Effectiveness of Community-Based Surveillance by Health Volunteers for Early Detection of Acute Flaccid Paralysis in a Conflict-Affected Region of the Democratic Republic of Congo: A Brief Report from North Kivu

Conflict-affected regions present major obstacles to routine disease surveillance. In North Kivu Province of the Democratic Republic of the Congo, protracted insecurity disrupts health services and impedes the detection of notifiable conditions such as acute flaccid paralysis (AFP), a key indicator for poliomyelitis. This brief report evaluates the effectiveness of a community-based surveillance (CBS) system, utilising trained community health volunteers, for the early detection of AFP cases in a conflict-affected zone of North Kivu. A descriptive analysis was performed using surveillance data from the CBS system. Community health volunteers were trained to identify and report suspected AFP cases from their villages to designated health facilities for investigation. System performance was assessed using standard indicators, including reporting timeliness and completeness. The CBS system demonstrated improved case detection. Community volunteers identified and reported all AFP cases detected in the project area. The median time from paralysis onset to notification of health authorities was reduced to three days, compared to over seven days prior to the system's implementation. Community-based surveillance using local volunteers can enhance early AFP detection in insecure, hard-to-reach areas where conventional health facility-based surveillance is compromised. Integrate and sustain community health volunteers within the national AFP surveillance framework for conflict-affected regions. Regular training and motivation mechanisms for volunteers are essential. Further operational research is needed to assess long-term feasibility and cost-effectiveness. acute flaccid paralysis, community-based surveillance, community health volunteers, conflict, Democratic Republic of the Congo, polio surveillance This report provides field evidence on the utility of a community-driven model for core surveillance functions in a complex humanitarian setting, contributing to the literature on adaptive health strategies in fragile states.