Background: Communities have a key role to play in global health security. The Red Cross/Red Crescent epidemic preparedness programme empowers volunteers and communities to: identify risks; recognise and notify epidemic alerts; take early action to control disease. The programme set out to establish community-based surveillance (CBS) as a preparedness model-yielding earlier detection and action to halt outbreaks at the outset. This paper reports on the mid-stage CBS implementation experience and results in Indonesia, Kenya, Sierra Leone and Uganda. Methods: Volunteers detect potential epidemic alerts and report immediately by mobile apps. The receiving supervisor cross-checks the alert and enters in a real-time database triggering response actions. Supervisors report to local authorities, integrating CBS alerts as notifications into national disease surveillance systems. Results: To develop health literacy and trust, volunteers achieved over 390,000 instances of contact with people; 70,000 house visits; 547 school health activities; and 17 radio shows. Volunteers are placed with wide geographic coverage and their weekly 'zero' reporting of 63%-83% indicates maintenance of the CBS system. The average accuracy of volunteers to identify alerts matching community case definitions is high in Sierra Leone 96%, Indonesia 90%, and Uganda 73%, however low in Kenya at 35%. Timeliness rates were high across all countries. Alerts were detected and notified to authorities within the targeted 24 hours at an average of 94%. Challenges and risks have related to: securing free SMS channels for alerts, time required for contextualised design, ensuring response action, and managing expectations of the scope of CBS. Conclusion: Early-stage results show positive impact and feasibility of preparedness CBS in highrisk zones to prevent large-scale outbreaks. Community engagement, stage-wise capacity building, monitoring and response actions, and collaborative relationships with stakeholders are important programme components for effectiveness. Communities themselves can be central change agents in global health security.
Risk communication and community engagement are critical elements of epidemic response. Despite progress made in this area, few examples of regional feedback mechanisms in Africa provide information on community concerns and perceptions in real time. To enable humanitarian responders to move beyond disseminating messages, work in partnership with communities, listen to their ideas, identify community-led solutions, and support implementation of solutions systems need to be in place for documenting, analyzing, and acting on community feedback. This article describes how the International Federation of Red Cross and Red Crescent Societies and its national societies in sub-Saharan Africa have worked to establish and strengthen systems to ensure local intelligence and community insights inform operational decision making. As part of the COVID-19 response, a system was set up to collect, compile, and analyze unstructured community feedback from across the region. We describe how this system was set up based on a system piloted in the response to Ebola in the Democratic Republic of the Congo, which tools were adapted and shared across the region, and how the information gathered was used to shape and adapt the response of the Red Cross and Red Crescent Societies and the broader humanitarian response.
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