Red Cross volunteers’ experience with a mobile community event- based surveillance (CEBS) system in Sierra Leone during-and after the Ebola outbreak- A qualitative study

Purpose: The objective of this study was to explore the volunteers’ experiences with and perspectives on the community event-based surveillance system in Sierra Leone. Methods and materials: 62 volunteers from 14 different chiefdoms participated in in-depth interviews and focus group discussions, which were audio recorded and transcribed. A comprehensive and systematic thematic analysis was conducted, which identified key benefits and challenges. Results: The volunteers believe CEBS positively impacts their communities. CEBS increases knowledge and behavior change, contributing to the prevention of Ebola and other diseases and decreasing overall mortality. Volunteers are motivated to participate by an aspiration of helping their community, although many volunteers also participated in the hope of receiving monetary incentives. Communities were initially reluctant to participate in surveillance due to fear of Ebola, but acceptance increased with improved community engagement. Reporting by phone call and SMS was perceived as a quick and simple way of reporting, although challenges with access to mobile network, sim registration and cost for charging were identified. Many of the volunteers could not repeat or explain the different case definitions and explained reporting on symptoms solely or other health events, suggesting that the volunteers did not have a clear understanding of case definitions or purpose of CEBS. Conclusion: SMS reporting directly from the community is perceived as a timely, easy and reliable way of sharing important information, but the usefulness of the system relies not only on the structure of the system itself, but also on external factors, such as the relationship between the community members and the volunteers, and the logistical structure