GETTING STARTED

Community-based surveillance (CBS) is a surveillance approach in which community members are trained to recognize and report cases of acute flaccid paralysis (AFP) based on a simple case definition to a designated focal person. These individuals are typically referred to as community volunteers (also called community informants), although they may receive compensation. These volunteers may be women or men and they can also mobilize their communities and raise awareness on the importance of disease prevention and treatment.

Formal CBS is highly resource intense because it involves incentives, close supervision, and using specialized digital tools. Formal CBS usually functions independently of facility-based surveillance with volunteers directly linked with surveillance officers.

Informal CBS builds upon other existing networks and has low resource intensity. Volunteers may receive minimal incentives for reporting AFP cases. Volunteers are usually linked to focal points within nearby health facilities. Informal CBS often works closely with facility-based surveillance.

It is critical to balance the needs of the program to increase AFP surveillance sensitivity with available funds and resources, making a low intensity CBS approach preferred if feasible in the given context. In some situations, especially in hard-to-reach and high-risk areas, the high resource intensity approach may be the only viable option to achieve the goal of polio eradication. Identifying which approach is best to reach hard-to-reach populations should be done in consultation with local stakeholders, including donors, who may be investing in polio CBS with a long-term vision of integrating polio surveillance into a country's broader Integrated Disease Surveillance System (IDSR) and/or Global Health Security surveillance system.

CBS is recommended on a case-by-case basis where health facility-based surveillance cannot be performed or is not functioning optimally, particularly in high-risk populations or areas with an elevated risk of undetected poliovirus transmission, importation, or vaccine-derived poliovirus emergence. Some examples include:

• Security-compromised areas,

• Special populations, such as refuges, internally displaced populations, economic migrants, urban slums, fishing communities, mining communities, nomads, ethnic and linguistic minorities, and remote or scattered populations, or

• Populations who are unlikely to receive care at a health facility.

Before implementing CBS, a needs assessment should be conducted to determine if CBS will be an efficient strategy to improve AFP surveillance sensitivity. 

See page 55 of the GPSAP for questions to explore during a needs assessment for CBS, and section 15 of the Guidelines for Implementing Polio Surveillance in Hard-to-Reach Areas for a discussion of mapping and other considerations.