Background

EmergingInfectiousDiseasesposenewinternationalsecuritythreatsbecauseofthepotentialtoinflictharmuponhumans,crops,live
stock,healthinfrastructure,andeconomies.H1N1simpactontheMexicaneconomyin2009,forexample,hasbeenestimatedatalmost1%
ofGrossDomesticProduct.Whatarethecultural,political,andeconomicchallengestoobtainingthenecessary(ordesirable)infrastruc
turetotranslatecommondeterminantsintoeffectivezoonoticvirussurveillance?

Methods
AqualitativecomparativecasestudyfocusingoneffectivesurveillanceinCambodiaandIndonesiawasundertakencenteredontheU.S.Na
valAreaMedicalResearchUnitNo.2(NAMRU2)asacommonbasisofcomparison.NearlyfiftyinformantswereinterviewedinIndonesia
andCambodia.

Results
ManyofthesimilaritiesinterviewsubjectsidentifiedasimpedingsurveillancesystemsinCambodiaandIndonesiastemfromthesestates
statusasdevelopingcountries.Thatalackoffinancialresources(lowsalariesforexamplewerementionedby42%and27%ofCambodian
andIndonesianrespondents,respectively),corruption,patronagenetworks(mentionedby33%ofCambodianrespondents),andthelack
ofaprofessionalcivilserviceconstituteachallengeinsuchacontextisnotsurprising.Itisreasonabletohypothesizethatotherdeveloping
countriesfacesimilarbarriersalongacontinuumfromoneextreme(Cambodia,asmallpostconflictcountry)toanother(Indonesia,ade
velopingcountryof230million).Inbothcountries,thislackoflocalresourceshasnecessitatedheavydonorinvolvementinorderto
achievethepresentsurveillancesystems.Notsurprisingly,thatexternalinvolvementhasresultedinvastlydifferentresponses(Indonesia
eventuallyterminatedNAMRU2'stenure,whileCambodiacouldnotbehappier).
KeyIssuesIdentifiedbyInterviewSubjectsbyCountry
Conclusion
Givenbothcountriesdevelopingcountrystatus,itislogicalthattheprimarychallengesimpedingsurveillanceareobservedonthehuman
resourcessideoftheequation.Nevertheless,asexperienceinbothcountriesdemonstrates,thetechnicalandhumansidesofsurveillance
systemsarecomplementaryinputs.Assuch,awarenessofandpreemptivereactionstoeconomic,political,andculturalissuesiscriticalif
policymakersaretobuildmoreeffectivesystems.
Cambodia Indonesia
Issue PercentRespondentsID(%)* Issue PercentRespondentsID(%)
Lowsalaries 5of12(42%) Poorhostdonorrelationship 13of26(50%)
Donordependencepathologies 5of12(42%) Differinghostanddonorpriorities 8of26(31%)
Poorstaffmanagement/HR 4of12(33%) Lowsalaries 7of26(27%)
Patronagenetworks 4of12(33%) DeclineintheMoHquality 6of26(23%)
Nocompensationforculling 4of12(33%) NAMRU2ismisunderstood 6of26(23%)
Differinghostanddonorpriorities 3of12(25%) Poorcompensationforculling 4of26(15%)
Local levels do not see reporting
translatedintoresponse
4of26(15%)
*ByproportionofinterviewsubjectsByproportionofinterviewsessions
DifferenceincalculationduetoprevalenceofgroupinterviewsinIndonesia
Source:Taganalysisofauthorsinterviewnotes
N A V A L P O S T G R A D U A T E S C H O O L N A V A L P O S T G R A D U A T E S C H O O L N A V A L P O S T G R A D U A T E S C H O O L
TheviewsexpressedhereindonotnecessarilyreflecttheviewsoftheDepartmentoftheNavyortheDepartmentofDefense.