Human Resources
Step 8
The SMSS requires a team of specialists at the community, provincial and central levels, as well as an organizational structure to manage and support staff members. The needs for each role must be identified, then individuals recruited at each level. As described in step 1 (Building Suppor), to be effective and responsive, a national data system must be managed by government institutions. Given the differing expertise of various government departments, the system may require cross-departmental collaboration.
While designing and implementing the SMSS, partners should clearly identify human resources (HR) needs and a management structure. The capacity of HR at each level must be assessed and adequate training must be provided prior to the launch of the system.
National Level Human Resources
The national level team can be divided into to groups – the technical team and the administrative team. The structure and job titling of each member is dependent on the specific context and institutional practice. A project director or principal investigator will oversee both the technical and administrative teams. It is proposed that technical officers be assigned to particular provinces/districts and be responsible for overseeing the surveillance in those provinces/districts. IT engineers will set up and will oversee the digital architecture and data flow. Data managers and analysts will be responsible for day-to-day review of the data and basic analysis. They will also respond to data queries. Technical experts for VASA data and mortality will provide methodological oversights on the design of VASA and the mortality surveillance. Communication and data visualization staff oversee the production of technical data briefs and other communications materials. Below is a example list which describes the structure of the Central level team. The number of staff at each position will depend on the size of the system and the amount of work expected.
Central level
As part of a governance structure, a national advisory committee may be created to draw on additional experts within the country. These include representatives from academia, professional organizations, donors or development partners, civil society organization and community leaders.
Provincial or Regional Level Human Resources
The staff at the provincial level fill the roles of coordinators, administrative assistants, supervisors, and verbal and social autopsy (VASA) interviewers.
The provincial/regional coordinators oversee technical, logistical and managerial aspects of the project within their specific province/region. They also update the provincial officials about the project during their monthly meetings. This position may require only part-time effort and thus an existing staff member from the implementing organization, such as a provincial technician from the national statistics office, may be available to fulfill this role. The provincial coordinator can be supported with management and administrative duties by assigning an administrative assistant to carry out finance and administrative aspects of the project at the provincial level. With this approach, the provincial coordinator is able to focus on technical issues related to data collection.
VASA interviewers are required to reside in the province or region where they collect data, have experience in collecting community information, be able to use mobile phones and tablet computers, speak at least one local language and be willing to spend several weeks collecting data in the study clusters, which are sometimes in remote areas.
Verbal and social autopsy data collection requires emotional intelligence on the part of data collectors, as it requires speaking with family members about signs and symptoms prior to a death. The questionnaire is long and requires sustained attention from both the interviewer and the respondent. It is essential that appropriate VASA data collectors are identified, recruited, and trained to proficiency. Typical data collectors will have completed secondary school, or ideally would have some college education.
Depending on the social context, it may be appropriate to match the gender of the interviewer with the respondent’s gender. The Mozambique SIS-COVE employs only female VASA data collectors. Usually, 2-4 VASA interviewers may be needed per province/region but the final number will depend on the total number of clusters within the region.
Community Level Human Resources
Community level data collection is the backbone of the surveillance system. Each cluster will have a resident community-based data collector, or a community surveillance agent (CSA). Many countries have an existing cadre of community health workers who may receive a stipend or salary from the government or non-governmental organizations to implement health prevention and promotion and community case management within their community. In some settings, this cadre may be suitable data collectors for the system. However, in most settings it is preferable to hire a new cadre tasked specifically for community surveillance as the existing community health workers are often overloaded with health-related activities and likely to give low priority to vital events surveillance.
The community workers should be selected by the community officials and ideally be a resident in the community. Data collection should only require part-time effort. In many rural settings, it is difficult to identify literate candidates that are available to work. It may be necessary to alter the level of formal education required. However, it is critical that the community worker is able to read, write, and proficiently use a smartphone to collect data.
In each cluster, key informants such as chiefs, religious leaders, community representatives, birth attendants, and health professionals can be invited to support the community workers in the identification and reporting of vital events.
Data on population size, births, deaths, and pregnancies (if included in the SMSS) is obtained by systematically monitoring households in the selected clusters and reporting events as they occur. When the system is launched, the CSAs will participate in creation of maps and take a census of all households in each cluster, recording the age and sex of all residents, as described in step 9 (baseline).
The community worker will be responsible for continuous surveillance of the clusters and reporting of events as they occur. A decision must be made on the frequency of visits to households within the community. Given that deaths are generally rare, ensuring that each household is visited once every two or three months will be enough to capture all vital events. When deaths events are identified, a team of verbal and social autopsy data collectors must be ready to visit the cluster to conduct verbal and social autopsy interviews with the bereaved family. In general, a mourning period must be allowed before collecting the data; the length of this period will depend on the context.
Training
Standardized cascade training is preferred, starting with a training of trainers (ToT) for central level staff, followed by training of interviewers (ToI) with the provincial and community interviewers. This method allows for building local capacity and for training a large number of community data collectors and VASA interviewers. However, care must be taken to supervise the lower-level training to ensure standardization.
Central-Level Training
The ToT includes a review of tools, manuals, tools, and field procedures from electronic data collection to data transfer to the cloud server. The training may be scheduled for two weeks and cover the following topics:
- Cluster mapping and household listing procedures.
- Community surveillance procedures and strategies for identification of vital events.
- Scheduling and conducting verbal and social autopsy interviews.
- Digital solution architecture and data flow.
- Procedure for data supervision at provincial and community levels and feedback.
- Basic mortality and VASA data analysis.
- Ethical procedures with informed consent, confidentiality, and data protection.
All central level technical staff must participate in this training course which must be led by the project director or PI, possibly with external assistance from experts in the implementation of similar systems. However, special emphasis must be directed to the staff responsible for specific technical areas, such as VASA tools, community surveillance tools, IT tools, data management and analysis. Each of these staff will lead the training at the provincial level on their specific areas of responsibility. The provincial coordinators may be invited to participate in the ToT.
Initial training of the data analysts and managers should be aimed at using the data to monitor fieldwork progress, providing feedback on data quality and deviation from procedures, and understanding common challenges related to data quality and how to address them. Additionally, this training should be aimed at providing a clear data flow plan and use of standard operating procedure (SOP) documents to guide efficient communication between the field and the data team. Secondly, the training should include procedures for data cleaning, processing and storing in a user-friendly format.
Provincial/Regional Training
The training implemented at the central level will be replicated at the provincial/district level by the trained central level staff. The decision on whether to bring all provincial level staff to one place for the training or group them will depend on each country and the size of the provincial team to be trained and distances between provinces.
At least a three-week training will be required to go over all components, of which two weeks must be dedicated to the training of VASA data collectors. Care must be taken to train at least 10-15% more data collectors than required to offset any dropout, eliminate low performers during the training, and constitute a pool of trained personnel from which to draw on to fill turnover among data collectors. The training should include in-class review of the questionnaire’s structure and understanding of each question. The data collectors should then be trained on the data collection software from their tablets, data editing and transfers. In addition to practice interviews using case scenarios, a one-day field practice should be planned to allow further piloting of the tools. The training must include interviewer and supervisor responsibilities and procedures, approaching the household, identifying the appropriate interview respondent, communication and sensitivity issues involved in conducting a VASA interview, research ethics and how to protect data collected, ensure privacy, confidentiality, and voluntary participation.
The VASA data collectors should also be trained to support and supervise CSA’s. Along with Supervisors, they will be primary contact for CSA’s. They will need to monitor CSA activity and be prepared to manage CSA turnover within their region. They will likely be charged with rapid replacement and training of CSAs that have left their communities.
Community Level Training
The training of community surveillance agents (CSAs) will then follow the provincial-level training of VASA interviewers with at least one training in each province/region. The provincial level team will be responsible for training the CSAs under the supervision of the central level staff. All selected community workers must be invited to join the training in the provincial city. However, due to remote areas and transportation issues, a small percentage of community workers may not be able to join the training. Those should be trained individually by the VASA team during bimonthly supervision visits. The training should take about three days and must ensure proficiency with the community surveillance tools and procedures, including electronic data collection and transfer.
The CSAs must be trained to identify the vital events (pregnancies, births, and deaths events), record them on their phone and transfer the data to a cloud server. Strategies for optimal identification of the events and how to approach grieving families must be discussed. These include frequency of house visits, engaging village chiefs, working with key informants such as religious leaders, traditional birth attendants, women’s group leaders, etc. Case scenarios should be simulated to ensure the CSAs understand well the steps for recording data onto their phone and transfer to the cloud server. CSAs’ training should also include the use of paper questionnaires to serve as temporary back up in case their phone is lost or damaged or if in areas that are not sufficiently covered by a mobile phone network. They must also be trained in research ethics, including how to obtain informed consent prior to data collection, voluntary participation, respect for privacy and confidentiality.
Following the training, each CSA will be provided with the tools for reporting, including a smartphone. Data collection should commence as soon as they return to their respective clusters. The CSAs should begin with conducting a complete listing of their cluster by visiting and recording the members of each household. This listing will be used as baseline population. It should be validating by comparing baseline population data collected by the cartography team.
The CSAs should be followed-up and supervised by the VASA data collectors who will ensure continuous refresher training and troubleshooting on their phones.
Capacity Building
The initial training to launch the system will not be enough to solidify the system in the long run. To ensure continued improvement, a capacity strengthening plan must be developed that includes professional development of the technical, IT, and administrative staff through short term training and specialization. For example, data managers’ and analysts’ skillset can continue to be improved through short term courses on the state-of-the-art data management and software implemented in the system. A similar strategy would be relevant for the IT staff, and data visualization and communication staff. Ideally, the capacity development plan must considered and budgeted at the beginning but may evolve throughout the course of implementation as needs arise or specific gaps are identified.
To Learn More:
Completeness and Factors Affecting Community Workers’ Reporting of Births and Deaths in the Countrywide Mortality Surveillance for Action in Mozambique An original research article from the 2023 COMSA supplement in The American Journal of Tropical Medicine and Hygiene.
From External to Local: Opportunities and Lessons Learned from Transitioning COMSA-Mozambique An original research article from the 2023 COMSA supplement in The American Journal of Tropical Medicine and Hygiene.
A Qualitative Assessment of Community Acceptability and Its Determinants in the Implementation of Minimally Invasive Tissue Sampling in Children in Quelimane City, Mozambique An original research article from the 2023 COMSA supplement in The American Journal of Tropical Medicine and Hygiene.
The Lifesaving Power of … Paperwork? A New York Times article from 2023 explaining a surveillance system in rural Colombia.
| Last updated |
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| May 19, 2025 |