Community Event-Based Surveillance (C-EBS)

Overview of the CHT workflow with a focus on enabling COVID-19 response

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Updated May 2020

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COVID-19 Event-Based Surveillance Priorities

• Achieve earliest possible detection of COVID-19 cases in communities
• Achieve national scale with maximum population coverage as soon as possible
• Achieve visibility into signals, reports, and investigations centrally for follow-up
• Coordinate and support local action based on existing roles in disease surveillance
• Surface and escalate signals formally and quickly, based on an established protocol

In addition, the goals of all COVID-19 surveillance apps include: to not further disrupt PHC; to spread verified information and not rumors; and to support engagement and education to combat COVID-19 within communities.

COVID-19 Event-Based Surveillance Opportunities

Event-Based Surveillance with the CHT offers the following opportunities for rapid deployment, sustainable use, and measurable community impact.

• EBS can be scaled by training CHWs remotely on their role and responsibilities via SMS
• Tiered reporting, verification, and escalation system can improve speed and quality of data
• Where CHW and Supervisor registries exist (names, phone #s), we can pre-populate supervisor apps with CHW contacts and supervisor workflows
• There is the possibility of continuing to use the COVID EBS platform following the end of the outbreak to ensure disease reporting within the community and PHC benefits
• EBS signal data can be mapped for data-driven decision-making by MoH staff

Event-Based Surveillance

Workflow Overview, User Roles & Hierarchy

EBS Workflow

CHW identifies signal in the community and reports the signal code

Supervisor calls CHW to gather more information and determine if threat exists

Sub-District staff dispatches a team for investigation and submits Case Investigation Report

CHT App

Signal ID

CHW sends SMS with Signal ID

SMS

confirmation

CHT sends SMS confirmation

SMS alert

CHT sends SMS alert to Supervisor and creates a task

If threat exists, supervisor submits Case Verification Report

SMS alert

Case Investigation

Report

Case

Verification Report

CHT sends SMS alert to Sub-District staff and creates a task

User Roles in EBS for COVID-19

CHWs & Other Volunteers

Role: Detect and report signals

• Provide feedback and guidance to patients and families
• Provide health education and feedback to the community on reported COVID-19 signals

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County & National

Roles: Monitor central analytics

• Monitor analytics regarding verified and investigated suspect cases
• Monitor overall system including missing verifications or investigations

CHW Supervisors

Role: Verify COVID-19 signals

• Verify signals & add additional information for verified signals
• Provide feedback and guidance to CHWs

Sub-District Investigator

Role: Investigate verified reports

• Within 24 hours of signal report, add data to signal case.

EBS Reporting Hierarchy, Users & Devices

Sub-District Investigators

CHWs

User Roles

Most CHWs have basic phones; some smartphones

Smartphone

Laptops, desktops, smartphones to monitor analytics

Devices

Location

Central Offices

Facilities or Local Office

Lives and works at community level

CHW Supervisors

Smartphone and personal phone

Lives at community level, based at facilities

District Health Officials

Laptop, desktop, smartphone to monitor analytics

District Offices

Verify COVID-19 signals. Provide feedback and guidance to CHWs.

Monitor overall system and analytics regarding verified, investigated, and missing cases.

Investigate verified reports within 24 hours of signal report; add data to signal case.

Detect and report signals. Provide guidance and health education to patients and families.

National-EOC Officials

CHW identifies signal in the community

CHW reports the signal code to the system using the Signal Reporting form

CHW Supervisor receives an SMS notification

CHW Supervisor calls CHW to gather more information

CHW Supervisor submits a Case Investigation request form to the Sub-District Investigator

Form comes to an end and no SMS notification is sent to the Sub-district staff

Sub-district staff receives an SMS notification and dispatches a team for investigation/ processing

Sub-district staff submits a Case Investigation report to trigger the next stage of response

County and National Level receive data for signals reported, verified, & escalated per sub county /county

Does the reported threat exist?

Yes

No

Signal Reporting may be filled out by a Supervisor if the CHW is unable to initiate workflow

If the Supervisor does not send the Signal Verification form, they get a reminder at 8, 16, and 24 hrs. The 24 hr reminder also goes out to the Sub-District Investigator.

If Sub-District Investigator does not send the Case Investigation report, they get a reminder at 8, 16 and 24 hrs.

High risk cases are escalated to District/National level.

EBS: Detailed Workflow

COVID-19 Event-Based Surveillance Signals

The EBS signals used for reporting by the Ministry of Health in Kenya include the following:

• Any person presenting with hotness of the body or cough or difficulty in breathing having a history of travel from outside the country

OR

• Lived with or visited someone known to have the COVID-19 disease

App

CHW Signal Reporting

Workflow for CHW COVID signal reporting:

• CHW observes signal in the community
• CHW texts signal code for COVID-19 to reporting short code to start workflow
• Data captured includes:
• CHW reporter
• Community
• Signal code
• Report time

C-EBS enables rapid reporting of signals in the community presenting a risk to human health

CHW Kathy (+123456789) has reported a COVID-19 signal. The Signal ID is 00590. Log in to the CHT App to verify the signal.

CHW Supervisor’s Phone

CHW Supervisor Signal Verification

Workflow for CHW Supervisor signal verification:

• CHW Supervisor receives SMS alert for reported signal
• CHW Supervisor calls CHW for more information and triages threat
• If threat exists, CHW Supervisor submits a Case Investigation Report to Sub-District

This process enables swift investigation of reported signals, triage to ensure only legitimate signals are escalated, and reporting to Sub-District

Community Health Toolkit

Supervisor Paula (+14155551212) has verified a COVID-19 signal that requires investigation. The signal ID is 27248. Log in to the CHT App for more details.

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Signal Investigator’s Phone

Sub-District Investigator Case Report

Workflow for Sub-District Investigator case reporting:

• Sub-District office receives SMS notification of signal report
• Sub-District staff visits community and investigates signal, including further risk assessment and associated test
• Sub-District recommends further action, including escalation of high risk signals

C-EBS enables rapid reporting, identification and action for verified signals - and integration with additional COVID use cases.

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Demo Video

Impact Metrics

COVID-19 EBS Impact Metrics

The CHT Event-Based Surveillance workflow has the following prioritized impact metrics for monitoring across deployments.

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• Event-Based Surveillance
• # of CHWs trained for EBS (total, by location)
• # of COVID signals reported (total, by location), of these signals we can look at the # or % verified by a CHW supervisor and investigated at the sub-county level
• total time from signal report by CHW to submission of investigation report at the sub-county (average per signal reported by CHW)

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We have also built template analytics dashboards via Superset and example images of those for reference will be linked here.

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If you have questions, comments, or would like to get in touch, please do not hesitate to reach out.

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hello@medicmobile.org

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Appendix

CHT Core Framework

CHT Core Framework

Event-Based Surveillance System

CHW Kathy (+123456789) has reported a COVID-19 signal. The Signal ID is 00590. Log in to the CHT App to verify the signal.

Signal Verification: CHW Supervisor

Community Health Toolkit

Supervisor Paula (+14155551212) has verified a COVID-19 signal that requires investigation. The signal ID is 27248. Log in to the CHT App for more details.

Event-Based Surveillance System

Signal Investigation: Investigator

C-EBS Users and Devices

National-EOC Officials

Sub-District Investigators

CHWs

Users

Most CHVs will have basic phones; some smartphones

Smartphone

Laptops, desktops, smartphones to monitor analytics

Devices

Location

Central Offices

Facilities or Local Office

Lives and works at community level

Details

CHW Supervisors

Smartphone and personal phone

Lives at community level, based at facilities

District Health Officials

Laptop, desktop, smartphone to monitor analytics

District Offices