Experiences with the use of participatory approaches in highly pathogenic avian influenza (HPAI) surveillance

Abstract

Animal health surveillance needs to provide information for action. Veterinary Services (VS), particularly in developing countries, are often under-resourced in personnel and budget and thus lack frequent contact with livestock farmers. By emphasizing the importance of farmers’ knowledge and experience, participatory disease surveillance (PDS) is an approach that helps VS to address this gap. It is a process of learning and discovery that fosters better cooperation and understanding between veterinary professionals and farmers. It evolved in response to past failures with classical approaches. Practitioners of PDS rely on semi-structured interviews during which techniques that allow for visualization, scoring and direct observation are used to increase communication and understanding. Secondary sources of information and diagnostic testing provide critical additional information.

Indonesia was one of the first countries to adopt PDS for HPAI surveillance. The program which started in 2006, expanded to include 31 of 33 provinces with an estimated coverage of 76% of villages using over 2,000 PDS practitioners. The program adopted a broad HPAI case definition for unvaccinated poultry that can be summarized as rapid death in one or more birds. The program evolved to consider the village rather than the household as the epidemiological unit of concern, and to link disease response (R) directly to surveillance (PDSR). The PDSR program in Indonesia quickly revealed that HPAI was widespread and circulating unimpeded, exhibited seasonal fluctuations, and showed geographic variability. In March 2009, the program considered 86.3% of villages visited by PDSR practitioners to be ‘apparently’ free from HPAI. However, there was variation in the implementation of control measures.

Other countries benefited from Indonesia’s pioneering experience. Egypt adopted PDS in 2007, creating a small team of highly skilled PDS practitioners. Eleven other countries in Africa adopted a standardized training program and performance assessment tool, and integrated PDS data into the national surveillance system. No further outbreaks were documented in these countries after the implementation of PDS.

The successful use of PDS for HPAI surveillance has provided valuable lessons for the use of PDS as a surveillance tool. Case definitions should be consistently applied with a clear understanding of diagnostic accuracy. Well-planned surveillance systems need to be properly budgeted and resourced, with PDS integrated as one component of a holistic system. Emphasis should be placed on the quality of the PDS program, not size. Permanent capacity should be created at public, private and academic levels, so as to meet emerging epidemiological problems. Data generated using PDS need to be integrated into normal reporting channels and structures, with policies that recognize the complementarity of PDS results. Surveillance should be tied to a functional national disease control plan. In some cases, it has been found that VS that adopt PDS undergo policy and institutional change, and therefore identifying the need for change should be recognized as an opportunity to improve VS. The Participatory Epidemiology Network for Animal and Public Health (PENAPH) works to support adoption of these best practices.