**Background:** Before 1991, the infectious diseases surveillance systems (IDSS) of the former Soviet Union (FSU) were centrally planned in Moscow. The dissolution of the FSU resulted in economic stresses on public health infrastructure. At the request of seven FSU Ministries of Health, assessments of the IDSS were performed to guide reform. The assessment of the Armenian infectious diseases surveillance system (AIDSS) is presented here as a prototype for the other republics.
**Methods:** The authors performed qualitative assessments using the CDC guidelines for evaluating surveillance systems. Face-to-face interviews and focus group discussions were conducted with approximately 50 epidemiologists at the Ministry of Health, the National Sanitary Epidemiologic Service, the Institute of Epidemiology, and two regional, three districts, and one city Sanitary Epidemiologic Service (SES) office. Additionally, 23 health-care workers at village health centers, polyclinics, hospitals, and laboratories were interviewed. The authors chose not to gather quantitative data (e.g., through chart reviews) to assess quantitative attributes, relying instead on qualitative observations.
**Key Results:** Until 1996, the AIDSS collected aggregate and case-based data on 64 infectious diseases, including diseases of low pathogenicity (e.g., pediculosis) and those with no public health intervention (e.g., infectious mononucleosis). Specificity was poor because of the lack of case definitions. Most cases were investigated using a lengthy, non-disease-specific case-report form (the 'epid carta,' containing 46 questions, many requiring subjective responses). Armenian public health officials analyzed data descriptively and reported data upward from the local to national level, with little feedback. Information was not shared across vertical programs. The system was paper-driven and labor intensive. The SES had approximately 10% of the entire medical person-power and budget of the Armenian Ministry of Health. Detection of most reportable conditions was enhanced because all citizens received free health care and primary care physicians were responsible for care of persons in their assigned territories. However, it was common practice for epidemiologists to conceal cases of infectious disease and willfully underreport epidemic morbidity, because outbreaks meant the epidemiologists were not performing their duties. This resulted in epidemiologists managing two sets of information: one officially reported and one unofficially kept with more accurate numerators. Cost analyses from Ukraine (using 1996 budget figures) revealed that excessive culturing represented 47% of the cost per capita expenditure of the L'viv Regional SES and disinfection procedures accounted for almost 30% of the entire Pustomity District SES's budget.
**Clinical Implications:** Reform efforts were initiated in December 1992 through a cooperative project among the Armenian Ministry of Health, USAID, and CDC. Since 1996, the HIS reform activity has been self-sustained with no additional monetary support from USAID. In 1996, the Ministry created a national HIS program. Diseases are now categorized by a three-tiered approach: disease elimination (e.g., polio), case-based (e.g., diphtheria), and indicator-based (e.g., number of children immunized by two years of age). New regional centers equipped with computers and faxes have been organized. National and regional public health bulletins are being published monthly in three languages—Armenian, Russian, and English. Tiered, standardized case definitions and essential health indicators for decision-making at the clinic and community level have been developed and disseminated. The authors recommend that reform should focus on enhancing usefulness, efficiency, and effectiveness by reducing the quantity of data collected, revising reporting procedures and information types, improving the quality and use of data at different levels, reducing system operations costs, and improving communications to reporting sources.