PHE Preparedness Initiative

PHE Preparedness Initiative

Publication info

April Houston

Project Name: PHE Preparedness Initiative

Funder: US Centers for Disease Control and Prevention (CDC)

Timeframe: 2017-2022

Locations: Democratic Republic of Congo, South Sudan

Objective: To build the capacity (of CARE and of the communities where we work) to prevent, detect and rapidly respond to public health emergencies (PHE), with an emphasis on enhancing disease prevention through community engagement and early detection through community-based surveillance.



In October 2018, CARE began implementation of the PHE Preparedness Initiative - a pilot project focused on enhancing risk communication and community-based surveillance (CBS) in Bipemba district, Kasai-Oriental province in the Democratic Republic of Congo. The initiative is taking place in a province where CARE's SAFPAC program is ongoing, and SAFPAC has utilized similar community-based approaches to explore attitudes and norms related to disease transmission and implement an approach to enhance CBS. At the beginning of implementation, the central provinces of Kasai-Oriental and Sankuru were experiencing a cholera outbreak with over 1,000 cases and nearly 100 deaths attributed to the disease in the first four months. Although the Kasai region had been cholera-free since 2004, the health and sanitation environment began quickly deteriorating in 2016 as a result of armed conflict between local militia groups and the national army, opening the door for the pathogen’s return.



CARE’s community-based surveillance (CBS) approach was informed by global guidance and aims to enhance the existing surveillance system by utilizing CARE program platforms and engagement approaches at the community level. Volunteers from the community were recruited and trained to act as liaisons between the health system and the community. As CBS focal points (CBS-FPs), these individuals support efforts for disease prevention and early detection to reduce the spread of transmission and enable faster responses (including but not exclusive to cholera) together with community health workers, facility-based health workers, and the Bipemba health district staff.

CBS-FPs provide education on good hygiene practices and promote the use of chloramine tablets for water purification. They also make routine home visits to check on the health of families in their area, reporting any suspected adverse public health events they find (including a community-defined description of cholera) back to the head nurse at the local health facility who would begin an investigation and ensure it is reported to the health district office.



After seven months of CBS implementation in Kasai, CARE interviewed health workers, staff members from the district ministry of health, and CBS-FPs involved in the project there to explore the effectiveness of the approach. They noticed:

Early detection of emerging public health threats improved. According to local CARE staff, the reported cases of cholera went from 80 in Bipemba to zero over the course of the project. Also, while making their home visits, CBS-FPs noticed some unusual cases of illness that turned out to be measles. An investigation was launched, and more cases of measles were quickly located and confirmed by the health district office, which then sent the patients to health facilities for treatment and prompted a measles vaccination campaign.

Hygiene behaviors among families in the community also improved. Health district officials noted increased latrine use, hand-washing, and use of chloramine tablets for water treatment after the community had been educated on disease prevention.

Community members began to trust the health system more. Through their outreach and sensitization efforts, CBS-FPs engaged the community to discuss causes of disease, health-seeking behavior, and signs of potential illness that require quick reporting. The interaction has resulted in strengthened awareness and trust between the health system and the community, and increased utilization of health facilities.


Next Steps

Implementation of a similar CBS approach began in Torit and Wau counties in South Sudan in late 2019, with the goal of strengthening the country's preparedness for Ebola. Similar to the work in DR Congo, CARE will work with communities to 1) assist them in making informed decisions and taking action to prevent the spread of Ebola and 2) strengthen the early detection and reporting of suspected Ebola cases. Check back soon for updates!



Evaluation: PHE preparedness pilot (year one)

BLOG: Building a Bridge for Better Infectious Disease Prevention and Control (Frontline Health Workers Coalition)