1. Kambia District Surveillance and Response Framework 2 April 2015

2. Rationale for Enhanced Response Framework Issues Despite efforts, community engagement remains challenging in some areas Multiple partners with different strengths could coordinate better Fragmentation of approaches Selection of areas is not adequately based on consistent criteria Reactive approach Opportunities Harness energy from HE’s visit and focus on need for improved community engagement Harness resources being offered by partners/other districts Bring all partners together in well-coordinated approach under DERC operational structure and target areas and activities more appropriately Incorporate cross-border work

3. Key Performance Indicators OBJECTIVESINDICATORS Last 21 days* Trend Compared GOALGet to zero in Kambia District Primary Objective Improve the efficiency and effectiveness of the district surveillance and response system 100% of confirmed EVD cases coming from a contact list 66% All suspect cases transferred to appropriate health facility within 24 hours of an alert being raised 100% Outcome 1 Strengthen alert system to better detect suspected EVD cases (live and dead) Number of live alerts104 Proportion of death alerts55% Outcome 2 Strengthen reactive and proactive capacity of the surveillance system 100% of credible alerts are investigated within 24 hours 94% 100% of confirmed EVD cases come from a contact list 66% Outcome 3 Strengthened community engagement in response activities Time between symptom onset and alert report is less than 48 hours 49% Median: 3 days All positive swabs come from known contact lists 20.0% 100% lab results are tested and returned to patient/family members <24h from publication 99%

4. What does it look like? IDENTIFY TARGET COMMUNITIES Understand key issues and define clear indicators to target communities Hotspots Silent Areas Positive swabs Under-reporting deaths Secret burials ACTIVITIES Identify key approaches to promote change and match to issues Active case searching Paramount chief eng. House to house Radio programming Dialogue with household OPERATIONALISE Define decision making process for operationalising SOPs Resource planning Flexible approach Regular meetings to coordinate An over-arching framework enhancing surveillance and response mechanisms Requires that we work through the following steps

5. Indicators and Approaches Issue Appropriate Approaches Hotspot E.g.Active Case Search, Community meetings Positive Swab E.g. direct household engagement New case not on a contact list E.g. Active Case Search in surrounding area, house to house mobilisation Death in a quarantine home E.g. Direct household Engagement Cross-border transmission E.g. Active Surveillance, radio messaging Under reporting of deaths E.g. Radio, IEC material dissemination, political engagement, community meetings, house to house Unsafe burial E.g. DERC/ DO meeting with Paramount Chief and/or other key leaders, community visit from DO and Paramount Chief Community resistance/mistrust and denial E.g. Community visit from DO and Paramount Chief, Community meetings with key stakeholders and appropriate target groups (e.g. women, soways, youth), EVD Survivors, engagement with religious leaders and traditional healers Remote/hard-to-reach areas E.g. House to House mobilisation, community meetings with key stakeholder,s radio, support to chiefdom and village taskforces Areas not reached by social mobilisation activities E.g. House to House mobilisation, Support to chiefdom and village level taskforces, Radio interviews with key spokespersons

6. Target Areas ISSUESCHIEFDOMVILLAGE Hotspot MagbemaMalal Gbingleh-DixonLokoya Positive swab MagbemaMalal Gbingleh-Dixon Konta Dubalai, Lokoya, Fouta, Rogberay, Yeam-Labey SamuSoriya Border issues SamuSoriya, Kanbagham Gbingleh-Dixon Magbengbeh, Yeam-Labey villages around Pamelap Community resistance MamboloMalambay MasungbalaWula Lol SamuMabonah, Kortimaw

7. Target Areas of Intervention Hotspot Positive Swab New case not on a contact list Death in a quarantine home Cross Border transmission Community resistance Community denial Under reporting of deaths Epi link to + case

8. 1.Issue: Hotspot 2.Indicators: Ongoing transmission. Out of nine confirmed cases in week 11, eight came from a single household under quarantine in Malal 3.Response: Dedicated surveillance/socmob team assigned for daily visits, detailed case investigation, contact tracing, PC engagement. 1.Issue: Under reporting and community mistrust 2.Indicator: Positive swab/death in quarantine home 3.Response: DO and DC meeting with PC to define action plan. PC making frequent visits to HH and community. SocMob Pillar Lead engaging community directly Weekly Response Plan e.g. Malal 1.Issue: Community Resistance to response efforts 2.Indicators: HH refusal to cooperate with surveillance team or to transfer suspect case to Holding Centre. 3.Response: Dedicated team surveillance and PSS to make daily visits to the household. All suspects now removed.