Community-Based Surveillance Training Manual for Targeted Diseases and Signals

"Communities play an important role in the prevention, detection, and response to infectious disease threats. Through a broad, 'whole-of-society' approach, they can help contain and control infectious disease threats, limiting geographic spread, saving lives, and mitigating negative impacts."

In Ethiopia, volunteers participate in community-based disease surveillance, which involves factors of tracking or detection, reporting, and outbreak response to disease threats. They regularly conduct house-to-house health education sessions and social mobilisation activities during routine and supplementary immunisation campaigns. A 25-member team of health and communications professionals affiliated with the CORE Group Polio Project (CGPP) Ethiopia originally developed this manual to provide information to community volunteers (CVs) on the definitions, causes, symptoms, and prevention of 3 vaccine-preventable diseases: acute flaccid paralysis (AFP - the key symptom of poliovirus), measles, and neonatal tetanus (NNT). The training manual was revised to educate CVs on how to go about the animal-to-human disease detection and reporting of rabies, anthrax, and brucellosis. It is intended for use by more than 11,000 CVs who work in underserved rural, pastoralist, and semi-pastoralist areas across 5 regions of Ethiopia.

In addition to supporting surveillance, this manual is intended to initiate and facilitate family dialogue on healthy behaviours and practices; to mobilise communities to encourage caretaker participation to increase child vaccination uptake; and to enable the tracking and referral of pregnant women, newborns, and defaulters to nearby health facilities for vaccination.

Thus, in addition to information on the 6 diseases, the manual offers guidance on topics such as use of folklore and participatory planning (see Annexes). The section on communication skills stresses that "Effectively communicating with families is an essential component to community-based surveillance." When conducting house-to-house visits or group health education sessions, CVs are encouraged to follow the steps provided by the "GALIDRAA" process:

• Greet (when you visit a household, according to cultural traditions);
• Ask (about the objectives of your visit, encouraging the parents, caregivers, and other family members to speak candidly;
• Listen (attentively and probe accordingly);
• Inquire or Identify (to better understand the problem);
• Discuss (the available options for potentially solving the problem, using educational materials and local examples, language, and stories;
• Recommend (doable solutions for the client, who makes the final decision);
• Agree (on the client's decision, providing support and encouragement to the client rather than just information); and
• Action plan (for when and how to next meet with the client (preferably in the near future) to assess progress on the agreed-upon action.

The CGPP supports community-based activities designed to strengthen supplemental polio immunisation, routine polio immunisation, surveillance of AFP, and outbreak response. In November 2001, CGPP Ethiopia began United States Agency for International Development (USAID)-funded activities to access hard-to-reach, high-risk, and "silent" communities with vaccination services and surveillance by working with international non-governmental organisations (NGOs) and their local partners. Rugged terrain, scattered population settlements, weak health service systems, limited participation of key community members in planning of vaccination activities, conflict, and porous borders with polio-endemic areas pose challenges to the control of polio transmission in Ethiopia. These barriers result in low community awareness about polio vaccination and AFP surveillance; actual resistance to the polio vaccine is very low, according to CGPP Ethiopia.