Online Program

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

Monday, November 2, 2015

Andrew Sechler, M.D., Department of Global Health Equity, Brigham and Woman's Hospital, Boston, MA
Kirby Erlandson, Programs, Last Mile Health, Boston
Avraham Kenny, Monitoring and Evaluation, Last Mile Health, Boston, MA
Vidiya Sathananthan, Monitoring and Evaluation, Last Mile Health, Boston, MA
Subarna Mukherjee, RN, Tiyatien Health/Last Mile Health, Zwedru, Liberia
Jenny Rabinowich, MPH, Tiyatien Health/Last Mile Health, Zwedru, Liberia
Elsie Karmbor, M.D., Grand Gedeh County Health Team, Zwedru, Liberia
Zonnoh Wright, R.N., Programs, Last Mile Health, Boston
Alice Johnson, RN, Tiyatien Health/Last Mile Health, Zwedru, Liberia
John Kraemer, Department of Health Systems Administration, Georgetown University, Washington, DC
Mark Siedner, M.D., M.P.H, Infectious Disease, Mass General Hospital, Boston, MA
John Ly, M.D., Programs, Last Mile Health, Boston
Netus Nowine, Community Health, Grand Gedeh County Health Team, Zwedru, 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.

Learning Areas:

Assessment of individual and community needs for health education
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Program planning
Provision of health care to the public
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe feasibility of community health workers in activities of ebola surveillance. Evaluate the effect of community health workers activities of ebola surveillance on their ability to carry out routine patient care activities. Describe experience of implementing community health worker ebola related surveillance activities in remote areas of liberia.

Keyword(s): Community Health Programs, International Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Director of Program Quality of Last Mile Health/Tiyatien health, the NGO who partners with the LIberia MOH improve rural health care delivery systems. I lead program design and evaluation of our in-country programs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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