BACKGROUND:
In 2023 the Western Cape Department of Health and Wellness established Cape Town Systematic Healthcare Action Research Project (C-SHARP), a health and demographic surveillance system (HDSS) integrated into community oriented primary care (COPC), in the low-income communities of Bishop Lavis and Nomzamo.

METHODS:
C-SHARP increased the number of community health workers (CHWs) employed by contracting non-profit organisations (NPOs) to 180, who, after providing routine services and COPC screening, ask consent and additional surveillance questions, all of which is collected digitally on an open-source mHealth application we customised, Community Health Action Mobile Platform (CHAMP). Nurses provide clinical oversight and digital health officers give technical support to CHWs. CHAMP data is uploaded live into the Provincial Health Data Centre, allowing for granular automated reports of outputs and findings.

RESULTS:
C-SHARP has visited 20 357 locations, and assessed 34 519 households and 101 748 individuals. 76% of household data comes from Nomzamo where near complete coverage can be demonstrated. Progress was slower in Bishop Lavis, related to NPO capacity constraints, as well as challenges in the community, including gang violence. The Nomzamo population has a median age of 28 and is 55% female. 31% of adults are unemployed, with 21% of households having no one employed in them. 35% of households received a social grant. In Nomzamo 49% of household dwellings are informal, and of these 27% accessed a public tap for water and are largely reliant on buckets and pit latrines for sanitation. 5% of all households have no access to electricity and 17% report no internet access, including on mobile phones. At least 8% of households have food insecurity.

CONCLUSIONS:
C-SHARP demonstrates the feasibility of HDSS service integration and the utility of digital community-based data collection by CHWs, although operational challenges persist. Clustering of service relevant household vulnerability is seen.