This case examine explores the 2018–22 implementation of a nationwide community-based surveillance (CBS) programme in Sudan. The programme was designed to fulfill crucial wants of the present well being surveillance system. It aimed to empower communities to detect and include public well being threats, enhance relations between communities and their native well being system, and contain villages in rural areas. Federal, state, and locality (district) employees attended CBS workshops earlier than recruiting and coaching neighborhood volunteers. Over 8,000 volunteers throughout 11 states have been recruited. The volunteers alerted employees to precedence syndromes for communicable ailments in addition to native occasions with public well being implications (e.g., pure disasters, conflict-induced displacement, meals insecurity). Lessons learnt can be utilized to extend understanding of large-scale CBS programmes and to establish alternatives to strengthen new and present programmes. For extra social science steerage on CBS, see our companion: Key Considerations: Community-Based Surveillance in Public Health.

The problem: strengthening well being info surveillance in Sudan

Community-based surveillance (CBS) entails partaking neighborhood members to systematically accumulate and report well being info from inside their communities. The info is used for public well being surveillance functions to immediate a speedy response.

The World Health Organization (WHO) has supported Sudan’s Ministry of Health to implement a nationwide CBS programme to handle the acute well being info scarcity in rural areas. It additionally contributes to the latest push throughout the African area to assist nations meet their worldwide reporting necessities to regulate epidemics and meet different international well being priorities.

Sudan’s CBS programme is designed to fulfill a number of crucial wants of Sudan’s present well being surveillance system. These embrace the hole in info reporting from two-thirds of public well being services and a perceived deficit in belief in native well being methods.1,2 Both points are most acute for rural populations as a result of lengthy historical past of presidency give attention to the capital and centre of the nation, and armed conflicts in peripheral areas.

Sudan’s CBS programme

In 2016, Sudan’s Ministry of Health’s Surveillance and Information Directorate (SID) began a brand new country-wide programme of event-based surveillance (EBS) to quickly seize and interpret details about occasions which are a possible threat to public well being. This concerned creating new nationwide and state constructions to behave on precedence info. The info may come from non-health and non-government companions or from present outreach initiatives, similar to a name centre with a free hotline for the general public to report emergency well being issues. The EBS programme was supposed to enhance the passive detection of epidemic info from the one-third of public well being services taking part in a sentinel surveillance programme.1

In 2018, a CBS programme was launched in 11 of the nation’s 26 states as a part of the broader EBS programme. CBS was the most important part of the EBS programme and had particular funding from the WHO and different donors (Sudan Humanitarian Fund, Central Emergency Response Fund, and catastrophe help departments of the USA, Qatar, Japan, and Italy).

The CBS programme began with an idea word written in September 2018 that highlighted the necessity for CBS to assist Sudan fulfil its worldwide commitments to the Integrated Disease Surveillance and Response (IDSR) in Africa, and to the worldwide elimination of key ailments similar to Guinea worm. The idea word additionally outlined the significance of CBS as a method of addressing Sudan’s historical past of predictable and a number of illness outbreaks and surveillance system gaps.3,4

The CBS programme implementation began with a pilot venture in December 2018 within the states of White Nile (Alsalam and Aljabalin localities) and Red Sea (Tokar and Sinkat localities). These websites have been chosen for the excessive prevalence of ailments and the perceived top quality of their well being info methods. Another issue of their choice was the potential problem of operationalising the idea of ‘community participation’ in these populations, given a number of giant populations of internally displaced individuals and refugees in White Nile, and politically marginalised populations in Red Sea. The goals of the pilot have been to evaluate the efficiency of neighborhood volunteers in figuring out occasions and the way the occasions have been reported upwards.

By 2021, the CBS programme had gained ample coverage traction and sources to develop into one of many key channels monitored for well being info alongside different sources (e.g., level of entry screening by border management officers; early warning, alert and response (EWAR) monitoring from settlements for refugees and internally displaced individuals; case-based surveillance and contact-tracing throughout particular outbreaks) and particular illness management programmes (e.g., antimicrobial resistance).