A resilient community to combat COVID-19: what engagement strategy we can learn from fragile settings in LMIC?

When the whole world has become vulnerable and fragile to the COVID-19 pandemic, the discussion and presentations as part of the webinar in CH-CoP highlighted how a resilient community system can be streamlined and utilized to fight along with our health care workers. 

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By Sanghita Bhattacharyya & Adalbert Tchetchia

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Please access the presentations here.

As part of Community Health-Community of Practice webinar series entitled- “Delivery of health services at community level: Country experiences in fragile settings the findings from Liberia and Cameroon points how community interventions involving multiple local actors are key to accelerate service delivery like immunization among children in case of Cameroon or handling Ebola epidemic in case of Liberia. The supply side challenges often seen in fragile settings are disruption of routine services, break down of supply chain, reduce workforce, their diversion from routine services and also limited coordination and supervision. Health system prioritises these supply challenges, which is very much needed in combating health crisis. But one should not overlook the demand side challenges, where engaging with communities can play a vital role by providing a support structure to health workers to deliver services.

The country cases highlights that without engaging with communities, results in dis-trusts, threat to health workers, duplication of efforts. So better coordination, better engagement leads to “Less suspicion, less tension and less fights”. A well-defined plan to take the community along in combating pandemic like COVID- 19, will result in easy access to the community, use of existing social structure to spread health messages, better surveillance and innovative solution adapted to local context. Liberia’s Ebola experience points to the four principle of community engagement – Empowerment, Participation, Consultation and Information. As for Cameroon case, facing fragility in the Extreme-Nord Region highlights, complexity of community interventions implemented by different community actors, health system and community-driven processes and package of integrated delivery. The strategy that Cameroon and Liberia adapted to engage communities is through, selected key community leaders (champions), social accountability of the village chief, target messaging through peers, participatory decision making and goal settings. 

With over 160 participants in the webinar, the discussion was very spontaneous, with sharing of their country experiences and challenges faced particularly to give the right messages to community when people are in confinement. Some of the suggestions were use of mega phone, extensive use of social media and other suited adapted solutions provided by information and communication technologies (verified medical information), use of community champions from different fields to spread the message. Along with the pandemic the info-demic being a serious problem, which needs a strategy adapted to each local context, where entrusting community head or leaders to spread the right message along with well-known scientists to broadcast preventive messages would be helpful. Involving faith leaders particularly when people are living in anxiety can also be one of the psycho-social intervention. There are examples from countries of use of existing programs where through mobile phone targeted messages tailored to COVID are been given to CHWs and mothers. Some concerns were raised about the security of CHWs and more broadly redesigning of CHWs programs in such context. Concerns from countries were also raised of using coercive measures in imposing the lockdown. Participants have also expressed challenges how to mobilise communities in confinement and quarantine, particularly where there is also political turmoil faced by the countries.

The webinar discussion highlighted the need for participatory approach involving different social network- “Combat with Care”. The learning from the Ebola epidemic, how it has handled stigma, helped the health workers in tracking cases, can be a learning. With limited resources, how several LMIC countries have handled epidemic can also be a learning for HIC and the situation can be a good opportunity for “South-North knowledge exchange and not just North –South. 

Meaningful community engagement in health response efforts in case of COVID-19 pandemic is very much needed which can increase trust, improved communication and collaborative efforts  – all necessary conditions for health system resilience. Instead of top-down strategy a bottom up approach to handle the health crisis can sustain the effort.  To take the community along is very much needed for a resilient health system, after all the efforts are for a healthy community.

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