Why do 2,497 Dominican health facilities report communicable disease but not noncommunicable events?

This is not a compliance failure. It is a design decision, it is published, and it has consequences worth naming.

Where do these figures come from?

From the weekly epidemiological bulletins published by the Dirección General de Epidemiología. Each bulletin carries the SINAVE operational indicators, among them the coverage and timeliness of the two weekly reports that structure notification in the country.

Two weeks a year apart were reviewed, so that a structural finding could be told apart from one week of noise. In week 27 of 2024 and week 23 of 2025 respectively:

• Epi-1, facilities required to report: 2,835 and 2,986.
• Epi-1, reported: 2,572 (91%) and 2,652 (89%).
• Epi-1, of those on time: 91% and 87%.
• Epi-2, facilities required to report: 490 and 489.
• Epi-2, reported: 412 (84%) and 434 (89%).
• Epi-2, of those on time: 84% and 86%.
• Difference between the two counts: 2,345 and 2,497 facilities.

The difference holds from one year to the next. It is not a one week fluctuation.

What separates Epi-1 from Epi-2?

Scope, and the bulletin states it plainly. Epi-1, the weekly report on notifiable syndromes, diseases and events, is measured across all health facilities nationally. Epi-2, the weekly report on noncommunicable events, is measured across health facilities offering inpatient services, at the second and third level of care.

Put another way: a first level facility is inside the system for a communicable disease and outside it for a noncommunicable event. Not because it fails to comply, but because it is not asked.

Does that boundary make sense?

It made sense when it was drawn, and in part it still does. The noncommunicable events Epi-2 watches are largely those detected and managed in inpatient care, and a first level facility with no beds does not see them. Requiring a report on what a facility does not treat produces empty forms, which degrade the data without adding to it.

The question is not whether the boundary was reasonable. It is whether it still matches where the things worth watching actually happen.

What falls outside it?

The part of the system that sees the person first and the acute episode least. The first level is where a routine blood pressure is taken, where a child is weighed, where a visit about something else surfaces a chronic problem. None of that reaches Epi-2, because Epi-2 does not pass through there.

That does not mean the information is lost. It means it does not travel through the weekly surveillance channel, which is the one feeding alerting and comparison between territories. It lives in the clinical record, in vertical programs, in service information systems. Places where it exists, but from which it is not consolidated weekly or compared across the 40 provincial and area health directorates.

What about immediate notification? Does that exclude the first level too?

No. There the obligation reaches everyone, and that contrast is what makes the Epi-2 boundary visible.

Immediate notification is required of every facility, public and private, including nonprofit organizations and the military and police health services. It is made by the fastest available means, within the first 24 hours of detection, and on clinical suspicion, without waiting for laboratory confirmation.

That channel indicators move far more than the weekly ones. In week 27 of 2024 and week 23 of 2025:

• Cases notified through the platform: 1,458 and 551.
• Notified on time: 65% and 84%.
• Average days to notify: 3.88 and 1.16.

Between those two weeks, timeliness rises 19 points and the average falls from 3.88 days to 1.16. Two isolated weeks are not a series, so they do not support a trend. What they do show is that this channel can move: the indicators respond.

What would it take to close the gap?

Less than it appears, and none of what tends to get proposed first.

A new system is not required. The channel exists, it has a web platform, it has 40 territorial directorates publishing indicators every week, and it runs at 89% coverage. What it does not have is the first level inside the noncommunicable report.

Three steps, in order of cost:

• Decide what would be worth seeing. Not all of Epi-2 makes sense in a facility without beds. A short subset, three to five events that genuinely are detected in outpatient consultation, is a question answerable with what is already recorded.
• Measure what reporting actually costs. The obstacle at the first level is rarely willingness: it is the staff minute, the intermittent connectivity, and the form that has to be filled in twice. That is measured in the field, not in a meeting.
• Pilot it in one province before 32. The comparison across provincial directorates already exists and is already published. It is the natural baseline for a pilot, and it makes the result assessable from the first week.

What this analysis does not claim

It does not claim there is undetected noncommunicable disease. That would require measuring it, and no public figure supports it: the difference between two counts of facilities is not an estimate of cases.

It does not claim the Epi-2 boundary is drawn wrongly. It claims the boundary is drawn, that it can be read in any week bulletin, and that it is worth revisiting against where chronic disease occurs today.

And it says nothing about the performance of any particular provincial directorate. The bulletins publish that comparison; this piece does not use it.

Sources

Decree 309-07 of 15 June 2007, establishing the regulation of the National Epidemiological Surveillance System. Resolution 000004 of 2 March 2020, updating the list of notifiable diseases and events. Weekly epidemiological bulletins of the Dirección General de Epidemiología, week 27 of 2024 and week 23 of 2025, the source of every figure and of both quoted passages.