Humanitarian led community-based surveillance: case study in Ekondo-titi, Cameroon

Abstract

Background Community-based surveillance (CBS) has been used successfully in many situations to strengthen existing health systems as well as in humanitarian crises. The Anglophone crisis of Northwest Southwest Cameroon, led to burning of villages, targeting of health personnel and destruction of health facilities which, in combination with distrust for the government services led to a collapse of surveillance for outbreak prone diseases. Methods We evaluated the ability of the CBS system to identify suspected cases of outbreak prone diseases (OPD) as compared to the facility-based surveillance, evaluated the timeliness of the CBS system in identifying an OPD, reporting of OPD to District Health Service (DHS) and timeliness in outbreak response. The paper also assessed the collaboration with the DHS and contribution of the CBS system with regards to strengthening the overall surveillance of the health district and also determine the interventions undertaken to contain suspected/confirmed outbreaks. Results In total 9 alerts of suspected OPDs were generated by the CBS system as compared to 0 by the DHS, with 8 investigated, 5 responses and 3 confirmed outbreaks. Average time from first symptoms to alert generation by the CBS system was 7.3 days. Average time lag from alert generation from the CBS to the DHS was 0.3 days which was essentially within 24 h. There was extensive and synergistic collaboration with the DHS. Discussion CBS generated a higher number of alerts than traditional outbreak reported used in the region, and had timely investigations and if appropriate, responses. Careful selection of CHWs with strong community engagement led to the success of the project, and the use of the mobile health team in situ allowed for rapid responses to potential outbreaks, as well as for feedback to CHWs and communities. CBS was also well utilized for identification of other events, such as displacement and malnutrition. Conclusion In conflict settings, CBS can help in outbreak identification as well as other events, and a mobile health team is crucial to the success of the CBS due to the ability to rapidly response to generated alerts. The mobile health team provided timely investigation of 8 of 9 alerts generated. Collaboration with existing DHS structures is important for systems strengthening in such settings.

Mobile clinics in conflict-affected communities of North West and South West regions of Cameroon: an alternative option for differentiated delivery service for internally displaced persons during COVID-19

“…Before the implementation of this intervention (mobile clinics), health service delivery in communities with non-functional health facilities was largely done by community health workers and community nurses trained and engaged by humanitarian organisations. Mobile clinics as an approach to provide PHC in the NWSW had been used before in Ekondotiti [ 14 ], but HIV services were not integrated in the package of care. Also, with the COVID-19 pandemic, adaptations had to be made to allow for essential services to be delivered in the context of a pandemic.…”

Community-based surveillance of infectious diseases: a systematic review of drivers of success

“…Successful CBS was believed to be associated with community acceptance of the CBS workers that was, in turn, associated with their recruitment (ie, having the community nominate the CBS workers 31 33 or recruiting CBS workers from within the community 25 27 38 ), or with having nested CBS within an existing emergency response system that itself had good acceptability (which, in turn, was attributed to active participation and collaboration with communities). 27 Trust between CBS workers and the community was also described as a key success factor. 25 29 31 38 Motivation of CBS workers Success was also attributed to high motivation of CBS workers who described their motivation in terms of: 'contributing to bringing good health to the people' 33 (p. 10), feeling a sense of service to the community 26 29 38 41 , and a desire to increase ties and trust with other community members.…”

Cardiac Surgery Development in Cameroon: Unexpected Challenges From a Socio-Political Crisis

“…Over the past 3 years, the armed conflict opposing governmental forces and separatist armed groups have caused more than 60,000 refugees in neighbouring east Nigeria, 600,000 internally displaced people, and ∼4,000 deaths. A countless number of villages, social infrastructures especially schools, markets, and medical institutions have been burned, with progressive destruction of the local economy 2 (12). The CCS located in the northwest region was at the epicentre of the violence undergoing significant changes in the course of its activities.…”