Preparing Communities for Avian Influenza: Community Based Systems for Early Surveillance

This 10-page case study from the Philippines describes a 2006 six-month United States Agency for International Development (USAID)-funded pilot project to develop community based reporting and early warning systems (EWS) for avian flu (bird flu) in six high-risk Philippine barangay (villages). It is intended to demonstrate how a strategy that uses an objective measure to select geographic locales and communities, as well as specific groups within those communities, for message dissemination provides a rational mechanism to implement start-up activities that can then be scaled up across the country. According to this document, a fundamental strategy of CARE’s approach to risk evaluation and message targeting is collaboration with key stakeholders, ensuring that those actors with intimate knowledge of relevant information at each level – government health and animal workers at a national level, and key community members at the local level – are integrally involved in the design of the project, utilising a ‘bottom-up’ approach in which communities are directly involved in the development of early warning, reporting, and surveillance systems at the local level.


Phase I of this pilot project involved the rationale by which CARE selected geographic areas for its focus. The following are the indicators of risk used in this process:

• Chicken population, duck population, and migratory bird counts;
• Origin and demographics of the non-national workforce and the seasonal national workers;
• The Human Development Index (income, health, and education);
• Household livelihoods and backyard poultry raising; and
• Illegal smuggling (goods entry points), and border areas.

Also used were the following indicators of community capability:

• Networks and outreach of partner civil society organisations (CSOs) and non-governmental organisations (NGOs) for community mobilisation;
• Socio-economic status and resources;
• Areas of potential cooperation and joint priorities of CARE and the national government; and
• Existing points of access for Information, Education and Communication (IEC) campaigns and surveillance networks (e.g. local health workers, church communities, and Parent-Teacher-Community Associations).

In the second phase, CARE, CSOs, and the Department of Health (DOH) and the Department of Agriculture (DA) formed a team to design modules for a training of trainers (ToT) exercise. The 5-module training kit contained modules on: (1) basic avian flu information; (2) activities to prevent AI in animals and humans; (3) community level responses to avianj influenza; (4) simulation/role playing exercises; and (5) contingency planning. After the training of trainers, leaders returned to conduct a 3-day workshop in each selected locale, among members of the community council, leaders of community-based organisations (CBOs), representatives of local institutions, and local DOH and DA officials. In these workshops, leaders assessed their capacities, resources, and vulnerabilities to avian flu/pandemic flu and led participants through the process of creating a ‘risk map’ of the community, identifying specific households and groups most vulnerable to avian flu/pandemic flu, for targeted education campaigns and monitoring. Workshop members drafted a contingency plan (also commonly referred to as a preparedness plan), including an Early Warning System (EWS), which was reviewed and refined though a two-hour simulation within the workshop.

Workshop participants worked with the Community Health Response Team (CHERT) to assign responsibilities and develop a routine monitoring form with the aid of the DOH and DA officials. Participation by municipal and regional government officials helped to check the accuracy of reporting, flow of information, and integration with national systems. Team members record observations of poultry and human health on a standardised form during monthly household visits, submit reports at the municipal level, where, in suspected cases, officials are alerted and a follow-up incident report is submitted within 24 hours.

A follow-up workshop trained teachers, daycare workers, community health workers and sector leaders to recognise AI symptoms in poultry and humans and gave a forum for input into the EWS design. This information continued to be disseminated to community groups with emphasis on the importance of community involvement in the EWS.

The document notes the following strategies that strengthened the project:

1. Partnerships;
2. Contextualising AI/pandemic flu campaigns and building capacity though community participation;
3. Focusing information on those at risk and tailoring it to each audience;
4. Building upon existing structures in suitable timeframes while informing national plans.

The document concludes by stating that the role of NGOs in AI preparedness should ensure "that the wisdom and knowledge found at the community level is harvested and incorporated into national level planning structures."