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Emergency health surveillance in Uganda

As a public health physician who has previously worked with Medicins Sans Frontieres in Sierra Leone and Turkey, I’ve just finished an assignment setting up an emergency community health surveillance system in Palorinya refugee settlement, northern Uganda.

Approximately 147,000 South Sudanese refugees have settled in Palorinya over the last few months, fleeing conflict and violence. With such high numbers, the reception centers and emergency response systems have been stretched. This is compounded by insufficient access to water, sanitation, shelter, food and access to basic healthcare.

Health surveillance systems help monitor and detect changes within a population to help inform medical and humanitarian interventions. We also use the information and data to advocate for more services from other organisations that can support the refugee population with things like latrines or hand washing facilities.

The team collects information about births, deaths and ill health from individuals through weekly household interviews, while also collecting medical data from health facilities in and around the settlement. Household interviews are a really important part of our data collection work, as we can build a better understanding of peoples lived experiences and needs, rather than only being exposed to those who are able to visit health facilities.

The importance of emergency health surveillance in large refugee settlements

In acute emergencies like this, when large communities are in chaotic new environments and new countries, it can be very difficult to understand their health status, making the population particularly susceptible to epidemics and diseases. Outbreaks of infectious diseases are common; in addition, the rainy season increases outbreaks of diseases like malaria, and often hinders access to health services. A functioning health surveillance system helps us detect changes in the health of the population, meaning we can respond to identified needs.

We have trained a team of over 100 surveillance officers from within the refugee settlement in the hope that they are more familiar with local customs, language and culture, and can collect more accurate information on sensitive topics such as deaths. We use this data to inform medical activities, and project trends such as birth and death rates across particular areas and age groups.

These teams also do a vital job in ensuring that sick people from the community are referred to the health centers.

In my last few weeks in Uganda, surveillance teams identified several stillbirths, neonatal deaths and a maternal death within one area of the settlement. This gave us an indication that women are facing challenges accessing sufficient care for the antenatal and postnatal period, as well as emergency obstetric care. In response, MSF has expanded women’s health care services to these areas.

Health surveillance also allows us to identify diseases of epidemic potential quickly, which means that we can respond at an early stage to reduce its impact. For example, when one of the community surveillance teams was on a routine household visit recently, they learnt about a woman who had passed away. Without that visit, her death would unlikely have been recorded anywhere, and we wouldn’t have known about her illness. Our teams found out that she had developed yellow eyes and symptoms consistent with a hepatitis infection before her death. Identifying this enabled us to heighten community surveillance in that area on acute jaundice syndrome, which may indicate a hepatitis infection, and it meant that our medical staff and sanitation staff could respond appropriately.

When I arrived here in February at the height of the displacement, it was overwhelming even to imagine where to start with establishing the surveillance system. It was a big task but by mid-March the surveillance team had managed to visit over 10,500 households and surveyed over 41,000 people. Data is delivered each week and it’s been hugely gratifying to see the interaction between the community and MSF in shaping the emergency response.

I feel lucky to have been here, to establish emergency surveillance from the start of an intervention, and to see it working. Most importantly, it’s been great to see how our health surveillance system is helping the community.

Sam Hoare
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