El Salvador

El Salvador grapples with elevated levels of vulnerability and a myriad of humanitarian challenges, stemming from both climatological and human-induced hazards. The nation's heightened susceptibility and exposure to multiple risks, including public health emergencies such as COVID-19, monkeypox, dengue, and Zika, are exacerbated by disruptions to water, sanitation, and hygiene (WASH) systems during severe weather events like floods, storms, hurricanes, and droughts. The lack of access to essential services, including health care, nutrition, education, and food, further compounds the humanitarian needs, contributing to food insecurity and insufficient access to water and sanitation services.

For instance, the Ministry of Health (MoH) actively combats arbovirus infections (e.g., dengue, Zika) on a national scale. However, a critical challenge lies in ensuring adequate coverage of health personnel across all territories. Therefore, it becomes imperative to strengthen community structures equipped to lead preventative and anticipatory health response actions.

The MoH, at the national level, is divided into 5 Basic Integral Health System (SIBASI) units responsible for executing and operationalizing health policies. These units oversee health facilities throughout the country and employ a local strategy to expand health coverage. Health promoters are hired to act as liaisons with the community, undertaking responsibilities such as health promotion, community surveillance, and collaboration with community health structures (Health Committees). These health promoters, based in health facilities, visit communities regularly, aiming to cover 12 communities each, contributing to the strengthening of community health structures.

Health Committee members are community volunteers trained and recognized by the Ministry of Health with support from Health and Nutrition Services (HNS) staff. Implementing Community-Based Surveillance (CBS) would enhance the efficiency of information gathering and facilitate quicker responses.

Epidemiological surveillance is conducted in all health facilities, adhering to the guidelines of the National Epidemiological Surveillance System in El Salvador (VIGEPES). A weekly epidemiological report covers 76 diseases, while an additional 22 are reported collectively. Different formats, both individual and grouped, are used for disease notifications. The MoH publishes weekly epidemiological bulletins on its website.

To bolster the MoH's efforts, a regional workshop on Preparedness, Anticipation, and Response to Epidemics and Pandemics (PARTE) was organized. Various MoH, National Society (NS), and NorCross team members participated, led by the International Federation of Red Cross and Red Crescent Societies (IFRC). The workshop facilitated an exchange of experiences with countries implementing community-based surveillance.

Participation in the workshop prompted reflection at the local level within the Ministry of Health on how to integrate the strategy into existing epidemiological surveillance. This reflection led to the possibility of replicating the PARTE workshop at both national and local levels.

At the local level, health providers from the San Carlos Lempa Health Unit underwent two 8-hour training sessions conducted by SIBASI staff. The training involved conducting a viability analysis for five communities, exploring geographical context, health background, prevalent diseases, health priorities, installed capacity, identification methods, current surveillance systems, and identifying gaps. Through this process, four communities were identified for active community surveillance, as they demonstrated the potential to train health committees and prepare them for timely identification and response. One community, lacking the personnel for an active response, will focus on reinforcing health actions by the health facility. An Implementation Protocol has been developed for these four communities, providing guidance and instructions for the community strategy.

The project will be implemented in four communities—San Carlos, San Bartolo, Nueva Concepción, and Santa Marta—in the municipality of Tecoluca, selected based on the viability assessment.

Above left to right: 

• Regional Preparedness, Anticipation, and response to epidemics and pandemics (PARTE) workshop, December 2022
• Elaboration of viability analysis and protocol, San Carlos Lempa Health Facility, June 2023
• Elaboration of viability analysis and protocol, San Carlos Lempa Health Facility, June 2023