Abstract
The public health surveillance has evolved both in topics and in methods along with the rapid developments in information technology, increases the potential linkage between public health authorities and healthcare providers, which developed a surveillance capability that is timely and more effective. From its original function of monitoring emergent infectious diseases, it expanded its scope into tracking nascent noninfectious threats (e.g. injuries, chronic diseases, mental illness, birth defects, drug abuse, etc.) while keeping its fundamental objective of providing crucial data for defensive public health interventions. Moreover, the expanded health surveillance program include postnatal children and the family. It is, however, facing challenges with the growing public health data and the increasing technological sophistication, which resulted to shortages in skilled employees and data access and management. The new health surveillance has strained the primary health system as its scope grew and became more complex with inadequate nurse workforce and insufficient knowledge in developmental childcare. The public health surveillance must be redefined to meet the current child healthcare needs.
Introduction
Since 2001, public health surveillance has evolved both in topics and in methods, largely spurred by rapid developments in information technology, particularly the proliferation of data archiving systems, such as electronic health records (EHRs) (Buehler, 2012; Thacker, Qualters, & Lee, 2012). EHRs increase the potential linkage between public health authorities and healthcare providers, which developed a surveillance capability that is timely and more effective. Public health surveillance today no longer just monitor emergent infectious diseases like centuries earlier (Thacker, Qualters, & Lee, 2012). It now tracks nascent noninfectious threats to public health, including injuries, chronic diseases, mental illness, birth defects, drug abuse, and other health risks in the environment and at work. The fundamental objective of public health surveillance, however, remained the same: providing information of the health of citizens that will be used to detect problems and improve public health (Hall, et al., 2012), including the minimization of damages (Yakuwa, et al., 2015), and safeguard their privacy (Buehler, 2012).
Parallel changes in child health surveillance, also information technology-driven, is occurring as well in the United States and around the world. In Brazil, for instance, these changes have altered the determinants of childhood diseases, particularly the social determinants (e.g. economic disadvantages, social inequities, etc.) (Yakuwa, et al., 2015).
Child healthcare is supposed to be an integral part of public health surveillance. However, the idea of child health surveillance remains an underdeveloped approach to primary healthcare programs, which primarily focuses on maternal healthcare, or at least only after delivery from prenatal care of the mother and the developing fetus. This project aims to explore the development and current state of child healthcare and child health surveillance as a unique primary healthcare program in public health delivery.
Health surveillance
Choi (2012) identified five functions of any public health system: (1) population health assessment; (2) health protection; (3) disease and injury prevention; (4) health promotion; and (5) health surveillance. Often referred to as the cornerstone of public health service, health surveillance is a fundamental element in public health assessment (Thacker, Qualters, & Lee, 2012). It involves the systematic and continuing collection, analysis, and interpretation of public data with an ultimate aim of motivating public health action. These data, however, have broad applications in public health. Data can be used to detect emerging epidemics and other public health problems; estimate the extent of these problems; facilitate public health planning; evaluate prevention and control measures; and even detect the evolution of healthcare practices (Hall, et al., 2012). In effect, public health surveillance takes the foundational role in public health planning and decision making. Nonetheless, the value of public health surveillance relates directly to the effectiveness and the efficiency in the delivery of useful information that will help improve public health delivery (Hall, et al., 2012; Thacker, Qualters, & Lee, 2012).
The Center for Disease Control and Protection (CDC), however, observed challenges in the growing volume of public health data and the increasing sophistication of information technology, such as availability of skilled workforce, access and use of data, and their management, storage and analysis (Thacker, Qualters, & Lee, 2012).
Nevertheless, one important objective of health surveillance is to integrate child healthcare into the broader health surveillance program (Yakuwa, et al., 2015). The broader objective is not merely to integrate child healthcare but also to provide healthcare to the people these children live with; that is, the family itself.
Child health
Children’s health may be viewed essentially as healthcare focus on the health development of the child from prenatal care and postnatal care to developmental care until at a minimum of two years when the child is highly vulnerable to developmental problems (Reichert, et al., 2015). This initial years of life are significant due to the profound changes that the child undergo both physical, psychological, and neuromotor. Thus, child healthcare in this period is significant in preventing potential developmental problems later on.
A study in Brazil indicated that the primary health center (PHC) ordinarily provide consultations on weight determination, vaccination access, and nutritional counseling (Reichert, et al., 2015). However, sense most mothers rarely visit the PHC to avail on these assistance, developmental deviations are detected only once already well-developed and even already showing severe symptoms; thus, already belatedly. Late discovery of developmental impairments consequently makes it more difficult to manage or treat the impairments.
Inclusion of child health surveillance into the broader program of public health surveillance can help avoid delayed diagnosis of developmental impairments. Blair and Hall (2006) identified three objectives of child health surveillance, name: (a) disease prevention; (b) abnormality detection; and (c) promotion of optimal health and development. Surveillance may include promotion of normal child development while detecting signs of developmental problems (Reichert, et al., 2015). This program can involve groups of people that are directly in contact with the children in their usual environment, such as parents, teachers, guardians, and healthcare professionals, either primary or private healthcare practitioners or both (Reichert, et al., 2015; Yakuwa, et al., 2015). All this stakeholders to the health of the child should be educated in supporting the normal child development and in detecting deviations.
Nursing practice
This approach, however, had been known to strain the primary healthcare nurses as the burden to care for the entire family demands heavily upon their resources, including time. The condition leaves nurses unable to adequately plan their strategy and simply react on the needs as they occur. A survey among nurses indicated that implementation of a family healthcare program is facing greatest difficulties in the provision of services, which current availability of healthcare professionals, including nurses, cannot sustain (Yakuwa, et al., 2015).
Moreover, studies (Reichert, et al., 2015; Ertem, et al., 2009) indicated that primary healthcare nurses have inadequate knowledge on the important milestones in child development and the capability to recognize indicators of developmental deviations and signs of emerging impairments. Thus, from the nursing perspective, the shift to the family healthcare model demands both adequate number of healthcare providers with adequate competency in understanding the developmental needs of each member of the family, not only the children.
Summary
Along with the advances in information science and technology, the approach to health surveillance is facing enormous changes, which shifted the focus of public healthcare from the more reactive monitoring of disease events to the proactive detection of the signs of emerging diseases as well as non-disease events, such as injuries, mental illness, birth defects, and substance abuse (Thacker, Qualters, & Lee, 2012). Challenges also have been encountered with the growing volume of public health data and the increasing sophistication of information technology (e.g. availability of skilled workforce, access and use of data, and their management, storage and analysis). The need for the inclusion of child health surveillance has also been observed, not separately from the other members of the family, but with them.
Moreover, there is also an increasing interest in extending child healthcare from prenatal to postnatal up to the first two years of life at the minimum. The introduction of the family healthcare program, however, resulted into overwhelming service loads among primary healthcare providers, particularly the nurses, primarily due to the limited number of workforce in the primary care level and the limited knowledge of nurses in the various developmental milestones of children under their care (Yakuwa, et al., 2015). In a sense, the nursing profession has recognized the need for a whole family healthcare service program, but is seriously impaired by extremely limited resources to fulfill these service needs. In effect, the current primary healthcare system is overwhelmed by the demands of advanced information technology and appreciation of further commitment into a family healthcare model at its current level of utilizable resources.
Conclusion
Advances in information technology have an effect of changing current health methodology and metrics as public health information expands. If redefinition of public health surveillance has not been conducted, the sheer demand for more and newer knowledge will eventually force public health administrators to respond to the demands of times. In fact, the current primary healthcare system is already being stretched to its limits in trying to provide healthcare services into a burgeoning public health need. The gap between the current primary healthcare needs and the available resources puts into question the validity of adapting advanced data systems when the healthcare system itself is rendered incapable of using these data to support its expanding program of services and clientele demands.
Apparently, the educational system also experienced difficulties in providing the necessary volume of new potential healthcare workers with better knowledge in handling effectively and efficiently the newer demands to the primary healthcare system. However, the low workforce level at the primary healthcare level perhaps also indicates the failure of the national healthcare leadership in establishing attractive employment schemes to healthcare professionals in order to motivate them to choose a career in primary healthcare. Given an adequate number of nursing graduates each year to support primary healthcare workforce need, it is apparent that the private health sector may have offered more attractive opportunities than the public health sector to justify its low hiring levels.
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