on Friday, 27 March 2020.

Dear Colleagues,

In these trying times let us share thoughts on strategies that can help us get over the COVID -19 pandemic. We start with a challenging quotation:

"Gentlemen, it is the microbes who will have the last word".
This quotation is attributed to the French microbiologist Louis Pasteur. How soon this will happen depends on how when we humans recognize and seriously respond to this threat from viruses and bacteria.

The COVID-19 pandemic presents yet another challenge and opportunity following upon Ebola, SARS, and MERS. It is also a loud call for the world to relearn and hopefully to remember once again that infectious diseases are a grossly neglected dimension of global security. In 2016, I was a member of an independent Commission on a Global Health Risk Framework for the Future that published a report titled; The Neglected Dimension of Global Security: A Framework to Counter Infectious Disease Crises. This Commission recommended three strategies namely:

1. Strengthening public health as the foundation of the health system and first line of defense

2. Strengthening global and regional coordination and capabilities

3. Accelerating(Research and Development) R&D to counter the threat of infectious diseases

African governments have so far responded by raising awareness and restricting entry of the virus from other countries with screening at airports and total closure of borders. They have also imposed restrictions on the movement of people inside the countries. However, travel and movement restrictions are time bound measures and not permanent solutions.

Today, COVID -19 has already been reported in 46 African countries and the next critical and strategic level of preparedness and response is to empower populations to stop transmission of the virus within the communities. This can be achieved by institutionalization of Integrated People Centered Primary Health Care that will become the foundation of the health system and the first line of defense even after this pandemic has gone.

On 25th March, 2020 Director General of WHO Dr. Tedros Adhanom Ghebreyesus recommended six key actions to attack and suppress the virus and all of them were about strengthening the public health system which significantly included a multi-sector action.

Controlling this epidemic, is first about prevention of transmission, early detection, contact tracing, isolation, treatment of new infections, and safe handling of body fluids and the remains of those who die. These things can only happen through closely inclusive collaborative work, that involves all individuals and households, in society; "A Whole of Society Approach".

The Guiding principle is that good health starts with, and is created by individuals, their families and the communities, and is supported, where necessary, by skills, knowledge and technology of the professionals. It is empowered individuals who have the primary responsibility for maintaining their own health and that of their communities. Government steps in to provide the overall enabling environment and resources beyond the capacity of communities.

It is therefore essential to build and sustain community trust for the public health system, where individuals participate actively as both a duty and a right in the prevention and control of outbreaks using existing structures, systems and resources as much as possible. This should be led and overseen by trusted local formal and informal community leaders. These leaders exist in all communities and go by different names such as political leaders, chiefs, technical officials, cultural and religious leaders.

These community structures and systems should be activated in all countries so that the routine governance of society integrates COVID-19 control measures into its routine activities. This should become the foundation of Community Health Systems for Integrated People Centered Primary Health Care that will prevent entry of the virus into the community as well as enable prompt identification, isolation, testing and treatment when necessary.

Examples of practical activities by rural communities may include: sharing correct locally understood information and ensuring that measures announced by the government are followed, that communal water sources are protected and water is available equitably using effective ways of hand washing, that hygienic practices take place in households, those who fall ill are isolated and reported and social support is provided to affected families.

Communities will be in charge of their destiny as the first line of defense against epidemics and take care of their health within Integrated People Centered Primary Health Care that "leaves no one behind".

The challenge and opportunity presented by COVID – 19 should be used to activate and institutionalize this approach so that after the current crisis it becomes the routine component of the public health system that puts priority on health promotion and disease prevention. Indeed the Whole of Society Approach goes beyond outbreak control and can also ensure that mothers attend ante natal clinics, children are immunized, the nearest health facility has required personnel and supplies, the referral system is in place, the correct food crops are grown and stored properly, all children are going to school, the rural road network is maintained, the water sources are safe and law and order is enforced etc.

This Whole of Society Approach can be rolled out immediately and quickly in most countries once the African Heads State and Governments call for them and assign roles in the same way that they have demonstrated unparalleled leadership by taking charge and issuing various directives on COVID -19 control across the continent.

Let us mobilize all people to delay that day when microorganisms will prevail over humans.

What do you all think?

Comments (5)

  • Dr David Okello

    Dr David Okello

    27 March 2020 at 14:59 |
    Dear Prof

    I am delighted to see this BLOG shading light on the role of communities in the response to COVID-19. I congratulate Prof Omaswa for taking the lead. This is the way to go. The biggest challenge for Africa will be how to deal with the outbreaks in remote communities where availability of soap and water is particularly limited. We now know better that hygiene precautions and hand-washing, in particular, is a crucially important way in which individuals and communities can protect themselves and others from this outbreak. But hand-washing is harder than it sounds and unless done frequently and meticulously with soap and water, it is not so effective.
    Thank you.

    Dr David Okello
  • Godfrey Sikipa

    Godfrey Sikipa

    28 March 2020 at 09:32 |
    Dear Prof Omaswa,
    As usual you hit the nail on the head. The fight against COVID 19 will
    be won at household and community levels with active participation of
    community leaders and existing community structures. Fortunately over
    the past few decades many countries in Africa have created fairly robust
    community level structures and processes that can be very effectively
    used to tackle most of the health problems in our countries. Countries
    like Kenya have gone a step further and institutionalized community
    participation through Constitutional Provisions. They have put in place
    a strong Community Health Division/Department in the Headquarters of the
    Ministry of Health. Similar steps have been taken in Ethiopia. There are
    other examples. My general observation however is that these structures
    are inadequately funded by the government. Many times they are funded by
    development partners/donors through “projects”. Whatever funds
    allocated to the “projects” ends up being used for workshops and per
    diems by the officials or NGOs with very little going down to support
    the day-to- operations of the community health workers and community

    So yes the COVID threat presents us with yet another opportunity to
    build on past progress on community involvement. I am informed that the
    recent outbreaks of Ebola in West Africa were brought under control when
    communities themselves realized the danger that they were facing and
    took action.

    Godfrey Sikipa
  • Miriam Khamadi Were

    Miriam Khamadi Were

    30 March 2020 at 12:48 |
    Dear Prof Omaswa and colleagues,

    We are at the point in history when we could permanently make human existence safer or better or have a future where human existence is very chakey and uncertain.

    Prof Omaswa refers to the six strategies outlined by the Director General of the WHO. I suggest that ACHEST brings together National Teams of Public Health Specialists to follow up on this and to be in consultation with their Ministers of Health in each country. I suggest this as an ACHEST-coordinated event for all African countries because I am familiar with the problem of going forward as a lone person with such an idea at such a time as this. I volunteer to be in the Kenya Team, and indeed, in the East African Team.

    I look forward to hearing from Francis and other ACHEST players.

    With kind regards and best wishes even at such a time as this,
  • Francis Omaswa

    Francis Omaswa

    30 March 2020 at 12:57 |
    Dear Miriam,

    Thank you for your input and suggestions. You are the Mother of Community Health in the continent your leadership and guidance is needed now. Thank you for taking the lead in Kenya.I want to ask you to work closely with us at ACHEST, CSOs, African HRH Platform, African Public Health Association, RECs, AFREhealth, AUC, WHO and others to drive this effort.

    We are openning a dedicated a site to serve as a Virtual Resource Center for sharing information and stimulating action by governments, CSO and Partners. We will link up with and support other efforts to support Africa to overcome this pandemic at minimal cost to our people.

    Our struggle continues.

  • Miriam Khamadi Were

    Miriam Khamadi Were

    30 March 2020 at 13:00 |
    Dear Francis,

    Thank you very much for your kind words. Yes, we have an obligation as Public Health Specialists in different branches to come together and help heal our continent and our world.

    I look forward to the dedicated site and trust that we shall effectively collaborate. No matter how I look at the health challenges and whatever the particular challenge one is addressing, the household and community levels are truly the stepping stones. We need to find ways of making Community Norms Healthy norms!

    With prayers for the well-being of all of us,

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