Uganda: Community-based surveillance

Using community-based surveillance to improve early detection of Ebola outbreak in western Uganda

There is no one who understands a community better than its own members. Community challenges are best known to its people and solutions are always with the same people. Uganda Red Cross employs the ‘community-based volunteer approach,’ which allows volunteers picked and trained from the communities to deal with their own people and present their community’s needs. With support from USAID Uganda and through the International Federation of the Red Cross, Uganda Red Cross is implementing a community-based preparedness program that focuses on epidemics and pandemics, dubbed #CP3 Project. The community is trained to be able to detect potential disease outbreaks and also respond by reporting the signs and eventually participating in the response to save lives.

Today, Uganda is one of the countries at risk for Ebola following the confirmed outbreak in neighboring DRC Congo. As the Ebola threat continues to loom around the Uganda-Congo border, Uganda Red Cross has trained over 300 volunteers in communities close to Congo in districts like Bundibugyo, Kasese, Ntoroko, Bunyangabu, Kisoro, Kabale, and Kanungu, among others. Volunteers are trained to carry out surveillance and risk communication activities, including screening for all people entering the country. In some busy communities, a special data collection app called "Kobo-Collect" was introduced and about 50 volunteers have been trained to use it.

This is to enable the reporting of any epidemic alerts in real time at low costs and resources for early response. "We trained our volunteers to use this real time mobile system to help us detect any epidemic alerts in the community. These communities are near the border and are at high risk. We have a lot of movement across the border, especially on market days, and the risk of an Ebola outbreak is imminent. This is why we have relied on our community-based volunteers to use this technology as a surveillance tool to further keep Ebola out of Uganda but also sensitize the people about Ebola," said Dr. Joseph Kasumba, the Community Epidemic and Pandemic Preparedness Program officer in Bundibugyo district.

The majority of the trained volunteers have already started working in communities, where they hold sessions with community members and sensitize them about Ebola. Others, like Adam Mugenyi, have already sent out alerts to their supervisor and highly commend the system. "I have so far sent two alerts to my supervisor. I am proud that the community trusts me and in case of any suspicions, I am the first one they call. After my door to door movements, a lady called and told me her grand-daughter was sick with what she described as Ebola symptoms. I checked on the child, indeed she was bleeding and had bloody diarrhea. She also had blood in her urine. I then called my supervisor and informed him about it. I was amazed to see a response in just 25 minutes. They checked on the girl, took her to hospital and fortunately she tested negative for Ebola. I kept checking on the family to ensure that they were doing the right hygiene practices. I am so proud of my work. I believe I saved her life," Adam said.

In Bundibugyo district, which is in South Western Uganda, the community-based surveillance system is at the preparedness phase, where surveillance, monitoring and reporting occur in partnership with stakeholders like WHO, UNICEF Uganda, the Ministry of Health, and the World Food Programme. Volunteers submit reports by short message service (SMS) or forms which upload to a computer system for automated data processing. Reports can be designed for very basic analogue phones or modern touch phones and, with a well-planned training approach, can be used by people with no experience and minimal literacy.

This is done through the Red Cross Community Epidemic and Pandemic Preparedness Program (CP3), which collaborates closely with the Ministry of Health, health care workers, sectors for animal health, agriculture and environment, development partners, civil society, and the communities themselves. "We have been trained in this approach by the Red Cross and we have worked closely with them to tackle community epidemics in this region. Given that Ebola is the major threat at the moment, all efforts have been focused on prevention and preparedness because of our proximity to neighboring Congo, where Ebola has already killed many people. The future of this project is very bright and the government always welcomes such support and collaborations," said Dr. Samson Ndyanabaisi, the District Veterinary Officer, Bundibugyo district.

In August 2018, the World Health Organization declared an Ebola outbreak in Congo, where over 250 people have died from the epidemic. Uganda has been on high alert and Uganda Red Cross, in partnership with other organizations and government structures, which include the Ministry of Health, Unicef Uganda, WHO, USAID and IFRC, has been at the center of Ebola prevention and preparedness, especially around the Uganda-Congo border.

URCS has trained and deployed over 360 volunteers who are doing risk communication, social mobilization and Ebola screening at the border. Other interventions like edutainment through use of music and drama, community engagement through mobile cinema have also been employed to ensure that people access messages on Ebola and communities are prepared to cope despite the high risk.