ESSENTIAL PUBLIC HEALTH FUNCTIONS EPHF 2 
EPHF 2: Surveillance, research and control of the risks and threats to public health
This function includes:
• The capacity to carry out research and surveillance of epidemic outbreaks and communicable and non-communicable diseases models, behavioral factors, accidents, and exposure to toxic substances or environmental agents detrimental to health.
• The infrastructure of public health services designed to support the elaboration of population analyses, case studies, and general epidemiological research.
• Public health laboratories capable of performing fast analyses and processing large volumes of tests to identify and control new health threats.
• The development of active programs for epidemiological surveillance and infectious disease control.
• The capacity to connect with international networks that make it possible to better tackle the health problems of greatest concern.
• Strengthening and preparation of the NHA’s ability to conduct surveillance at a local level and produce rapid responses to control health problems or specific risks.
Indicators:
1. Surveillance system that identifies public health threats.
2. Competence and knowledge of epidemiology.
3. Capacity of public health laboratories.
4. Ability to respond to public health problems in a timely and effective manner.
5. Advisory services and technical support for the sub-national entities of public health.
EPHF 2: Regional Measurement Results
This function performed better in the Region, with a median of 0.63. The median distribution histogram of the measurement performance approaches normal and shows consistency.
Most indicators revealed a performed above 50%. The strongest areas include adequate surveillance systems to identify public health threats, the capacity of public health laboratories, and support at the sub-national level. The main weakness is the lack of timely and effective responses to control public health problems, as the following table demonstrates:
The indicator on timely and effective response showed the greatest variation in results. Although this indicator is generally a critical area for the Region, it performed well in some of the countries. The first indicator, public health surveillance systems, was identified as a strong area as it showed the least variation in performance. Other indicators exhibited intermediate variation, as shown in the following graph:
The primary factors determining this function’s performance are:
• Surveillance systems identify the magnitude and nature of health threats, the monitoring of adverse circumstances and risks over time, the detection of threats that require a response, and the analysis of disease trends considered national priorities. Surveillance systems involve sub-national entities while also integrating themselves into supranational surveillance networks. However, these systems do not report any information produced by personnel outside of the public sector (such as private providers, NGO’s, etc.).
• Most countries have defined the functions and responsibilities of the various levels, especially at the local level.
• Weaknesses were observed in the evaluation of the quality of data produced by the surveillance systems. Also, a limited number of countries have established a formal feedback mechanism to monitor the performance of these surveillance systems.
• Most countries have developed protocols to identify the principal public health threats of each country.
• Most countries have trained personnel to monitor basic sanitation and infectious diseases, conduct evaluations and fast screenings, and design new surveillance systems for potential problems. A smaller number of countries (24%) have geographic information systems to support surveillance. The greatest weaknesses are in the lack of experienced and knowledgeable personnel, epidemiological research of chronic diseases, accidents, occupational and mental health, and accidents. These areas represent the major health challenges for the Region of the Americas.
• An identified critical area is the lack of incentive and recognition mechanisms to promote good performance among the public health surveillance teams.
• Although the vast majority of countries give examples of public health threats that were detected in a timely fashion within the past two years, only one-third of the countries evaluated the response capacity of the surveillance system, disseminated the results, and supervised the implementation of corrective measures.
• Countries maintain an updated registry of public health laboratories, have formal coordination and reference mechanisms, and periodically evaluate the quality of diagnoses through the use of international laboratories as parameters. However, weaknesses in laboratory coordination and reference mechanisms still exist, and most countries do not fulfill regulations to guarantee the quality of its laboratories.• In all countries, the NHA advises and provides support at the sub-national level to develop and strengthen their surveillance capacity.