Community-Based Surveillance
With training, members of the community can expand facility-based
surveillance
by detecting and reporting cases that may go undetected
by the health
facility. A good example of this is the use of community
members to detect
cases of guinea worm (dracunculiasis). In villages where
the disease is endemic,
volunteers are trained to detect and report cases using
a standard diagnostic
criterion, e.g., painful legs that have skin ulcers with
worms protruding.
They then may undertake treatment, referral, and containment
measures such
as bandaging the ulcer, instructing infected persons
not to bathe in water from
ponds and streams, and promoting the use of filtered
drinking water.
Community-based surveillance needs the support of
trained health care workers who in turn provide training
to the community on how to recognize the
disease and how to respond when people are ill. While
the focus of community
surveillance may be on a specific disease, community
members may also
be trained to detect an array of health problems. Community
members and
health workers can work together to organize transport,
childcare, and other
assistance and, sometimes, provide medical supplies,
treatment, and vaccinations.
Reports by community members should be incorporated
into the overall
surveillance data managed by health personnel. Health
systems should also
provide feedback to the community about disease patterns
in their own and
surrounding areas.
Community-based surveillance can be very useful in
detecting and treating
some illnesses. However, it generally has a high error
rate and should be
used carefully. Case definitions need to be very simple
and specific for community
identification and this means that diagnoses need to
be confirmed by
someone with more advanced training. While it is always
wise to involve the
community as much as possible in health initiatives,
community-based surveillance
is not appropriate for all conditions and situations.
Health workers
should carefully test the community-based approach
before initiating it and
should be prepared to regularly monitor activities
to ensure that definitions are
being applied correctly and that the health of the
community members is
being served well by this approach to surveillance.
Types of Surveillance
Facility-Based Routine Surveillance
Sentinel Surveillance
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