Community-based surveillance programme evaluation using the platform Nyss implemented by the Somali Red Crescent society – a mixed methods approach

Abstract

Background The Somali Red Crescent Society (SRCS) and the Norwegian Red Cross have implemented community-based surveillance (CBS) in Somaliland branches to reduce the high risk of epidemics by strengthening early warning and response from and at community level. CBS is implemented through SRCS community volunteers reporting health risks or events from the community via SMS to the software platform Nyss. This paper presents results of the CBS programme evaluation from 2021. Methods The attributes usefulness, flexibility, simplicity, data quality, acceptability, sensitivity, and timeliness were investigated. Routine CBS data from 2021 from Nyss for Awdal and Togdheer region and data from qualitative interviews with different stakeholders were analysed. Results The usefulness of the CBS programme in preventing, detecting, and responding to disease outbreaks was acknowledged by the stakeholder. In 2021, CBS generated 138 alerts in Awdal region out of which 83% were escalated to the Ministry of Health and Development (MoHD) as true, meaning they were matching the Community case definition (CCD). For Togdheer region it was 218 out of which 97% were escalated. Cross-checking of alerts by supervisors was done timely. The programme was flexibly adjusted for new diseases and changing CCDs. Average completeness was 68% for Awdal and 64% for Togdheer. Alert outcome documentation was done for 63% and 64% out of the escalated alerts for Awdal and Togdheer respectively. For 85% and 98% of these, “action taken” was recorded, indicating any form of response had been carried out. Evidence on sensitivity was limited. Stakeholders appreciated being engaged, the good collaboration and acceptance of the programme. Conclusion The evaluation showed positive results related to the attributes but also identified indicators to improve on. One major improvement to be worked on is documentation of the outcome of alerts to provide better evidence on further system attributes. A participatory approach and implementation through volunteers showed to be vital in conducting CBS successfully to prevent large scale epidemics by rapid response through the volunteers themselves and early warning of the health authorities and communities. Nyss was useful to ensure early warning of potential health risks, as well as for efficient programme monitoring and evaluation.