Evaluation through outbreak simulation exercise points to need for considerable improvement in the capacity of peripheral health workers for outbreak detection and response, South India, 2018

  • Occupational and environmental health
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Background:
Outbreaks are emergencies, requiring skilled peripheral health workers in the health system. Performance during outbreaks bring out skills of health workforce at different levels of the health system. In view of the lack of evaluations of knowledge and practices of peripheral health workers regarding outbreak investigation and response, we conducted a survey to estimate the performance level of health workers in outbreak detection and response.

Methods:
Using inputs from the manual of India’s Integrated Disease Surveillance Programme (2015) for health workers and following expert discussions, we developed a simulation exercise based on hepatitis and fever outbreak to ascertain knowledge and skills in outbreak detection and response. Following pilot-test, we finalised the instrument in the local language. In an outbreak investigation, health sector plays the first role in detection and response. Hence the simulation exercise was self-administered among all health inspectors (n=39) responsible for outbreak investigation working in a district in South India. We collected socio-demographic factors, training, education level, awareness about the surveillance program, outbreak triggers and prior experience with an outbreak. We assigned 0.25 score for each correct response (Range: 0 to 10.75). We categorised score of < 75% as poor performance. Academic ethics committee of ICMR-National Institute of Epidemiology approved the protocol.

Results:
All the health inspectors were male except one. Median age was 51 years [Interquartile range (IQR) 37.5-54). Median years of service was 12 (IQR 5.3-23), 22 received training and 15 had prior exposure to an outbreak in the previous year. Overall performance of health staff was poor with the highest mark being below 40%. Median score in section of history taking was 0.25 [IQR: 0-0.5], 31% (n=12) scored zero. The median score in the section of data entry, analysis and outbreak detection was 0.25 (IQR 0-0.25), 28% (n=11) scored zero. Median score in section of outbreak response was 0.75 (IQR 0.75-1.13), 5% (n=2) scored zero.

Conclusion:
Peripheral health workers performed poorly in a simulation exercise on outbreak preparedness and response. Currently, practices of outbreak investigation are taught through traditional methods. We recommend practical field epidemiology training with periodic field/facility-based evaluations to improve their performance.

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