Preparing for Avian Influenza: Community-Based Systems for Early Warning, Reporting, and Surveillance

This project centred around the use of communication to develop community-based reporting and early warning systems (EWS) in six high-risk Philippine barangay (villages). CARE describes the thinking behind this initiative as follows: "Participatory by design, rooted in local knowledge, and integrated into local government infrastructure, community based programs not only help populations highly vulnerable to AI prepare directly for the impacts of a pandemic; they also have the unique ability to pinpoint potential gaps in national preparedness plans. Based on successful experiences from field programs, CARE is advocating for AI and pandemic flu responses to increase involvement of local communities and to increase the communication between these groups and national planning bodies." The idea is that asking communities to merely report suspected cases of avian influenza "fails to draw on the innate capacity of local communities to protect themselves and their environments....Villagers...are a rich source of information, both for technical issues and disaster preparedness."

To elaborate, at the heart of CARE's approach to identifying the geographic regions and communities most at risk is partnership - collaboration with key stakeholders. This process involves ensuring that those actors with the most intimate knowledge of relevant information at each level - government health and animal workers at a national level, and key community members at the local level - are integrally involved in the design of the project. In the Philippine pilot, project design began with participatory meetings between CARE, partner civil society organisations (CSOs), and national, regional and municipal representatives of the Department of Agriculture (DA) and the Department of Health (DOH). In composing the team, the goal here was to ensure that geographic assessments would be informed by factors related to both animal and human health, as well as community and local government capacity. The information gathered from these meetings enabled CARE to assess and rank the avian influenza/pandemic flu outbreak risk for Philippine provinces based on indicators already established by the government's National Task Force on AI. CARE's final risk evaluation emerged from a quantitative screening using these indicators and a qualitative assessment based on focus group discussions and key informant interviews with local government units and people's organisations.

Ensuring local relevance and participation was another key guiding principle in the pilot project. Organisers explain that they took care to ensure that information, education, and communication (IEC) campaigns created as part of the project were adapted to the specific context of each community. One belief informing the shape of these campaigns was that presenting the threat and implication of avian influenza in the context of daily life motivates leaders and villagers to participate actively in the contingency planning process. Organisers also feel that building local awareness strengthens the accountability of leaders and government to fulfill their obligations to prepare for and mitigate avian influenza. In the Philippines pilot, this obligation was formalised through the creation of a municipal taskforce.

The second phase of the project centred around the training leaders from the selected locales to lead their communities through a process of vulnerability mapping for the purposes of what CARE Philippines calls "demographic targeting", followed by the development of a contingency plan. Specifically:

• Representatives from CARE, civil society organisation (CSO) partners, and the DOH and DA formed a team to design modules for a training of trainers (ToT) exercise. The 5-module training kit contained modules on:
  
  
  1. basic AI information, including signs and symptoms of AI in poultry and humans, modes of transmission, and precautionary measures;
  2. activities to prevent AI in animals and humans;
  3. community-level responses to AI;
  4. simulation/role playing exercises; and
  5. contingency planning.

  
  

• The team members conducted ToT sessions for wider CARE staff, partner CSO staff, and local leaders (who, in turn, trained local leaders from the barangays). Trained leaders then returned to conduct a 3-day workshop in each selected locale, convening members of the community council, leaders of community-based organisations (CBOs), representatives of local institutions, and local DOH and DA officials.
• Workshop participants worked with the Community Health Response Team (CHERT) to assign responsibilities and develop a routine monitoring form in collaboration with DOH and DA officials (who checked the accuracy of reporting, flow of information, and integration with national systems). The monitoring and reporting process was led by the CHERT surveillance committee and community health workers (who were trained to use the routine monitoring form during the previous workshops). Team members recorded observations of poultry and human health during monthly house-to-house visits within their catchments of 40 households. They then submitted findings to municipal health and agriculture officers (who incorporated the surveillance data into their monthly reports to the district-level authority). In the instance of a suspected case, the community chairman would be expected to alert municipal health and agriculture officers and the mayor within 8 hours, and the surveillance team would produce a written incident report and submit it to the mayor within 24 hours. Repeated simulation sessions were used to sustain confidence and ensure accuracy in this reporting system.
• In a second workshop, animal health and human health sector representatives trained teachers, daycare workers, community health workers, and sector leaders to recognise AI symptoms in poultry and humans. This workshop also provided a forum for feeding back into the EWS design.
• Leaders who attended the original ToT workshop were responsible for holding assemblies to sensitise the general public and inform them about contingency planning activities. Aside from gatherings and workshops, multiple media channels were used as a part of a public information campaign. Brochures were disseminated to households, streamers were placed along highways and in public places, and radio spots promoted basic messages.

CARE also worked with the leaders of specific "target" groups to disseminate information regarding AI to group members through established mechanisms. For instance, Parent-Teacher-Community Association (PTCA) members, including teachers, daycare workers, students' parents, and other members of the community learned about the AI virus during PTCA meetings. A detailed orientation was provided to the teachers, who then took the messages into their classrooms. Teachers and daycare workers were supplied with primary- or secondary-level instructional materials to present to their pupils through storytelling and other techniques.

Health, Risk Management.

To access PDF documents that include additional details about this project - and the case study and tools emerging from it - click here and scroll down to "CARE Philippines".