Methods: Information on established syndromic surveillance systems was collected from peer-reviewed articles, conference proceedings and searches through reference lists of papers, from the years 1998-2010. In addition, web pages of international health organizations, surveillance networks, and Ministries of Health were explored. After reviewing identified systems, eight were selected and examined in detail to extract transferable information.

Results: The literature demonstrates the many successful syndromic surveillance efforts being implemented, and the variety of data sources, data transmission techniques, and analysis methodologies being instituted. Frequently, syndromic surveillance systems are a coordinated effort among several partners, supplement existing systems, incorporate both specific and non-specific disease detection, and are used in conjunction with laboratory-based surveillance.

Conclusions: Though not without challenges, syndromic surveillance has the potential to serve as a valuable disease detection tool in resource-limited settings. Further examination and evaluation of these systems will benefit global disease surveillance capacity.

Referral is commonly understood as sending clients to seek care at higher level facilities and is an individualized process dependent on various factors. Providers sending clients rarely hear back on any regular basis about those clients. Referrals and linkages for certain services are particularly weak including nutrition support, psychosocial support, palliative care and home-based care. Many providers recommended that referral protocols with improved communication tools are needed and said referred clients should be given priority at referral-receiving sites. Policy recommendations include: referral form redesign; formalizing or reforming the referral protocol; strengthening communication and linkages between community- and facility-based providers; and improving patient-flow at referral sites.

In response to the disaster, the Japan Medical Association (JMA) initiated the dispatch of disaster medical teams, JMATs, to affected areas through prefectural medical associations. JMA relief efforts did not end with coordinating JMAT operations: autopsies, medical supply transport, and advocating for healthcare for evacuees and survivors were other major efforts of the JMA following “3.11”.

The JMA’s healthcare support in Fukushima and other prefectures was unique and effective. However, the JMA recognizes the need for continued planning and preparation for disaster response and relief because of Japan’s high risk for future disasters. Thus, current priorities of the JMA are the restoration of the healthcare system in disaster-affected areas and preparation for future disasters.