Crumbling Public Health Infrastructure Contributes to Spread of Ebola
August 5, 2014
Partners In Health: Focus on Contact Tracing
May 1, 2014
Contact tracing is a simple concept that is vital to stopping the spread of deadly infectious diseases such as Ebola and drug-resistant tuberculosis. When a patient is diagnosed, community health workers will speak with the patient to learn who may have come into contact with him or her and been exposed. A community health worker will then travel to screen the family members, friends, or neighbors to make sure they’re not infected. If one of these contacts is presenting symptoms, he or she will be accompanied for further evaluation and monitoring.
Why is it important?
The status quo in the public health world is “passive case finding,” or, in other words, waiting until a patient is sick enough to seek care on his or her own. As we know, poverty, lack of transportation, stigma, and countless structural barriers prevent patients from doing this, which results in delayed—or no—access to care.
PIH has long championed the opposite approach: “active case finding.” Contact tracing, one component of an active case finding strategy, is a cornerstone of any well-coordinated health system. It helps us diagnose patients earlier in the course of their illness, improving the likelihood that they will be cured and reducing the chance they’ll infect others.
Contact tracing also helps us better understand the social determinants of a patient’s illness. A community health worker may notice that the family of a drug-resistant TB patient is living in a crowded home with no windows or has very little access to food. If that’s the case, the health worker can determine how best to provide the necessary social support—renovating the house or helping the family start a kitchen garden—in addition to delivering clinical care.
Can contact tracing help stop the spread of Ebola?
Contact tracing is key to stanching the Ebola outbreak in West Africa. Our partners Last Mile Health in Liberia and Wellbody Alliance in Sierra Leone have community health workers on the ground presently conducting contact tracing. Partners In Health will help them strengthen their work and link the patients they are finding with Ebola Treatment Units so they get the care they need.
Contact tracing is especially important with regard to Ebola because if we can find patients early in their course of illness, before they’re vomiting or suffering from diarrhea, we can significantly reduce the risk of exposure to family members and community health workers.
That said, we are aware of the risks health workers face in doing this work, and we are working to ensure they have proper protective equipment, proper training, and proper support. We are also committed to working with local health workers who understand the cultural context and are trusted in the communities they serve.
Is contact tracing the only way PIH finds patients who may need care?
No. It’s important to note that contact tracing is just one part of our active case finding strategy. As mentioned above, active case finding is central to PIH’s mission and it’s critical for several reasons, including the fact that many patients are too sick to seek care and would be connected to the health system if it wasn’t for dedicated community health workers.
In addition to contact tracing, PIH conducts active case finding in many different ways, and not just for sick people. At PIH sites in Lesotho, for example, specially trained maternal health workers make monthly door-to-door visits to see if women may be pregnant. If a woman has had morning sickness or her menstrual cycle is late, she will be accompanied to a nearby clinic for a pregnancy test that day. If she’s pregnant, she’s enrolled in a comprehensive maternal care program that provides ongoing clinical and social support.
How do you know you’ve screened everyone who needs to be screened?
Often we don’t. That’s why contact tracing is just one part of our comprehensive approach to active case finding. It’s also why PIH is committed to hiring health workers from the communities we serve.