Effective surveillance hinges on consistent access to reliable, real-time data that captures a comprehensive range of information on population health needs and events of public health significance 1 2 3 Collecting these data is particularly challenging in countries facing significant resource-constraints and a significant rural or isolated population.  To address this challenge, a number of countries have used community-based or crowd-sourced data, such as InfluenzaNet and social media postings, to complement traditional facility-based data used in surveillance systems.4

Considering the rapid global expansion of community health worker (CHW) programs, CHWs offer a promising platform for strengthening surveillance systems in rural, resource-constrained settings. Several countries are already experimenting with CHW-based participatory-surveillance systems, often through the use of mobile phones.4 In this model, CHWs collect data as a part of their routine course of care. Studies conducted on CHW-based surveillance in Nepal, Malawi, and Kenya have shown promise that CHW-collected data can supplement data collected at local facilities and support surveillance activities.4 5 6 The efficacy of this model relies on factors that affect data validity, reliability, and quality such as local participation, presence of well-trained and supervised CHWs capable of conducting surveillance activities, 7 and ongoing support and quality improvement training. These CHW-based data collection strategies have the potential to improve surveillance capabilities in resource-constrained settings and aid real-time decision-making response to population health needs and resource allocation at the local and policy-making level. While these interventions have shown some success in tracking disease trends, it is important to note that individual, self-reported data can have limitations, including a lack of routine collection and should be supplemented with other sources.

References:

  1. Kruk ME, Myers M, Varpilah ST, Dahn BT. What is a resilient health system? Lessons from Ebola. Lancet. 2015 May 9;385(9980):1910–2.
  2. PAHO/WHO. Health promotion: achievements and lessons learned from Ottawa to Bangkok. Pan American Health Organization World Health Organization; 2006 Aug. Report No.: CD47/16.
  3. Kroll M, Phalkey RK, Kraas F. Challenges to the surveillance of non-communicable diseases--a review of selected approaches. BMC Public Health. 2015 Dec 16;15:1243.
  4. Meyers DJ, Ozonoff A, Baruwal A, Pande S, Harsha A, Sharma R, et al. Combining Healthcare-Based and Participatory Approaches to Surveillance: Trends in Diarrheal and Respiratory Conditions Collected by a Mobile Phone System by Community Health Workers in Rural Nepal. PLoS ONE. 2016 Apr 25;11(4):e0152738.
  5. Amouzou A, Banda B, Kachaka W, Joos O, Kanyuka M, Hill K, et al. Monitoring child mortality through community health worker reporting of births and deaths in Malawi: validation against a household mortality survey. PLoS ONE. 2014 Feb 18;9(2):e88939.
  6. Otieno CF, Kaseje D, Ochieng’ BM, Githae MN. Reliability of community health worker collected data for planning and policy in a peri-urban area of Kisumu, Kenya. J Community Health. 2012 Feb;37(1):48–53.
  7. Darmstadt GL, El Arifeen S, Choi Y, Bari S, Rahman SM, Mannan I, et al. Household surveillance of severe neonatal illness by community health workers in Mirzapur, Bangladesh: coverage and compliance with referral. Health Policy Plan. 2010 Mar;25(2):112–24.