Indian Journal of Community Medicine

: 2020  |  Volume : 45  |  Issue : 3  |  Page : 270--273

Toward the development of an integrated climate-sensitive disease surveillance in southeast asian countries: A situational analysis

Sandul Yasobant1, Somen Saha2, Tapasvi Puwar2, Deepak Saxena2,  
1 Center for Development Research (ZEF), Bonn, Germany
2 Department of Public Health, Indian Institute of Public Health, Gandhinagar, Gujarat, India

Correspondence Address:
Dr. Deepak Saxena
Indian Institute of Public Health Gandhinagar (IIPHG), Opp. Air Force Head Quarters, Nr. Lekawada, Gandhinagar - 382 042, Gujarat


Changes in climatic conditions influence the transmission of water and/or vector-borne diseases. It is one of the reasons for the emergence and re-emergence of various infectious diseases. This case study documents the learnings from selected Southeast Asian countries that can be useful for developing integrated disease surveillance and early warning system for selected climate-sensitive diseases. Through informal key-informant interviews and site-visits to Sri Lanka, Bhutan, and Thailand, we studied the disease surveillance, meteorological surveillance and early warning systems. These leanings suggest that an integrated data sharing mechanism is essential for real-time disease prediction. Further, there is immense scope for developing mechanisms on the uniform in data collection, data processing and analysis. There is an urgent need for developing a multi-sectoral collaborative plan for the integration of surveillance for real-time prediction of climate-sensitive diseases.

How to cite this article:
Yasobant S, Saha S, Puwar T, Saxena D. Toward the development of an integrated climate-sensitive disease surveillance in southeast asian countries: A situational analysis.Indian J Community Med 2020;45:270-273

How to cite this URL:
Yasobant S, Saha S, Puwar T, Saxena D. Toward the development of an integrated climate-sensitive disease surveillance in southeast asian countries: A situational analysis. Indian J Community Med [serial online] 2020 [cited 2022 May 23 ];45:270-273
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Full Text


Globally, 250,000 additional deaths per year would be attributable to climate change between 2030 and 2050.[1] As per the WHO, there are five major impacts of climate change i.e., malnutrition, mortality, and injuries caused by flood and storm, heat waves, vector-borne diseases such as malaria, dengue, and water scarcity and contamination. Recent studies from the South-East Asia (SEA) region provide some evidence of the impact of climate change on health at the local level. A study from India found that heatwaves had increased in frequency, as had their average and maximum duration all over India.[2] A study from Nepal showed that a 1°C increase in mean temperature increased the incidence of malaria by 25%.[3] A study from Bangladesh revealed the disproportionate health risks of vulnerable population groups from climate change, mainly malaria, dengue, childhood diarrhea, and pneumonia.[4] A sentinel surveillance conducted as part of a pilot project on health adaptation in Bhutan found the presence of Culex and Anopheles vectors at very high altitudes (>2100 m) for the first time. There are global evidence that changes in climatic conditions can extremely influence the transmission of water-borne and vector-borne diseases.[5],[6],[7],[8] Although countries of the SEA region are vulnerable to many climatic hazards, there is a paucity of documentation of their response to such threats. This study documents the mechanisms of disease surveillance and early warning systems for priority climate-sensitive diseases. The aim is to study strategies for effectual integration of disease surveillance and early warning systems in selected Southeast Asian countries.


About 21 informal key-informant interviews and three focus group discussions were conducted to develop this case study (August to October 2018) in Sri Lanka, Bhutan, and Thailand. Key-informants were the officials from departments of health, environment and climate change, academia. Interviews were conducted at the date, time, and place convenience of participants. Interviews conducted at the participants' workplaces after obtaining permission and consent to participate. A pilot-validated interview guide with broad open-ended questions documenting the current disease surveillance mechanism, health system structure, data management and organizational structure for climate change, and policies was used to document the information. Audio recordings (after consent) and verbatim notes were taken during the interview. The summary of the interviews was read back to the participants to ensure participant validation. Transcripts were made on the same day based on the verbatim notes and the recordings. Manual descriptive content analysis was used to analyze the transcripts.[9],[10] The decision on coding rules and theme generation was done by using the standard procedures and in consensus.[11] Both inductive and deductive codes were generated. To ensure that the results are a reflection of the data, the codes/themes were related back to the original data.[12] The themes were described in the form of Strengths, Weaknesses, Opportunities, Threats (SWOT) matrix. The findings were reported by using Consolidated Criteria for Reporting Qualitative Research.[13] This study was approved by the Technical Advisory Group of Indian Institute of Public Health Gandhinagar, India.


The observations are presented country-specific with two major focus, i.e., disease surveillance system and the meteorological surveillance system. The key observations are summarized in [Table 1].{Table 1}


The Ministry of Health (MOH), whose major focus is on preventive and health-care services, provides free services for all.[14],[15],[16] The private health system is not so prominent for delivery care; however, few private diagnostic centers are observed.[17] Three main surveillance systems documented in Bhutan, i.e., National Early Warning Alert and Response Surveillance (NEWARS), constituting both indicator-based surveillance (IBS) and event-based surveillance, disease-specific supplementary surveillance systems such as influenza-like illness (ILI) and severe acute respiratory infections, Water Quality Monitoring Information System.

The Royal Center for Disease Control is the key agency under the Department of Public Health, MOH, Royal Government of Bhutan, controls the surveillance system. NEWARS is the prime surveillance system of the country. Under the IBS component of NEWARS, 21 identifiable diseases are reported from all health facilities. The National Environment Commission is the key agency that tackles and implements climate change actions in the country. However, the National Center for Hydrology and Metrology is an independent body that looks after meteorological surveillance across the country, through 92 meteorological stations across Bhutan. These stations measure local weather conditions (temperature, humidity, and rainfall) daily. Although these two institutes work independently, they share some information.

 Sri Lanka

Sri Lanka has a robust disease surveillance system, which is evident in the successful elimination of malaria from the country.[18] The MOH, Nutrition, and Indigenous Medicine is the leading agency providing stewardship to health service development and delivery. The public health-care system is divided into the Community Health Care System (preventive and promotive health) and the Curative Health Care System.[19]

The private sector contributes more than 48% of outpatient care in the country.[20] The epidemiology unit at the ministry level technically supervises the entire system of surveillance in Sri Lanka. The medical officer at MOH and the public health inspector of the area play crucial roles at the peripheral level. The disease surveillance program involves disease-specific notifications, special surveillance on selected diseases such as vaccine-preventable diseases, leptospirosis, human rabies, and dengue fever. In addition, sentinel site surveillance is being carried out for ILI and severe acute respiratory illness.[21],[22]

The Ministry of Mahaweli Development and Environment is the nodal ministry for monitoring climate change. However, there is no formal mechanism to share climate data from the meteorology department with the health ministry. The health department does not utilize climate data for disease prediction. In one instance, the Colombo municipal corporation reported purchasing seasonal data from the meteorology department. Overall the country needs a convergence plan for all departments, training on modeling, prediction, and development of a replicable model.


The Ministry of Public Health (MOPH), along with several autonomous agencies like Health Systems Research Institute, Thai Health Promotion Foundation, National Health Security Office, National Health Commission Office and Healthcare Accreditation Institute, formulates, implements, monitors, and evaluates the health policies of the nation. The government runs three-fourths of the hospitals in Thailand. Most of the private health-care set-ups are small and <100 bedded, while large private hospitals cater to mostly international patients.[23] The Epidemiology Bureau, Disease Control Department, MOPH collects disease information from the community. As per observations, a combination of indicator-based and event-based surveillance is achieved with the help of Surveillance Rapid Response Teams and network.

The agency responsible for weather forecasting and monitoring in Thailand is the Thai Meteorological Department under the agency of the Ministry of Digital Economy and Society. A total of 122 weather stations are employed throughout Thailand that record mostly surfaces weather. Data are recorded manually at the station in a logbook and is then entered into a personal computer, to be sent as the World Meteorological Organization-coded messages to the headquarters. However, the data are not analyzed adequately for disease forecasting.

SWOT analysis of each country with respect to the current surveillance systems and meteorological data integration is shown in [Table 2].{Table 2}

 Need for Developing an Integrated Surveillance System

There are some country-specific initiatives such as Integrated Surveillance and Climate Informed Health Early Warning System that have been implemented on a pilot basis across these three countries. However, the convergence, information sharing, and data integration to predict the outbreaks of climate-sensitive diseases are largely missing. While these initiatives merit a robust evaluation to understand their capability to predict diseases, it is essential to have intersectoral collaboration. There is an urgent need for convergence of departments responsible for the integrated surveillance system, as documented in this case study.

While these countries are making efforts to mitigate the impact of climate change, there is scope for better uniformity in data collection, processing, and analysis. The need of the hour is an integrated training program with the involvement of both meteorology and public health departments to strengthen the quality, data integration, and sharing for real-time prediction of climate-sensitive diseases.


We would like to thank the team from WHO and ministries of respective countries who supported our visits. We are also thankful to WHO-SEARO for their support in facilitating the visits to these countries. We would like to thank Dr. Anurag Saxena, Dr. Mahaveer Golechha from IIPHG for assisting in country-specific visits during data collection and Dr. Komal Shah, Dr. Vebhav Patwardhan from IIPHG for assisting in the initial literature review process.

Financial support and sponsorship

This activity was funded by WHO-SEARO. Funders have no role in the design of the study and interpretation of findings of the study.

Conflicts of interest

There are no conflicts of interest.


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