Community-based surveillance: A scoping review
Community-based surveillance: A scoping review
Jose? GuerraID 0 1
Pratikshya Acharya 0 1
Ce? line Barnadas 0 1
0 Editor: Linda A Selvey, University of Queensland , AUSTRALIA
1 World Health Organization (WHO) , Lyon , France
Involving community members in identifying and reporting health events for public health surveillance purposes, an approach commonly described as community-based surveillance (CBS), is increasingly gaining interest. We conducted a scoping review to list terms and definitions used to characterize CBS, to identify and summarize available guidance and recommendations, and to map information on past and existing in-country CBS systems.
Data Availability Statement: All relevant data are
within the manuscript and its Supporting
We searched eight bibliographic databases and screened the worldwide web for any
document mentioning an approach in which community members both collected and reported
information on health events from their community for public health surveillance. Two
independent reviewers performed double blind screening and data collection, any discrepancy
was solved through discussion and consensus.
From the 134 included documents, several terms and definitions for CBS were retrieved.
Guidance and recommendations for CBS were scattered through seven major guides and
sixteen additional documents. Seventy-nine unique CBS systems implemented since 1958
in 42 countries were identified, mostly implemented in low and lower-middle income
countries (79%). The systems appeared as fragmented (81% covering a limited geographical
area and 70% solely implemented in a rural setting), vertical (67% with a single scope of
interest), and of limited duration (median of 6 years for ongoing systems and 2 years for
ended systems). Collection of information was mostly performed by recruited community
While CBS has already been implemented in many countries, standardization is still
required on the term and processes to be used. Further research is needed to ensure CBS
integrates effectively into the overall public health surveillance system.
Prevention. The funders had no role in study
design, data collection and analysis, decision to
publish, or preparation of the manuscript. The
authors alone are responsible for the views
expressed in this article and they do not necessarily
represent the decisions, policy or views of the
World Health Organization.
Public health surveillance is an essential function of a health system, defined as ?the systematic
on-going collection, collation and analysis of data for public health purposes and the timely
dissemination of public health information for assessment and public health response as necessary?
Conventionally, public health surveillance relies on healthcare facilities where information
is captured from in- and outpatients [
]. However, it has been suggested that only a portion of
sick individuals visit healthcare facilities [
], due to unavailability or inaccessibility of health
facilities ; a reliance on self or alternative medication [
]; or an assumption that disease
condition is not serious enough to seek treatment [
]. Therefore, to complement healthcare
facility-based surveillance, another approach is to involve community members in identifying and
reporting health events occurring in their community.
This approach was the topic of a 2001 handbook for community surveillance coordinators
published to ?encourage the involvement of communities themselves both in detecting and
reporting diseases and in preventing disease and promoting positive health habits? [
Involvement of communities was also part of the 2001 technical guidelines for integrated
disease surveillance and response used in the African region which sought to: ?emphasize
community participation in detection and response to public health problems? [
]. In its 2010
edition, the term ?community-based surveillance? was introduced and a definition provided:
?trained surveillance informants identify and report events in the community that have public
health significance? [
]. In 2014 and 2015, the World Health Organization published a ?guide
for establishing community-based surveillance? and a dedicated training manual [
was followed by a guidance document on ?community-based surveillance? published by the
International Federation of Red Cross and Red Crescent Societies in 2017 . These
additional guides provided much needed support to involve community members in the approach
of identifying and reporting health events occurring in their community. However, certain
discrepancies were seen between the guides and information on certain aspects of such
an approach were missing. Furthermore, the occurrence of the term ?community-based
surveillance? in the literature increased, but it was often used to characterize very different
approaches. For example, while some documents used the term to describe the involvement of
community members for public health surveillance [
], others used it to describe studies
performed in healthcare facilities by dedicated surveyors for research purposes [
Overall, there is a lack of standardization of the approach involving community members
in identifying and reporting health events occurring in their community for public health
surveillance (hereafter designated by the acronym CBS), namely a consensual term and definition
to characterize it, and the actors and processes involved in its implementation and operation.
In order to support the further standardization of CBS, a scoping review was conducted to
systematically list terms and definitions used to characterize CBS, to identify and summarize
guidance documents and recommendations available for its implementation and operation,
and to map the details of any past and existing examples of in-country CBS systems.
Materials and methods
This scoping review follows the method proposed by Arksey and O?Malley [
] and modified
by Levac [
]. The protocol of the study was not registered.
In this scoping review, we defined our inclusion criteria as any document mentioning an
approach or system with the following characteristics:
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? collection of information from the community performed by community members, and
? reporting of this information for public health surveillance purposes (i.e. monitoring of the
health status of a population or early detection of public health risks and events).
We defined a community as people living in a defined geographical area.
The following exclusion criteria were applied:
? ad hoc prevalence or incidence study for a specific condition;
? description of an approach or system solely involving collection of information from
? language other than English, French, Spanish or Portuguese;
? full text unavailable; or
? conference presentation.
No publication time limit was used for the selection of the documents.
Search of information sources
A search for eligible documents was conducted using the eight following bibliographic
databases: Medline, Global Index Medicus, Popline, Cochrane library, Excerpta Medica database
(EMBASE), Iris, The European Library, and Africabib.
The search strategy was designed to identify documents including: both concepts of
community participation and public health surveillance, or terms denoting CBS. Tailored search
requests were used to select documents from each bibliographic database. As an example, the
search request used for Medline using Pubmed on the 28 March 2017 was: (("sentinel
surveillance" [MeSH Terms] OR "population surveillance" [MeSH Terms] OR "public health
surveillance" [MeSH Terms] OR surveillance [Title/Abstract] OR "public health surveillance") AND
("Community-Based Participatory Research" [MeSH Terms] OR "Community-Institutional
Relations" [MeSH Terms] OR "Community Health Workers" [MeSH Terms] OR "volunteers"
[MeSH Terms])) OR "community-based surveillance" [TIAB] OR "participatory surveillance"
[TIAB] OR "household surveillance" [TIAB] OR "community based sentinel surveillance"
[TIAB] OR "community based health reporting" [TIAB].
Additional searches were also conducted using the Google search engine on the worldwide
web, where the 50 first results of each of four search requests were screened for suitability.
Detailed search requests and search results from each database and the world-wide web are
presented in the S1 Table.
Subsequently, the reference lists of each of the documents found to meet the inclusion
criteria were also screened to identify any additional documents of interest.
Selection of sources of evidence
Two reviewers (JG and PA) independently screened in a blind standardized manner the titles
and abstracts of each of the search results using the Rayyan web application [
Disagreements between reviewers on inclusion or exclusion were resolved by discussion and consensus.
Further exclusion of the documents was performed during the data collection process (i.e. a
document could be later excluded based on its full-text review).
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Fig 1. Variables collected from each included document.
Data charting process and data items
We developed a data collection form using the LimeSurvey software [
] to systematically list
terms and definitions used to characterize CBS, identify and summarize guidance documents
and recommendations available for its implementation and operation, and map the details of
any past and existing examples of in-country CBS implementations. The variables collected
are listed in Fig 1. The same two reviewers independently filled the data collection form for
each included document. Any discrepancy in the collected information was resolved by
discussion and consensus.
Synthesis of results
An analysis of the collected data on terms and definitions used for CBS and past and current
examples of in-country CBS systems was performed using the R statistical software [
Data collected from different documents were consolidated for each unique CBS system
Evidence tables were developed to present all collected information.
Available guidance and recommendations to implement or operate CBS were summarized.
4 / 25
Supplemental study on the usage of the term ?community-based
We conducted a supplemental study on the use of the term ?community-based surveillance? in
the literature. All unique documents retrieved from the search of information sources were
screened anew by one reviewer, the sole inclusion criterion was the explicit mention of the
term ?community-based? and ?surveillance? with or without other elaborative words in
between in the title or abstract. Information was collected for the following variables: type of
document and description of the approach termed as ?community-based surveillance? in the
document (full method available in S2 Text).
Role of the funding source
The funder of the study had no role in study design, data collection, data analysis, data
interpretation, or writing of the report. The corresponding author had full access to all the data in
the study and had final responsibility for the decision to submit for publication.
Selection and characteristics of sources of evidence
One thousand nine hundred ninety-three documents were identified by the search strategies.
After screening and selection, 134 were included in the review [
illustrated below in Fig 2.
The bibliographic reference and type of each included document are available in the S2
Terms and definitions used to characterize CBS
Sixty-six percent of documents (n = 88/134) used at least one specific term to denote the
approach of involving community members in identifying and reporting health events
occurring in their community for the purpose of public health surveillance. The remaining 46
documents mentioned such approach, but without a specific term to denote it. The most
commonly used term was ?community-based surveillance? (n = 46/88, 52% of documents),
followed by ?community event-based surveillance? (n = 7/88, 8%). In total, 44 unique terms to
denote the concept of CBS were identified. All unique terms comprised two basic components:
a component to denote the involvement of community members and a component to denote
the concept of public health surveillance. A list of all the terms is available in the S2 Table.
Ten documents contained a specific definition of the term that was used for CBS (7%,
n = 10/134) with eight unique definitions retrieved (see Table 1).
Available guidance and recommendations for the implementation and
operation of CBS
Twenty-three documents (17%) contained guidance material or recommendations related to
the planning, implementation or operation of a CBS system [
]. A summary of
available guidance and recommendations is presented in the S1 Text. Seven of these
documents were detailed guidance documents with a specific focus on CBS and are presented in
Table 2. Many of these documents noted that it was crucial to keep the CBS systems simple,
purposeful and easy to set up [
], with information collected only if it can lead to a
5 / 25
Fig 2. Documents selection.
Several guidance documents provided simplified health events case definitions to be used
for CBS, most of which could be found in an available World Health Organization guide for
establishing a CBS system [
]. Whilst several documents highlighted the crucial role of
feedback in ensuring an effective CBS system, there was almost a total lack of concrete guidance on
how to provide such feedback. Similarly, no practical guidance?s or tools were found available
to support the proper evaluation of the effectiveness and utility of a CBS system.
Descriptions of past and existing CBS systems
One hundred fourteen documents (85%) mentioned a past or existing in country-CBS system.
From these, 79 unique CBS systems were identified.
The data collected for each unique CBS system is displayed in the S2 Table.
Missing information on CBS systems. For each type of variable, the percentage of
missing data was (n = 79 unique CBS systems): country 0%; start year 20%; end/ongoing year 22%;
coverage 9%; setting 25%; purpose 28%; scope 0%; data collection actor 0%; data collection
method 37%; data reporting method 53%, and frequency 24%; report recipient type 28%, and
level 32%; performance indicators 75%.
Country of implementation. CBS systems were identified in 42 countries (see Fig 3).
Operation period. Ninety-two percent of identified CBS systems were established after
1980 (n = 58/63), with an upsurge notable in the period from 2001 to 2010 (45%, n = 28/63).
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Oum (2005) [
Chau (2007) [
World Health Organization and Centers for
Disease Control and Prevention (2010) [
Curry (2013) [
World Health Organization (2014) [
Health Organization (2015) [
Okiror (2015) [
International Rescue Committee (2015) [
Ebola Response Consortum (2015) [
International Federation of Red Cross and Red
Crescent Societies (2017) [
[Community-based surveillance is] ?a network of lay people
involved in the systematic detection and reporting of
healthrelated events from their community?
?CBSS [Community-based surveillance system] is a surveillance
system which detects and report diseases from within the
community by village health volunteers?
?In this system [Community-based surveillance system],
trained surveillance informants identify and report events in
the community that have public health significance.
Community informants report to the health facility or, in the
case of a serious event, directly to the district authorities.?
?CBS [Community-based surveillance] is a set of activities that
increase public awareness of the symptoms of a disease or
condition and encourage self-initiated case-reporting by the
community to the official MOH [Ministry of Health] and/or
WHO surveillance authorities. This system includes a
mechanism for active case search in the community by
nonclinical volunteers or employees and a system for tracking the
cases detected. Two elements of this definition are important to
note as central to distinguishing CBS from other forms of active
surveillance or outreach: (1) case detection activities occur
outside a health facility, and (2) those performing case
detection activities are community members.?
?Community-based Surveillance (CBS) is an active process of
community participation in detecting, reporting, responding to
and monitoring health events in the community. The scope of
CBS is limited to systematic on-going collection of data on
events and diseases using simplified case definitions and forms
and reporting to health facilities for verification, investigation,
collation, analysis and response as necessary. CBS should be a
routine function for: (a) the pre-epidemic period (to provide
early warning or alerts); (b) the period during epidemic (to
actively detect and respond to cases and deaths); (c) the
postepidemic period (to monitor progress with disease control
activities). CBS should also include a process to report rumours
and misinformation of unusual public health events occurring
in the community.?
?It [Community-based surveillance] is an ongoing activity
conducted at community level by community volunteers and
includes active case searches during house-to-house visits,
religious and traditional healing sites (holy water, prayers,
church, mosque) visits, with kalicha (Muslim traditional
healers) and reporting to the nearby health facilities?
?Community event-based surveillance is the organized and
rapid capture of information from the community about events
that are a potential risk to public health.?
?Community-based surveillance is a surveillance system that
monitors a broad range of information directly from
community members. It is a simple, adaptable and low-cost
public health initiative managed by communities to protect
communities. CBS empowers trained RC [Red Cross/Red
Crescent] volunteers to report unusual events in the
community where they live through the use of a mobile phone
or other form of communication?.
To support the ?design of
eventbased surveillance systems?.
Process of CBS implementation:
roles of different health authority
levels and NGOs, modalities to
involve community in surveillance
Activities of CBS: roles of different
health authority levels and NGOs.
Actors for data collection: desired
qualities, selection modality, ways to
motivate them, training modality.
Data collection: case definitions,
samples of reporting forms.
Supervision, monitoring and
evaluation: supervision modality.
Actors for data collection: types of
Data collection: sources of
information, list of trigger events,
Data reporting: modality.
A guide to establishing
eventbased surveillance [
Integrated disease surveillance
and response in the African
Region: a guide for establishing
Regional Office for
Regional Office for
Ebola and Marburg virus disease
epidemics: preparedness, alert,
control, and evaluation [
Integrated Diseases Surveillance
and Response in the African
Surveillance (CBS) Training
Regional Office for
8 / 25
National RC societies, Setting: relevance of a CBS system in
RC?s health program staffs, a community.
Other partner Scope: considerations to determine
organisations, scope for surveillance.
National Process of CBS implementation:
authorities, steps to implement a CBS system,
RC volunteers community engagement.
Activities of CBS: procedure / key
Actors for data collection:
requirement, selection modality,
Data collection: desired qualities of
triggers and case definitions,
Data reporting: modality.
Feedback: modality to communicate
with and receive feedback from
Supervision, monitoring and
evaluation: performance indicators.
The oldest system was established in 1958 [
]. Sixty-nine percent of systems were described
as ongoing (n = 43/62) whilst the remaining 31% (n = 19/62) had ended. The median duration
of operation of the ongoing CBS systems was 6 years (IQR [2 years; 13 years], n = 37). The
longest-running CBS system was also the oldest, established in Guatemala for malaria surveillance
34 years ago in 1992 [
]. The median duration of operation for the ended CBS systems was 2
years (IQR [1 year; 3 years], n = 19), with a range of 1 month (Democratic Republic of the
Congo for a measles outbreak [
]) to 6 years (Tanzania for children?s nutritional status
Coverage and setting. CBS systems were mostly implemented in limited geographical
areas (n = 58/72, 81%) and in the following settings:
? rural (n = 41/59, 70%),
? both rural and urban (n = 10/59, 17%),
? urban (n = 5/59, 8%),
? refugee settlements (n = 3/59, 5%).
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Fig 3. Distribution of CBS systems identified across different countries.
Purpose. Purposes of the systems were noted as: ? monitor the health status of a population (n = 26/57, 45%), ? early detect public health risks and events (n = 17/57, 30%), ? both above purposes (n = 14/57, 25%).
Scope. The scope of the health events under surveillance are presented in Fig 4. Most
systems focused on a single health condition or event (n = 53/79, 67%).
Actors in charge of data collection. Three different types of community members were
identified in the documents as performing data collection (hereafter named as ?data
? locally recruited surveillance cadres (i.e. community members who were selected and
recruited as volunteers or paid workers): n = 56/79 (71%);
? general community members (i.e. any community member could report an event): n = 12/
? a specified group of the community (i.e. certain group of community members such as
teachers, students, community leaders): n = 3/79 (4%);
? more than one type of data collectors was present in 8 systems (10%).
Out of the 63 systems involving locally recruited surveillance cadres, 18 systems (29%)
provided information on their selection processes. Selections were made either by community
members (n = 12/18, 67%), local healthcare staff (n = 4/18, 22%), or by both community
members and healthcare staff (n = 2/18, 11%). Information on the selection criteria used was
10 / 25
Fig 4. Distribution of CBS systems by scopes of interest (n = 79 systems). a includes influenza like illness and avian influenza; b includes cholera, acute
gastrointestinal illnesses; c includes Buruli ulcer (n = 1), cutaneous leishmaniasis (n = 1), yaws (n = 1), smallpox (n = 1); d includes Ebola virus disease and dengue;
e includes pregnancy complications (n = 2), low birth weight (n = 1), suicidal and self-injurious behaviour (n = 1); f includes maternal, neonatal, infant, under-five
available for 13 systems (21%), out of which two did not have formal selection criteria. Literacy
was the most commonly used selection criterion (n = 10/11, 91%), which encompassed the
ability to read and write (n = 7) and to hold at least a secondary level education (n = 3). Other
frequently employed selection criteria included a motivation to work for the community
(n = 6/11, 55%) and being someone respected in the community (n = 4/11, 36%).
Information on the use of incentives for data collectors to perform their duties was available
for 21 systems (33%). In 16 systems (76%), data collection was performed on a voluntary basis.
In 11 systems, the form of incentives given included monetary incentives (n = 4/11, 37%);
material incentives (n = 3/11, 27%); service incentives (n = 1/11, 9%); both material and service
incentives (n = 2/11, 18%); and both monetary and service incentives (n = 1/11, 9%).
Information on the training received by data collectors was provided for 18 systems (locally
recruited surveillance cadres, n = 17; specific group of community members, n = 1). The
training duration was: less than a week (n = 11/18, 61%), from one week to one month (n = 2/18,
11%), more than a month long (n = 5/18, 28%).
Data collection method. Three data collection methods were used in the CBS systems:
? Active data collection (n = 21/50, 42%): locally recruited surveillance cadres proactively
searched for diseases or events under surveillance by making home visits (n = 21/21, 100%)
and actively meeting and talking to the community members (n = 5/21, 24%).
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? Passive data collection (n = 11/50, 22%): surveillance actors collected information when a
sick person visited them for diagnosis or treatment (n = 8/11, 73%); or when they received
information on the occurrence of an event under surveillance (n = 3/11, 27%).
? Self-collection and reporting (n = 13/50, 26%): general community members collected
information about themselves or their families and reported it, this was primarily used for
triatomine bugs surveillance (n = 8/13, 62%) and for surveillance of influenza like illness (n = 4/
13, 31%). In five systems (10%), several data collection methods were applied.
Data reporting method. In most systems, surveillance actors visited a supervisor or
viceversa to submit or collect reports (n = 23/37, 62%). In 35% of the systems, reporting was done
through telecommunication (n = 13/37), using a combination of phone calls (n = 6), mobile
phone applications or SMS (n = 5), websites (n = 4), fax (n = 1), or wireless radio (n = 1). In
one system, reporting involved both making visits and making phone calls [
]. All systems
reporting via telecommunication were implemented in the last 15 years (n = 11, two systems
had missing information for their start year). All systems started after 2010 reported via
telecommunication (n = 4, three systems had missing information for the reporting method). The
four CBS systems using websites to report were implemented in high-income countries for
self-reporting of influenza like illness.
Most systems reported data in a routine manner using predetermined schedule (n = 37/60,
62%): weekly (n = 12), monthly (n = 18), less than monthly (n = 11), combination of several
frequencies (n = 6). In 30% of the systems (n = 18/60), data was reported on an ad hoc manner;
whilst 8% of the systems (n = 5/60) reported data in both an ad hoc and routine manner. In
59% of the systems with an early detection purpose, reporting was done in an ad hoc manner
(n = 16/27), while in 90% of the systems with a monitoring purpose, reporting was done in a
routinely manner (n = 28/31). Reporting was commonly done to the local level (n = 46/54,
86%), and the most common recipient was a health authority (n = 41/57, 72%).
Performance indicators. Estimates of the sensitivity (i.e. capacity of the system to detect
the events under surveillance) or of the positive predictive value (i.e. capacity of the system to
correctly detect the events under surveillance) were available for seven CBS systems (see
Table 3). The completeness of data reporting was provided for ten CBS systems (see Table 4).
Supplemental study: Usage of the term ?community-based surveillance? in
Out of the 1494 unique search results from the scoping review, 232 documents used the term
?community-based surveillance? in their title or abstract (full results in S2 Text). Description
of the approach termed as ?community-based surveillance?, including the source of data, was
available for 177 documents.
Around one third of these documents used the term ?community-based surveillance? to
describe the approach we defined as CBS, where data was collected from the community by
community members for public health surveillance purposes (31%, n = 54/177). All of these
documents, except two, were included in our CBS scoping review (out of the two excluded
documents, for one [
] there was collection but no reporting of information for public
health surveillance, and for the other [
] CBS was discussed as one of the possible strategies
for control of Buruli ulcer, without providing any specifics).
The second most frequent use of the term ?community-based surveillance? in the literature
was to denote a research design where information was collected from the community by
surveyors or healthcare facility staff (28%, n = 50/177) for research purposes.
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Confirmatory follow-up visits (No. of villages reported (No. of villages reported
by an investigator in the confirmed as having cases confirmed as having cases
villages reported having new through the follow-up visit) / through the follow-up visit) /
cases as well as villages reported (Total No. of villages with (Total No. of villages with
having zero cases. verified cases of guinea cases reported by the CBS
(No. of confirmed cases
detected by the CBS system)
/ (Total No. of confirmed
cases identified in the area).
survey: in 2011 surveyors
visited all households covered
by the CBS system to collect the
same information as collected
by the CBS system in 2010.
survey: surveyors visited
households (in 3 out of 7 areas
implementing CBS) to collect
cases of diseases (preceding
month) and vital events
(preceding year), using the
same case definitions as used by
the CBS system. The survey was
For measles: outbreak
Cross-sectional survey: in
randomly selected villages
implementing the CBS system,
the blood of suspect malaria
cases identified by CBS actors
were tested to confirm malaria.
Cross-sectional survey: (No. of mosquito larvae
investigators visited and habitat identified by the CBS
searched for mosquito larvae system in the areas covered
habitat in randomly selected by cross-sectional survey) /
housing clusters (consisting of (No. of mosquito larvae
20?100 houses) covered by CBS habitat reported by
system. investigator during the
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(No. of catchment areas submitting
reports per month) / (Total No. of
catchment areas (n = 78))
(No. of catchment areas submitting
reports per month) / (Total No. of
catchment areas (n = 160))
(No. of reports received per week) /
(Expected number of reports per
week (n = 164))
(No. of surveillance actors
submitting reports per month) /
(Total No. of surveillance actors
(n = 7142))
Completeness of data
95% on average
90% on average
60% on average
74% overall (range: 53%?94%
for different districts)
91.6% overall by women
66.6% overall by members of
another village group.
12.4% stated they reported
every month during the 3
previous months (n = 17/137);
27% made reports ?some
months? (n = 37/137);
60.6% indicated never sending
reports (n = 83/137).
84% on average
82% on average (range:
38%?92% for different months)
40.5%: average reporting rate in
2005 for each State.
100% on average
95% on average
The third most frequent use of the term ?community-based surveillance? met none of the
criteria that we used in the scoping review to describe a CBS system (22%, n = 39/177). They
generally described a specific research study where surveyors collected data on a sample of
enrolled patients at healthcare facilities.
The other approaches termed as ?community-based surveillance? were: community
members collecting information from the community for research purposes (11%, n = 20);
noncommunity members collecting information from the community for public health
surveillance purposes (5%, n = 9); surveyors collecting information from healthcare facility patients
for public health surveillance purposes (3%, n = 5).
Summary of evidence
This scoping review retrieved 134 documents mentioning the approach of involving
community members in identifying and reporting health events occurring in their community for
14 / 25
public health surveillance. As many as one third of the documents did not use any term to
characterize CBS, and amongst others, 44 unique terms were used. Only 10 documents
provided a definition for CBS, showing a similar display of the lack of clarity surrounding CBS.
Seven major guidance documents on CBS were identified [
three guides solely focused on CBS [
]. Guidance and recommendations on CBS
practices were identified in sixteen additional documents. Description of the specific activities
required for CBS implementation and operations were scattered across several documents.
Their consolidation into a single process, with clear expectations on the roles and
responsibilities of the different actors involved, would be highly beneficial to facilitate the set up and
operation of a CBS system. A similar case is also noted for recommendations related to the best
modalities for the selection, training, and incentivisation of locally recruited community
members for CBS.
This review identified 79 unique examples of CBS systems implemented since 1958 across
42 countries. They were mostly implemented in low and lower-middle income countries
(79%), and appeared to be fragmented (81% covering a limited geographical area and 70%
solely implemented in a rural setting), vertical (67% with a single scope of interest), and of
limited duration (median duration of operation: 6 years for ongoing systems and 2 years for
ended systems). This highlights the lack of scale up of pilot programs, and the lack of
integration of CBS into the overall national public health surveillance system. CBS implementation
was mainly performed in rural settings and the best approaches to implement it in urban
settings were still to be defined [
Only 72% of the systems provided information on their purpose: 45% were implemented
solely to monitor the health status of a population, 30% solely to early detect and respond to
public health events, and 25% for both purposes. Eighty percent of the systems recruited
community members as volunteers or paid workers to collect and report data, the others relied on
general community members or a specific group in the community.
A surge in the use of telecommunication for CBS reporting has taken place in the last fifteen
years, which is linked with the dramatic surge of phone connectivity in most countries. The
use of telecommunication creates an opportunity to enhance completeness and timeliness of
] and to improve data management. However, the specific challenges
generated by the use of digital tools for public health surveillance, such as their cost and
sustainability, cannot be ignored [
Only a fraction of the documents provided evaluation results of the implemented systems.
Estimates of sensitivity and positive predictive value were available for seven systems, and
results of completeness of data reporting for ten. However, these estimates were computed in
an inconsistent manner, and usually for a short time duration, making it difficult to generalize
or compare findings. Minimum requirements and sound methodology to evaluate CBS
systems and disseminate evaluation results are thus urgently needed.
The main limitation of included documents was the inconsistent manner in which
information on CBS systems was available, with a lot of missing information for several aspects of the
systems. One explanation is our broad inclusion criteria which included documents that did
not have a main focus on the description of a CBS system, but merely mentioned its existence.
We tried as much as possible to correct this limitation by consolidating all available
information for each specific system from several documents.
For this scoping review, we strove to apply best standards with double-blind screening and
data collection, discrepancies being solved through consensus. We tried to be as sensitive as
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possible using tailored search algorithms to each bibliographic database, specific terms to
search the worldwide web, screening the references of each included document, removing any
time limits, and looking at publications in four languages (English, French, Portuguese and
Spanish). Exclusion of papers based on language may have missed some CBS implementations,
especially in Asia. There is also a risk that a publication bias may have favoured externally
supported CBS implementations, the existence of such a bias and its magnitude are yet to be
The major challenge we faced for this scoping review was to decide what should be
considered as ?community-based surveillance?. Indeed, lack of prior consensus in the term and
definition for CBS mandated that we define in advance what should be encompassed in the CBS
concept. We decided as minimum requirements that community members be both the source
of information and the actors collecting it, and that this information be used for public health
surveillance purposes. In addition, we had to define what we considered as a community. For
the sake of simplicity, we defined a community as people living in a defined geographical area,
excluding healthcare facilities from the community level. The rationale behind the exclusion of
healthcare facilities was to avoid healthcare facility-based surveillance systems that are already
well-known and broadly used for public health surveillance. With our inclusion criteria we
considered any document presenting both concepts of community and public health
surveillance. This may explain why a third of the included documents didn?t use any term to denote
CBS. To ensure the validity of our inclusion criteria we conducted a supplemental study on the
approaches termed as ?community-based surveillance? in the literature (see S2 Text). Only
22% of the documents with mention of the term ?community-based surveillance? in their title
or abstract were included in our scoping review. Indeed, the sole purpose of 61% of these
approaches termed as ?community-based surveillance? was research. For the remaining
approaches termed as ?community-based surveillance?, and aimed at public health
surveillance, 79% fulfilled our inclusion criteria of community members being both the source of
information and the actors collecting it.
To our knowledge, and the best of our search efforts, this is the first scoping review on CBS
to date. In 2002, Oum has conducted a previous narrative review on CBS as part of his
Doctorate in Public Health [
], documents of interest from his review were included in ours.
This scoping review, through the mapping of practices, guidance and recommendations on
CBS, provides the foundational work to standardize and improve the involvement of
community members in identifying and reporting health events occurring in their community for
public health surveillance. As such, in June 2018, the results of this scoping review were
presented to international experts convened by the World Health Organization [
]. They used
these results and their experience to reach a consensus on the term ?community-based
surveillance? and its definition: ?Community-based surveillance is the systematic detection and
reporting of events of public health significance within a community by community members?
]. They also agreed on a list of good practices and challenges for CBS and provided a list of
priority activities to be conducted to further promote and support CBS implementation. The
top three proposed activities were: develop and compile case studies of existing CBS,
consolidate existing guidance and fulfil existing knowledge gaps in global CBS guidelines, and create a
CBS community of practice with a shared repository of available material [
It was no surprise that a large majority of the CBS systems identified in this scoping review
were implemented in low and lower-middle income countries. Healthcare facility-based
surveillance systems face numerous challenges in these countries [
], including: healthcare
16 / 25
access; communication with hard to reach areas; lack of human, logistic and financial
resources; lack of coordination between multiple surveillance systems; lack of use of data for
response. The burden put by health information systems on healthcare facility staff is often
]. CBS can appear as an opportunity to tackle some of these challenges.
Yet, these challenges should also be stark reminders of the need to carefully craft CBS systems
to their specific setting, so that their contribution to the public health surveillance system is
not hindered by the creation of an additional vertical system, or by adding undue burden on
selected community members . Further research is needed to do so. A first step could
indeed be to consolidate available guidance and recommendations, and develop standardized
protocols and indicators to evaluate the effectiveness and integration of existing CBS systems
into the overall health information system.
S1 Table. Search strategies and results.
S2 Table. CBS review evidence tables.
S1 Text. Summary of available guidance and recommendations for community-based
S2 Text. Supplemental study on the usage of the term ?community-based surveillance? in
S1 File. PRISMA-SrC checklist.
We thank Lisa Stevens for reviewing the paper and Pierre Nabeth and Se?bastien Cognat for
their strategic oversight.
2019 World Health Organization. Licensee Public Library of Science. This is an open access
article distributed under the Creative Commons Attribution IGO License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited. http://creativecommons.org/licenses/by/3.0/igo/. In any use of this article,
there should be no suggestion that WHO endorses any specific organization, products or
services. The use of the WHO logo is not permitted. This notice should be preserved along with
the article?s original URL.
Conceptualization: Jose? Guerra, Pratikshya Acharya.
Data curation: Jose? Guerra, Pratikshya Acharya.
Formal analysis: Jose? Guerra, Pratikshya Acharya.
Methodology: Jose? Guerra.
Software: Jose? Guerra.
17 / 25
Supervision: Jose? Guerra.
Validation: Jose? Guerra.
Visualization: Jose? Guerra.
Writing ? original draft: Jose? Guerra.
Writing ? review & editing: Pratikshya Acharya, Ce?line Barnadas.
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19 / 25
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surveillance in Honduras. BMC Health Serv Res. 2015. https://doi.org/10.1186/s12913-015-0785-4
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