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.