People-Centered Surveillance: A Systematic Review of the Implementation of Community-Based Surveillance Among Crisis-Affected Populations

Abstract

Background: Large-scale epidemics often occur in fragile states, and expand rapidly due to late disease detection, delays in pathogen confirmation, and weakened public health systems. The WHO recommends community-based surveillance to rapidly detect disease events in complex environments, displacement camps, and during epidemics. As such, community-based surveillance contributes to a core capacity of the International Health Regulations for rapid detection and response at the community-level which can facilitate immediate control measures. Methods: Using PubMed and EMBASE without date restrictions, we conducted a systematic review of articles and evaluations on community-based surveillance to describe the characteristics of community-based surveillance systems by crisis context, and to document and compare effectiveness for disease detection. Findings: 27 articles describing 23 community-based surveillance systems met the criteria for inclusion. We found that community-based surveillance has the potential to provide sensitive disease detection capacity, produce valid data that can provide early warning and enable targeting of interventions for at-risk populations, and can continue to operate during periods of acute crisis. However, it has important operational requirements for continuous training and supervision of large cadres of community health workers and volunteers, verification of validity of cases and events detected, and provision of technical assistance for implementation. Interpretation: Community-based surveillance is an important means of front-line detection and surveillance of outbreaks. Like other community systems, it requires planning and resource mobilization for technical assistance, supervision, and monitoring of performance. CBS should be integrated into formal surveillance systems to support not only early warning, but rapid verification and response. Funding: There was no specific source of funding used for this article. Declaration of Interest: All authors declare that they have no competing interests. Ethical Approval: Not applicable; This review did not involve human participants, human data, or human tissue.