Feasibility of an integrated community based surveillance program of Ebola by Community Health Workers in Rural Liberia

Background: In rural Liberia, community health workers (CHWs) are an integral part of health service delivery.  There is little evidence of the role CHWs systems could play in disease surveillance during an Ebola outbreak.

Methods: In the Konobo district in southeast Liberia, we developed a CHW based Ebola surveillance program.  The purpose was to: 1) Train CHWs in Ebola education and case identification 2) Develop an integrated screening survey to be used for routine active case finding and prior to patient care activities 3) Implement a CHW based surveillance program to cover all communities in the entire district.  The screening survey was based on MOH of Liberia and WHO guidelines for Ebola case definitions. Per MOH standards, all activities by CHWs adhered to a strict "no-touching" policy, including the screening survey.  If a positive screen occurred, no patient care would be provided, and appropriate isolation and referral would be coordinated with CHW supervisors.

Results: A total of 55 CHWs were trained in Nov, 2014.  All CHWs met proficiency standards after the training.  Overall, the training and screening survey were well received by participants. From Nov, 2014 to Feb, 2015, 6250 people were screened for Ebola using the survey via active case finding and prior to any patient care encounter by CHWs. None met criteria for an active case, or contact.  Of note, during the timeframe of the study, no known cases of Ebola were reported by the MOH in the county where this study was undertaken. 

Conclusions: Integrated Ebola surveillance program by CHWs in rural Liberia was feasible and acceptable by CHWs and community members.  Further evaluation of this tool in a setting with an active Ebola epidemic is needed, as well as its potential impact on service delivery by CHWs and resiliency of the health system.