Dengue fever is a viral disease that has long been a significant public health concern in Sri Lanka, with outbreaks occurring twice annually during monsoon seasons. However, in the last decade, the frequency and intensity of these outbreaks have increased dramatically. An economic crisis and COVID-19 restrictions presented new challenges for dengue fever control in Sri Lanka, hindering health professionals from carrying out site visits due to shortages of supplies and fuel. In 2022, 36 000 cases of dengue fever had been reported across 12 high-risk districts by June – the same number of cases as were reported for all of 2021. The World Health Organization (WHO) recognized that dengue control in Sri Lanka could not be achieved by the health sector alone and advocated for community involvement. WHO Sri Lanka and the Ministry of Health (MoH) launched a community engagement intervention, which aimed to educate the community on eliminating dengue mosquito breeding sites. It led to a nearly 60% decline in hospital admissions for dengue fever in the intervention districts and prevented major outbreaks that would have otherwise required national-level interventions [1].
Key WHO Contributions
Advocating for community involvement through the creation of evidence-based guidelines
Collaborating with MoH to launch a community engagement intervention
Providing technical support to NCDU to establish coordination structures
Organizing a series of national and subnational level meetings to facilitate collaboration between the Government of Sri Lanka and the Sarvodaya Shramadana Movement
Providing equipment and supplies, training, tools, and logistical and financial support to enable the implementation of dengue control activities
Providing supportive supervision to support the coordination of activities on the ground.
How did Sri Lanka, with the support of the WHO Secretariat, achieve this?
WHO Sri Lanka provided technical assistance to the MoH for the creation of an operational guideline and the identification of potential stakeholders for an intervention. The operational guideline was developed from WHO’s international evidence-based guidelines and adapted to context through dialogue with public health professionals, medical officers and entomologists. The community engagement approach was aligned with the policy foundation of Sri Lanka’s National Action Plan for dengue 2019–2023, which had been developed previously with WHO's technical and financial support [2]. The plan, which drew from WHO’s Global Strategy for Dengue Prevention and Control, includes intersectoral collaboration and coordination with community-based and nongovernmental organizations as a key strategic area.
The community engagement intervention aimed to target high-risk areas through prevention and control strategies at the local level. To ensure that geographically dispersed efforts would be well coordinated from the national level, WHO Sri Lanka provided technical support to the National Dengue Control Unit (NDCU) to establish a central operations room. WHO Sri Lanka then conducted supportive supervision visits to share global best practices in risk communication and outbreak response with technical officers at NDCU and the MoH to endow them with the necessary skills and knowledge to support the intervention.
A tire is inspected as a potential mosquito breeding site by a mosquito control field assistant from the Medical Officer of Health Office.
Photo credit: Pearl Gan.
In July 2022, WHO Sri Lanka initiated a series of coordination and planning meetings between the MoH’s National Dengue Control Unit (NDCU) and the Sarvodaya Shramadana Movement [3], Sri Lanka’s largest civil society organization (CSO) which strives to empower communities through self-help and collective action. The aim of the meetings was to identify effective mechanisms to address the increasing magnitude of the dengue problem through community engagement. To enable coordination on the local level, WHO facilitated connections between regional epidemiologists from selected high-risk districts and Sarvodaya district facilitators. To enhance local knowledge and skills on dengue prevention, WHO technical staff, the NDCU and Sarvodaya collaborated to facilitate online training for Sarvodaya community leaders and facilitators in high-risk districts. This initiative built upon WHO’s previous efforts to strengthen national capacities for dengue control. WHO Sri Lanka had previously provided equipment and supplies such as fogging machines and chemicals for vector control, provided training in integrated vector management, and offered logistical and financial support for field vector control activities, outbreak preparedness and response. Additionally, WHO Sri Lanka had implemented surveillance tools for service availability and readiness assessment (SARA) surveys for dengue.
“In realising our public health mandate, the Sarvodaya Movement strives to promote community-based interventions to address public health challenges. We believe in the capacities of our communities to be both recipients of positive health outcomes as well as to be active participants in shaping their own health, wellbeing, and development. We are delighted to partner with the formal health sector and the World Health Organization to foster sustained preventive action for dengue vector control, knowledge dissemination as well as to promote public health-activism at the grassroots level to reinforce community resilience.”
- Dr Vinya Ariyaratne, President, Sarvodaya Shramadana Movement
In July 2022 the NDCU, Sarvodaya and WHO Sri Lanka launched a programme to target 12 of Sri Lanka’s highest risk districts. The Sarvodaya Shramadana Movement declared a special community engagement week, which included public awareness and source reduction and premises inspection activities that aimed to identify and remove mosquito breeding sites. Efforts focused on high-risk locations for transmission, including schools, religious sites and government offices. To ensure source reduction capacity was sustained, existing platforms that were integral to the community such as school development and village committees were encouraged to participate. Public health inspectors, public health midwives, local public administration and social security officers oversaw the programme, with WHO Sri Lanka helping to coordinate public health staff and community leaders. Ultimately, 35,000 at-risk community members and 900 households were reached.
“Community engagement is critical to the success and sustainability of dengue prevention and control. Through this intervention, WHO has supported the Ministry of Health to strengthen engagement mechanisms with CSOs on the ground in order to promote greater community ownership of vector control and strengthen resilience against future dengue outbreaks.”
- Dr Alaka Singh, WHO Representative to Sri Lanka
The dengue control initiative, which focused on community involvement, was successful and resulted in increased collaboration between community organizations, public health personnel, the NDCU and local authorities in the 12 high-risk areas. The collaboration enabled the reduction of mosquito breeding sites and an increase in public knowledge on how to create and sustain mosquito-free environments. It is anticipated that the community-based approach taken will help sustain progress through continued dengue control activities in the future.
References
- DenSys real time surveillance data, National Dengue Control Unit, Ministry of Health Sri Lanka [information site] (accessed 16 March 2023)
- National Dengue Control Unit, Ministry of Health, Nutrition and Indigenous Medicine. National Action Plan on Prevention and Control of Dengue 2019–2023, Sri Lanka; 2019 (ISBN 978-955-3666-16-1)
- Sarvodaya Shramadana Movement Sri Lanka; 2022 [website] (accessed 16 March 2023)
