Exploring community-based surveillance in urban and peri-urban settings: Case-study of the Limete and Nsele Health zones in Kinshasa, Democratic Republic of the Congo

Abstract

Introduction: the Democratic Republic of Congo is the only country in the world to have experienced more than ten Ebola epidemics, highlighting the need for a functional surveillance system, especially at the community level. The objective of the study was to explore the community-based surveillance system in the provincial city of Kinshasa. Methods: a case study exploring the community-based surveillance system, supplemented by a document review, was carried out between March and July 2023 in two health zones in Kinshasa, Limete, and Nsele HZs. Community health workers and key informants (head and supervising nurse, provincial health and epidemiological surveillance division staff), selected by purposive sampling, were involved. Semi-structured interviews explored the essential functions of community surveillance, barriers and intersectoral collaboration. The weekly surveillance database for 2022 was also analyzed. Data were summarized in proportions, and a thematic analysis was carried out for the interviews. Results: fifteen semi-structured interviews were conducted. The 2022 weekly surveillance database reported 5,393,557 disease cases and health events in Kinshasa, with 260,812 cases in Limete and 171,675 in Nsele. Malaria was the most common disease reported by community-based surveillance. The analysis of the measles cases reported suggested that an epidemic was ongoing in Kinshasa in 2022. In each HZ, community health workers visited monthly required households, collected cases and events, and transmitted them to HZ officers directly or through Head nurses, suggesting that the community-based epidemiological surveillance was functional. Community members also participated in the investigation as support for HZ and provincial officers. Barriers, including the absence of event monitoring registers, lack of continuous training, low remuneration, inadequate equipment, insecurity, and the absence of clear intersectoral collaboration at the community level, were highlighted. Conclusion: the community-based surveillance system is operational, but requires enhanced training for agents, adequate remuneration, and stronger intersectoral collaboration.