The most critical issue related to the health system is the surveillance system. The notification of communicable diseases in Turkey was changed in recent years. In the new system, influenza group diseases are subject to sentinel surveillance. According to the sentinel surveillance, primary health care centers have no obligation to notify influenza group diseases including the possible avian influenza cases. Only the training and research hospitals in some selected provinces have the duty for notification of confirmed influenza cases. During the Turkish avian influenza outbreak, Van and Dogubeyazit (Agri) were not included among the selected provinces.