Primary health facilities are often the first place people go when they’re feeling sick—so they’re well positioned to detect and respond to infectious disease cases. But primary health facilities are busy. Workers are often dealing with a wide variety of problems simultaneously and may not have received formal training to recognize every combination of signs and symptoms that could be the result of a disease with outbreak potential.
It’s no surprise, then, that symptoms can go unnoticed and specimens uncollected, putting workers and patients at increased risk while allowing outbreaks to spiral into epidemics. Making sure that every worker is adequately trained, therefore, is essential to meeting standards and stopping outbreaks in their tracks.
Clinical Integrated Disease Surveillance and Response, or cIDSR, is a free online training designed to help frontline workers detect cases, protect themselves, treat patients and report cases to public health authorities to initiate response efforts. Developed by Resolve to Save Lives in partnership with HealthLearn, cIDSR offers frontline workers a selection of engaging, mobile-friendly short courses to provide knowledge and skills on a range of important infectious diseases. The training has already helped thousands of frontline workers improve their knowledge and thereby increase their suspicion of suspected disease cases.
“cIDSR has been created with and for health care workers,” said Dr. Stacey Mearns at Resolve to Save Lives, who pioneered the training as part of our Epidemic Ready Primary Health Care initiative.
“It’s designed to complement existing IDSR training, but it delivers the material through patient stories, rather than case definitions, to better resonate with frontline workers, and it combines instruction on infection prevention and control with surveillance to equip them with everything they need to keep themselves and patients safe. Our intention is for the modules to form a part of preparedness training as well as offering rapid support in times of crisis.”
Rapid response to emergencies
While cIDSR can be completed as part of ongoing training, individual modules can also be rapidly deployed to bolster response efforts during public health emergencies. In early June 2024, Nigeria experienced a sudden surge in cholera cases, part of a wider outbreak. As of July, the nation reported the highest number of deaths of any country in the region. At the request of, and in partnership with, the Nigerian government, Dr. Mearns and her team immediately released a cIDSR training on cholera as a single module, allowing health care workers to quickly get up-to-speed on essential signs and symptoms and critical protective measures.
The training module was offered to primary health care facilities across the country, including many located in Lagos state, where more than half of cases had been reported. Within three days, the training had reached 3,000 health care workers, rising to almost 6,000 within a week and over 7,000 within three weeks. Frontline workers who completed the training saw a 29% increase in their knowledge about cholera, and over 98% reported increased confidence in how to identify and report suspected cases.
“Just in time” training
Although the outbreak is ongoing, Dr. Mearns contends that releasing this module will ultimately make a meaningful contribution to altering its trajectory, as well as that of future outbreaks. Getting critical information into the hands of frontline workers soon after an outbreak has started allows them to immediately adapt their approach, whereas traditional in-person teaching methods could take days, if not weeks, to achieve the same results.
Taoheedah Abdulkareem, founder of the HealthForAll Initiative For Community Health, which used the cholera training module as part of its handwashing outreach efforts, said “the course was developed just in time.” Abdulkareem praised the course for its contributions in minimizing the spread of cholera by focusing on upstream measures before a case has been confirmed.
While the impact of releasing this module during the cholera outbreak will take time to understand, feedback from health care workers already suggests cIDSR has played an important role in minimizing the spread of disease, which suggests that deployment of similar trainings could prove useful in future outbreaks. One user remarked that the course “helped me to understand the disease better, beyond the case definition. How the patient might present, all of the different signs and symptoms.” Another added that the course “helped me to improve my knowledge in managing cases. In knowing how to better advise the health workers and not just record the case.”
Getting information to health care workers
The cIDSR module on cholera is just one of six modules designed specifically for Nigeria, with each module targeting a different “priority pathogen” as identified by Nigerian health authorities. Each module integrates concepts from surveillance, infection prevention and control, laboratory procedures and case management. The content is contextualized for Nigeria by aligning with local guidelines and including relevant contact information for reporting suspected cases. Dr. Mearns and her team plan to expand the number of modules available for Nigerian health care workers beyond these six pathogens while also exploring how to adapt the modules for use in other countries.
“cIDSR is ultimately about getting the right information to health care workers so they’re equipped to do their job safely and effectively,” said Dr. Mearns. “We’ll continue working with our partners to make these learning tools as valuable as possible so that every health care worker knows exactly what to do whenever they’re presented with an infectious disease case.”
Visit HealthLearn for an interactive demo of a cIDSR module tailored to Nigeria.