CARE Vietnam's Community-based Surveillance Model: Bringing the Fight to the Flu

This 13-page report describes and evaluates the strategies shaping a community-based surveillance initiative developed by CARE Vietnam in an effort to improve the detection and reporting of highly pathogenic avian influenza (HPAI) at the village level. Mobilising and building the capacity of volunteers are hallmarks of this public health approach.

As detailed here, the CARE approach diverges from systems that rely on passive surveillance and self-reporting. The rationale behind a more robust surveillance system is that "a community that knows little about the symptoms of a disease and is not aware of the reporting mechanism will identify far fewer cases than a community implementing communication activities and training community level workers on identifying and reporting." To that end, the organisation launched the Targeting the Risk of Avian Influenza Now (TRAIN) project in May 2007 to close the gap between commune-level authorities and households, as well as to facilitate a level of local engagement that large international organisations are not well positioned to reach.

Specifically, as part of TRAIN, local partners at the administrative levels closest to communities – village, commune, and district – take the lead in implementing surveillance activities. Community-based surveillance trainers are recruited from the district-level departments for human health and animal health; they then participate in training-of-trainer (TOT) workshops on surveillance methodology, zero disease reporting, key avian influenza (AI) prevention and control messages, and adult learning techniques. These sessions also prepare participants to train surveillance volunteers (who come mostly from commune-level women's, farmers', and youth unions) to identify AI cases, record appropriate information, and alert authorities. After training, each volunteer begins visiting a fixed number of households (typically 40) in his or her own village each week. In addition to completing human and animal surveillance forms, the volunteers attend monthly village-level meetings where they discuss challenges and opportunities with other volunteers and the surveillance coordinator.

Having outlined the TRAIN strategy, this case study examines how the model operated at the time of an actual (June 2007) AI outbreak in the project area (Tien Minh commune, within Haiphong municipality in northeast Vietnam). Having explored in detail the AI detection and control activities that the CARE-trained volunteers undertook leading up to and following the H5N1 outbreak, CARE concludes that "[t]he newly established community-based surveillance network detected the outbreak early, setting in motion rapid response activities that quickly contained it. The actions of the surveillance team are particularly noteworthy because the surveillance network was less than three weeks old when they successfully countered the outbreak....Not only did the local surveillance efforts prevent outbreaks from spreading, but engagement at the community level improved both traceability and prevention, two areas that HPAI control programs have struggled with. The success...became clear a few weeks after initial detection. Within two weeks, volunteers achieved a 100 percent vaccination rate among all domestic poultry commune-wide, providing protection from this and future outbreaks in the area."

A concluding section of the report outlines key questions for those seeking to replicate the TRAIN strategy.