Community-Based Surveillance (CBS)

Community-Based Surveillance (CBS) Definition

• CBS defined as a surveillance system, gathers community health info, monitors entire population, not just a segment.

Community Member Roles

• Early warning or alerts during pre-epidemic
• Reporting alerts, information on unusual public health events to nearest health facility
• Support in active case detection, response during epidemics, includes contact tracing, mobilization, sensitization
• Providing community forum for feedback on outbreak or event assessment

Establishing CBS

• Catchment health facility/Sub-district Head/Manager are responsible for CBS
• Support is provided from district, region/province and at the national level

Roles of the responsible parties:

• Develop CBS structures
• Define selection criteria for CBS focal persons
• Draw terms of reference
• Define roles, responsibilities of CBS focal persons
• Coordinate, supervise, monitor all CBS activities

Steps for Establishing CBS System - Part 1:

• Engage all stakeholders
• Define information sources about health events in the community
• Identify community-based surveillance (CBS) focal persons
• Compile list of priority diseases, conditions, events/alerts
• Develop simple case definition for priority diseases, conditions, events

Steps for Establishing CBS System - Part 2:

• Develop, disseminate data collection, reporting tools
• Define reporting methods
• Train all key actors in the CBS system
• Develop risk communication, social mobilization structures
• Define methods for monitoring, supervision, evaluation

CBS Focal Person Selection

• District, sub-district health team works with community leaders to identify community members as CBS Focal persons
• Any community member acceptable by the community can be a CBS focal person

CBS Focal Person Selection Criteria

• Hardworking, committed to reporting
• Resident in the community
• Well-known, trusted, respected member of community
• Community welfare at heart
• Accepted, able to communicate effectively with the community
• Literate enough to record events/data
• Selected irrespective of gender
• Recognized by identified groups where ethnic/religious differences exist
• Training in roles, responsibilities is needed after selection

Roles and Responsibilities of CBS Focal Person

• Use community case definitions to identify and record priority diseases, conditions, events
• Report to nearest health facility or sub-district immediately (within 24 hours)
• Support health workers during case/outbreak investigation, contact tracing
• Conduct regular household visits
• Meet with key informants regularly
• Sensitize the community on priority diseases, conditions, unusual events
• Mobilize local authorities, community members to support response activities
• Attend local ceremonies/events and follow up on anything unusual
• Participate in risk mapping of potential hazards

Example CBS Activity:

• CBS focal person hears of multiple cases of acute watery diarrhea with vomiting
• CBS focal person suspects cholera, reports to local health facility, district health officer by text
• Public Health Emergency Rapid Response Team (PHERRT) investigates possible outbreak
• Based on results, PHERRT implements control, prevention measures
• Outbreak gets contained quickly due to early warning from CBS focal person

IDSR Community Case Definitions

• Used at community level
• Inform community members of priority diseases, conditions, events under surveillance
• Use simple language for case definitions, easy to understand
• Refer to Section 1, Annex 1B of the 3rd Edition IDSR Technical Guidelines Booklet Two for sample community case definitions

Reporting from Community Levels

• Report to CBS supervisor, surveillance officer, or nearest health facility manager
• Communicate by phone, text, hand delivery, or going to nearest health facility
• Record in community alert forms

What to Report in CBS

• Report anyone with an illness meeting IDSR community case definitions within 24 hours
• Report any sudden death, if community area experiences public health event of IDSR priority conditions
• Report any unusual public health event, like similar cluster of illnesses within a week or absenteeism at school

Facility-Based and CBS Linkage

• HF/sub-district health team with DHMT, check all reports from CBS focal person
• If confirmed as TRUE then- HF surveillance focal person captures on IDSR form for HF catchment area
• It gets reported to district, to region and to national authorities weekly and monthly

Verification and Investigation of CBS Events

• The National Level: National PHRRT supports the investigation in the community
• Provincial/Regional Level: Provincial/Regional PHRRT support investigation in the community
• District Level: District PHRRT is deployed to initiate the investigation of the alert in community
• If an alert is TRUE EVENT, informs District Health Team Within 24 hours, and take action
• If an alert is NOT a TRUE EVENT, informs the community, No investigation required
• Reassurance to CBS and maintain SURVELLANCE

CBS Supervision

• Health facility/sub-district regularly supervise CBS Focal Persons (at least monthly)
• Feedback is given to CBS focal points
• On-the-job training gets provided if there is a problem identified
• Follow-up on requests for assistance gets provided
• Supervisory plans for improvement of surveillance/response are updated
• Record Successful activities and receive encourage continuation
• Feasible solutions get provided for the identified problems

Providing Feedback to the Community

• District PHERRT liaises with authorities at regional, provincial, national levels
• Guidance on giving feedback to the community occurs
• Directions and key messages provided by national authority must be followed
• CBS focal persons disseminate preventive messages
• Regular Community briefings
• Identified local channels
• Regular meetings with local stakeholders
• Door-to-door campaigns used

Effective CBS System

• The key to early detection
• Enables a quick response to public events and emergencies
• CBS focal persons should report suspected cases within 24 hours
• The health facility or sub-district health team is there too verify with the tools provided