3. SESSION OBJECTIVES
Identify suspected cases of notifiable illnesses, based on clinical case definitions, and initiate
appropriate referral
Correctly fill out the referral/counter-referral form and provide care during referral
Provide post-referral follow up care in the home
Correctly complete the surveillance register
4. Sessions in Unit 4
Community based disease surveillance
Reporting
Referral and Counter referral
5. BACKGROUND
◦ Unit 4 gives the basics that CHWs need to know to understand their role in
surveillance and execute all related tasks.
◦ The surveillance register helps CHWs keep a record of all suspected cases
and also vital events, namely births and deaths.
◦ The unit also covers the details of referral of suspected cases of notifiable
illnesses and maintaining the continuum of care between the home and
the facility.
6. TOPICS AND KEY CONCEPTS
Topics/key concepts
Notifiable illnesses – some of which have the potential to cause deadly
outbreaks - need to be identified early and notified for further action
Data for community surveillance is captured, compiled and reported by the
CHW.
For cases of emergency notifiable illness, urgent referral is made.
8. OBJECTIVES
Explain what community-based basic disease surveillance is and why it is
needed
Explain the role and tasks of the CHW in basic surveillance
Understand how to complete the surveillance register
9. TOPICS
Community-based disease surveillance
Data for basic surveillance
Clinical case definitions of notifiable diseases
CHW tasks in basic surveillance
the surveillance register
10. ACTIVITIES
◦ The need for community based surveillance
◦ Clinical case definitions
◦ Case studies
◦ CHW tasks in basic surveillance
◦ The surveillance register
◦ Practice completing the surveillance register
11. COMMUNITY BASED (BASIC) SURVEILLANCE
Community based surveillance is the process where community people and CHWs keep watch
over what is going on in the community and its surroundings and report such events to
relevant authorities for necessary action.
CHWs collect data in their registers and compile them every month so that the CHPS and the
sub district can use it to understand the health situation.
The CHW’s contribution to surveillance is on-going reporting of vital events – births, deaths
and occurrence of any of the notifiable diseases.
12. DATA FOR BASIC SURVEILLANCE
The CHW would receive information about these events through three key
routes: someone from the household might inform the CHW about the event, or
the CHW might come across the event during household visits (routine or
priority visits) and through other interactions from household members.
The third route is a possible note from the health facility or from the CHO
regarding the event, for the CHW to follow up.
13. CLINICAL CASE DEFINITIONS OF NOTIFIABLE ILLNESS
◦ Clinical case definitions help CHWs identify suspected cases of illnesses
and notify health authorities in time for them to carry out the necessary
tests to confirm the disease.
14. CHW TASKS IN BASIC SURVEILLANCE
In the case of a reported birth
the CHW would check if the mother and baby have returned from the facility (in the case of a facility
birth) and visit the home at the earliest convenience.
The birth has to be entered in the surveillance register, even if it was a stillbirth (baby born dead) or
if the baby died right after being born alive. In the latter case, the case has to be reported as a death
as well.
15. In the case of a reported death
◦ The CHW and one or more members of the CHMC must pay a visit to the
bereaved household. The CHW must be sensitive and discreet about asking for
the details about the event, and the possible cause of death.
◦ The CHW and CHMC members must maintain confidentiality regarding the cause
of death, as appropriate.
◦ The CHW must fill the details in the surveillance register and include them in the
monthly report.
◦
16. ◦ In the case of a suspected notifiable illnesses which is an emergency, the
CHW must endeavour to inform the CHO or the health facility that same
day
◦ In the case of a suspected notifiable illness which is not an emergency, the
CHW must visit the home at his or her earliest convenience, unless of
course, if the illness was discovered during the course of a household visit.
The CHW must obtain details of the illness and refer the person to the
health facility.
17. THE SURVEILLANCE REGISTER
◦ The surveillance register is used to record events: births, deaths
and cases of notifiable illnesses
18. Referral and counter referral
OBJECTIVES
Use the referral form to refer patients with suspected notifiable illness
Provide care (or counsel family to provide care) for the patient on the
way to the facility
Correctly interpret counter referral forms
20. SESSIONS
◦ Determine what they already know
◦ Give relevant information: The referral form
◦ Give relevant information: Considerations when referring
◦ Reinforcing the information: Case studies
◦ Give relevant information: Interpreting counter referral forms
21. REFERRAL FORM
This is a written form communicating to health facility staff important
information during a referral such as:
22. TRANSFERRING THE PATIENT
◦ Referring a patient to a facility takes time, even in emergency situations
when the family appreciates the dangers of delaying.
◦ During the process, the patient’s condition might worsen, and hence it is
important for the CHW and the family to provide basic, life-saving care
while the patient is in transit.
23. INTERPRETING COUNTER REFERRAL
FORMS
A written counter-referral (*facility discharge note), may be written by
facilities, with the patient’s consent and can communicate important
information about the care of the patient which might be important for
the, CHWS or family such as: condition identified, medicines being taken,
possible danger signs and when to follow up at home.
