This post was written by Judith Tsague and William Corley, with Palladium.

In the wake of the 2014-16 Ebola virus disease outbreak in West Africa, regional and international health officials underscored the importance of community-based surveillance for early detection of, and rapid response to, infectious diseases. Senegal, which experienced only one confirmed case of Ebola and no deaths during that outbreak, has nevertheless taken steps to strengthen such surveillance with the view that emerging diseases should be identified as quickly as possible to prevent the occurrence of pandemics.

Palladium, under the MEASURE Evaluation project, has worked in the Senegalese districts of Podor, Pete, Koumpentoum and Tambacounda to bolster multisectoral coordination for exchange of SMS alerts on outbreaks of priority infectious diseases, including zoonotic diseases. The experience in Senegal to date confirms the success of using mobile phone technology to improve community-based surveillance.

The first phase of the Senegalese project, spanning March 2016 to April 2018, began with the identification of eight human diseases for surveillance, including measles, meningitis, yellow fever and cholera. The project also identified community health volunteer groups, consisting of eight to ten volunteers per group. The community health volunteer groups and other stakeholders received training related to disease identification and the use of the existing mobile platform mInfoSanté. Volunteers received mobile phones to send disease alerts via the platform to local nurses, who also received mobile phones. Upon receipt of an alert, the nurse visits the community to verify and collect a sample to send to the district health center if it is a suspected case. The district may process the sample in the district hospital lab for certain diseases or forward it to a regional lab or other facility.

“Community-based surveillance is a symbol of readiness and geographic networking that combines passivity and activity,” says Amadou Diallo, head nurse at the Pont health post. “It is important because it allows us to detect community cases that never went through the health [care] channel,” he explains.

Broadening Scope

The project has also addressed emerging threats to human health. “Approximately 75 percent of new infectious diseases that threaten people have been shown to be zoonotic—that is, originating from animals or animal by-products,” says Scott Moreland, PhD, of Palladium.

The second phase of the project, under way since October 2017, has expanded surveillance to six zoonotic diseases: rabies, zoonotic influenza, zoonotic tuberculosis, hemorrhagic fever (Ebola and Marburg), anthrax and Rift Valley fever. This phase brings together veterinarians and other animal health professionals and includes livestock agents and breeders in the community health volunteer groups. The phase has promoted interoperability between sectors for the exchange of alerts.

To date, 2,094 community health volunteers have been trained, 526 mobile phones have been registered in mInfoSanté and distributed to community health volunteer groups, and 102 mobile phones have been given to nurses. In total, 77 percent of community volunteer groups in the districts have been trained. A high percentage of suspected cases among the community alerts after the first three months of training showed the usefulness of the program in identifying cases that would have gone unidentified or where notification would have been delayed.

The community-based surveillance has “boosted surveillance indicators for priority diseases and zoonoses,” says Diallo.

Combining Fields

“I think the surveillance is a good thing because it has allowed us to do integrated home visits and to raise awareness about diseases, the vaccination schedule and prenatal visits,” says Fatoumata Cissokho, a community health volunteer from the Pont health post. She explains, “It has allowed us to acquire new knowledge and strengthened my relationships within the community. It has allowed me to have very close relationships with the health post nurse, veterinary post livestock officer and forest guards.”

The project works multisectorally to consider animal, human and environmental health as one unit, otherwise known as the One Health approach. It represents Senegal’s commitment to the Global Health Security Agenda, a partnership of more than 60 countries and international organizations that addresses infectious disease threats in multisectoral and multilateral ways.

Djiby Malick Diallo, a veterinary post livestock officer for more than 15 years, thinks One Health’s time has come and will allow collaboration of sectors. “MEASURE Evaluation will contribute a lot with this mInfoSanté platform to definitively solve health problems at the community level with regards to early referral and care of populations,” he says.

Africa is expected to become one of the fastest-growing economic regions in the world. As incomes grow, the demand for livestock and livestock products also will increase. These developments, along with continued population growth, are likely to spur dramatic intensification and expansion of livestock production.

But, notes Moreland, “Rapid growth also poses economic and health risks from diseases among and between animals and people, antimicrobial resistance and environmental degradation.”

Fortunately, projects such as the one in Senegal will help mitigate threats while demonstrating the effectiveness of community-based surveillance as a tool for detection and response in resource-constrained settings.