ENGAGING COMMUNITIES TO DEFEAT COVID-19.

Dear Colleagues,

Let's discuss how to live with COVID-19 in our homes, communities, and workplaces.

“So let’s do it. If health development does not happen in African communities, it will not happen in Africa nations’ is a statement by Miriam Were, a famed Kenyan Community Health Advocate in the book African Health Leaders; making change and claiming the future. “The path to UHC is integrated people-centered Primary Health Care’ is another regularly stated position by Dr. Tedros, Director-General of WHO. African Union Health Strategy 2016-2030 “calls for vibrant ways of leveraging community involvement and integration” …well as recommending a paradigm shift to assist the Member States in addressing the effects of public health emergencies in a more systematic and comprehensive manner”.

At face value, these quotations sound obvious and undisputed; however, there is no palpable movement in Africa to translate this vision into reality in African communities.

What is palpable now is the effort on COVID-19 where advocacy is about Standard Operating Procedures (SOPs); namely hand washing, social distancing, contact racing, testing, and care including provision of pulmonary ventilators. There is a flood of education messages sponsored by so many partners in the media which are telling people what to do and none asking for the people’s views. What is NOT palpable is the message that all these SOPSs take place within the homes of people, their communities, and workplaces except for the use of pulmonary ventilators. What is NOT palpable are messages that ask for the views of the population and the challenges that they face accessing water, soap, stigma related to contact tracing, isolation, quarantine, travel, teenage pregnancies, gender-based violence, etc.

During the first week of October, 2020, a team from ACHEST and the Ministry of Health visited a Community Health initiative in the Ngora district of Eastern Uganda where ACHEST is implementing a pilot on Inter-sectoral collaboration for health in five villages. Village Health Teams (VHTs) working under the oversight of the village administrator have mapped and numbered all households, they visit five to ten households each day, maintain a Village Health Register containing a record of the health status of members of households, they discuss and share information with the families and advocate for health-seeking behavior, home cleanliness and hygiene. VHTs are facilitated with bicycles, cell phones and receive equivalent of $50 each month as compensation for their time. They work in close collaboration with the health facilities and other sectors and actors such as cultural and religious leaders, community development and agriculture extension staff and parish chiefs. Once a month they conduct Community dialogue and we watched the deliberations of such a meeting.

It is impressive how the community identifies their problems and discusses the solutions during the Community dialogue. Health seeking behavior has been transformed in these villages and in a short period of time. This is an example sustainable community ownership and accountability for their own health outcomes in practice. There have been so many such pilots in many countries but very few countries have scaled it up to national level.

This week,in a major scale move, the Prime Minister of Uganda launched the National Community Engagement Strategy for COVID-19. This is at the direction of President Y K. Museveni and developed by a multi-sectoral committee that I am honored to Chair. The overall goal is that all people in Uganda are aware, empowered and are participating actively in the prevention and control of COVID-19 as both a duty and a right, using existing structures, systems, and resources as much as possible. This is underpinned by the principle that individuals have the primary responsibility for maintaining their own health and that of their families and communities. They are supported, where necessary, by the skills, knowledge, and technology of the professionals.

This CES will strengthen the existing Community Health Systems for Integrated People-Centered Primary Health Care as the National COVID-19 response transitions to Phase 4 with widespread community transmission. The CES will ensure that infections do not occur in the community and if they do, will enable prompt identification, testing, treatment, and rehabilitation as needed.

Inter-sectoral collaboration and the Whole of Society approach are recognized as the most effective interventions for achieving SDGs, UHC, and Pandemic control. COVID-19 is an opportunity to implement to scale the existing multi-sectoral Community Health Strategy. Uganda will have a strong Integrated People-Centered Primary Health Care system for the current COVID-19 response and remain long after as the foundation and the first line of defense against infectious diseases.

Expected outcomes from the Uganda CES are that: (i) Communities are mobilised, aware, trusting and taking ownership of personal and community responsibility for health and well being, (ii) Communities are actively implementing COVID-19 SOPs and pandemic suppressed and mitigated, (iii) Uganda’s health system is strengthened and better prepared to achieve SDGs and UHC long after COVID-19, and that (iv) Inter-sectoral Collaboration and the Whole of Society approach for health institutionalized in Uganda.

I urge all African countries and partners to use COVID-19 as an opportunity to make health development happen in African communities. This will generate very high returns in social and human capital as well as economic growth when compared to many other investments.

What do you think?

Francis.