This paper reviews the experiences of the Combatting Child Communicable Disease (CCCD) project with routine epidemiologic surveillance in 13 sub-Saharan African countries from 1981 to 1993, and presents lessons learned. After briefly reviewing the historical aspects of epidemiologic surveillance in sub-Saharan Africa, the paper discusses the key attributes and issues facing epidemiologic surveillance systems and describes three types of facility-based reporting systems (single site, sentinel, and universal). Several examples of each type of surveillance system are cited, and the structure of CCCD’s approach to surveillance is placed within the context of development of overall health information systems. Lessons learned from this review include the following. (1) Routine epidemiological surveillance provides an important segment of information needed to support public and child survival programs. (2) These systems must be supplemented by or include management and health service delivery information, special surveys, applied research, outbreak investigations, and program monitoring and evaluation activities. They work best when they are integrated with other elements of the health information system. (3) Support of surveillance systems is best assured if the Ministry of Health (MOH) creates a budget line item and allocates specific resources for their maintenance. (4) Every effort to should be made to ensure the quality of the data collected, reported, analyzed, communicated, and used as the basis of decisions. Pertinent concerns include the development of standardized case definitions, simplification of data collection, and development of supervisory systems. (5) MOH staff should receive training in areas relevant to surveillance — epidemiology, data management, and communication. (Author abstract, modified)
