedness and a response plan was available only at the district level. Weekly report completeness and timeliness were 95% and 87% respectively. We found weak supportive supervision and feedback, and no regular analysis and interpretations of surveillance data. The participation of surveillance stakeholders in implementation of the system was good. The surveillance system was found to be useful, easy to implement, representative, and can accommodate and adapt to changing operating conditions. Report documentation and quality of data was poor at lower level health facilities. The stability of the system has been challenged by a shortage of budget, logistics, staff turnover and lack of update trainings. CONCLUSION: The surveillance system was acceptable, useful, simple, flexible, and representative. Quality of data, timeliness, and the stability of the system were attributes that require improvement. The overall performance of measles surveillance systems in prevention and control of measles was weak. Hence, regular analysis of data, preparation, and dissemination of epidemiological bulletin, capacity building, and regular supervision and feedback are recommended to enhance performance of the system.