Among all the respondents, 55.5% reported that they had developed syndromic surveillance systems for certain diseases and 84.4% required that physicians on duty should report any abnormity to the hospital's presidents (the definition of abnormity see in appendix). Abnormity in admission diagnosis, routine microbiological tests, emergency room patients, and death with unknown causes were systematically monitored by 74.6% of institutions and 47.4% of hospitals shared their surveillance information with the local health authority. There were statistically significant differences between tertiary grade hospitals (Grade A 95% CI: 5.6,6.6; Grade B 95% CI: 5.6,7.3) and secondary grade B hospitals (95% CI:4.1,5.9) for this capacity, with tertiary hospitals scoring higher on their ability to detect and identify a PHE.