Kambia DistrictSurveillance and Response Framework
2 April 2015
Rationale for Enhanced Response Framework
Issues
• Despite efforts, community engagement remains challenging in some areas
• Multiple partners with different strengths could coordinate better
• Fragmentation of approaches • Selection of areas is not
adequately based on consistent criteria
• Reactive approach
Opportunities
• Harness energy from HE’s visit and focus on need for improved community engagement
• Harness resources being offered by partners/other districts
• Bring all partners together in well-coordinated approach under DERC operational structure and target areas and activities more appropriately
• Incorporate cross-border work
Key Performance Indicators OBJECTIVES INDICATORS Last 21
days*Trend
Compared GOAL Get to zero in Kambia District
Primary Objective
Improve the efficiency and effectiveness of the district surveillance and response
system
100% of confirmed EVD cases coming from a contact list 66%
All suspect cases transferred to appropriate health facility within 24
hours of an alert being raised100%
Outcome 1Strengthen alert system to
better detect suspected EVD cases
(live and dead)
Number of live alerts 104
Proportion of death alerts 55%
Outcome 2Strengthen reactive and proactive capacity of the
surveillance system
100% of credible alerts are investigated within 24 hours 94%
100% of confirmed EVD cases come from a contact list 66%
Outcome 3Strengthened community engagement in response
activities
Time between symptom onset and alert report is less than 48 hours 49% Median:
3 daysAll positive swabs come from
known contact lists 20.0%
100% lab results are tested and returned to patient/family
members <24h from publication99%
What does it look like?
IDENTIFY TARGET COMMUNITIESUnderstand key issues and define clear indicators to target communities
• Hotspots• Silent Areas• Positive swabs• Under-reporting deaths• Secret burials
ACTIVITIESIdentify key approaches to promote change and match to issues
• Active case searching• Paramount chief eng.• House to house• Radio programming• Dialogue with household
OPERATIONALISEDefine decision making process for operationalising
• SOPs• Resource planning• Flexible approach• Regular meetings to
coordinate
An over-arching framework enhancing surveillance and response mechanisms Requires that we work through the following steps
Indicators and Approaches
Issue Appropriate Approaches
Hotspot E.g.Active Case Search, Community meetings
Positive Swab E.g. direct household engagement
New case not on a contact list
E.g. Active Case Search in surrounding area, house to house mobilisation
Death in a quarantine home E.g. Direct household EngagementCross-border transmission E.g. Active Surveillance, radio messagingUnder reporting of deaths E.g. Radio, IEC material dissemination, political engagement ,
community meetings, house to houseUnsafe burial E.g. DERC/ DO meeting with Paramount Chief and/or other key
leaders, community visit from DO and Paramount ChiefCommunity resistance/mistrust and denial
E.g. Community visit from DO and Paramount Chief, Community meetings with key stakeholders and appropriate target groups (e.g. women, soways, youth), EVD Survivors, engagement with religious leaders and traditional healers
Remote/hard-to-reach areas E.g. House to House mobilisation, community meetings with key stakeholder,s radio, support to chiefdom and village taskforces
Areas not reached by social mobilisation activities
E.g. House to House mobilisation, Support to chiefdom and village level taskforces, Radio interviews with key spokespersons
Target Areas
ISSUES CHIEFDOM VILLAGE
HotspotMagbema Malal
Gbingleh-Dixon Lokoya
Positive swab
Magbema Malal
Gbingleh-Dixon Konta Dubalai, Lokoya, Fouta, Rogberay, Yeam-Labey
Samu Soriya
Border issuesSamu Soriya, Kanbagham
Gbingleh-Dixon Magbengbeh, Yeam-Labey villages around Pamelap
Community resistance
Mambolo Malambay
Masungbala Wula Lol
Samu Mabonah, Kortimaw
Target Areas of Intervention
Hotspot
Positive Swab
New case not on a contact list
Death in a quarantine home
Cross Border transmission
Community resistance
Community denial
Under reporting of deaths
Epi link to + case
1. Issue: Hotspot 2. Indicators: Ongoing transmission. Out of
nine confirmed cases in week 11, eight came from a single household under quarantine in Malal
3. Response: Dedicated surveillance/socmob team assigned for daily visits, detailed case investigation, contact tracing, PC engagement.
1. Issue: Under reporting and community mistrust2. Indicator: Positive swab/death in quarantine home3. Response: DO and DC meeting with PC to define action
plan. PC making frequent visits to HH and community. SocMob Pillar Lead engaging community directly
Weekly Response Plane.g. Malal
1. Issue: Community Resistance to response efforts
2. Indicators: HH refusal to cooperate with surveillance team or to transfer suspect case to Holding Centre.
3. Response: Dedicated team surveillance and PSS to make daily visits to the household. All suspects now removed.