Pilot Community Surveillance Project

This 30-page report documents the process of implementing a pilot study of the Community Surveillance project in Ile District, Zambezia Province (Mozambique). It identifies strengths and weaknesses of the project’s functioning, assesses the effectiveness of the referral system, and makes recommendations that might help improve it and permit its eventual expansion to other parts of the country.

Specifically, in September 2002, Project HOPE/Mozambique initiated a planning process to implement disease surveillance at the community level. Conducted in collaboration with the Ministry of Health (MISAU) and the World Health Organization with technical assistance from the CHANGE Project, this process focused on involving the community directly in tracking:

1. Acute Flaccid Paralysis
2. measles
3. neo-natal tetanus
4. meningitis
5. cholera

The decision to foster active local community participation was motivated by the observation that the traditional approach, where health workers wait for patients to show up at a health facility, had limitations. Further, there were shortages of staff, especially with respect to preventive health care, so involvement on the part of the community became crucial.

Project HOPE trained 20 community health councils, who then trained 610 Community Health Volunteers (VCS), 250 Community Leaders (LC), 31 Traditional Midwives (PT), 68 Traditional Healers, 25 Reproductive Health Agents (ACSR) and Family Planning Promoters, 7 Community Child Health Care Agents (ACSI) and 12 Mothers Groups (GM). As part of this process, CHANGE’s generic Surveillance Kit was modified and adapted to suit Mozambican local conditions. For instance, a flip chart was developed that explained how to identify each of the 5 targeted diseases and steps to take once the cases were confirmed. "The graphic nature of the material ensured that the less literate volunteers could use it to conduct Community Surveillance activities; moreover, translating the text into Lomwe (the local language) made it easier for volunteers with difficulties in reading Portuguese to understand it."

The evaluation process was based mainly on feedback obtained from interviews conducted with health workers, community health volunteers, and members of the community who benefit from the project’s activities.

An excerpt from the report follows:


Positive aspects that contributed to the project’s success

• Coordination and Partners' Involvement - MISAU, the World Health Organisation and Project HOPE were involved actively from the project’s inception...Similarly, there was also a lot of community involvement through their leaders (and also direct community participation) from the beginning of the project and throughout implementation...
• Adaptation of the generic Community Surveillance Kit for the country - ...The extensive involvement of the different participants (at the institutional level) in the adaptation and preparation of materials was crucial ensuring the production of the final materials.
• The Community and Volunteers' Motivation - ...they were unanimous in showing their willingness to continue working on the Community Surveillance project for an indeterminate period of time....Some people enjoy being volunteers because they learn new benefits, (e.g. “now I know how to prevent my family from contracting certain diseases, and I know what to do when they get sick.”)
• Integration of Volunteer-reported cases to National Health Information System - Once a suspected disease case reported by the Community Health Volunteers is diagnosed and confirmed, it becomes integrated into the monitoring system, which implies integration and confirmation at the district level before being reported to the next referral levels...

Community Volunteer aspects that need improvement

• The Involvement of MISAU’s partners - While these were actively involved at all levels at project inception, this involvement almost became non-existent during implementation. MISAU’s lack of involvement during this stage had some repercussions...
• Volunteer training - The course was too short (only 2 days)...In the event that the Community Surveillance project is expanded to other parts of the country, we strongly recommend that all the training material (e.g. the training manuals, job aids and any other relevant resources) be made available to the volunteers during the training sessions in order to aid their understanding...
• Keeping Activity Records - There is a need to improve the recording of the Community Surveillance Volunteers’ activities...
• Feedback - ...The volunteers have little information about the 'state of affairs' of the program they are implementing.....Some volunteers pointed out that they would like to hear something about their project on the community radio...