By Faiswal Kasirye
Today, COVID-19 has already been reported in almost all countries in the world, and now our critical and strategic level of preparedness and response should be to empower people to stop the transmission of the virus within the communities.
This can be achieved by institutionalisation of Integrated People-Centred Primary Healthcare that will become the foundation of the health system and the first line of defence even after this pandemic has gone. Therefore, the hard to reach communities deserve to be equipped with enough information to properly combat this pandemic as its spread is widening to the furthest areas in the country.
This pandemic presents yet another challenge and an opportunity following others we have seen before like the Severe Acute Respiratory Syndrome (SARS), H1N1, the Middle East Respiratory Syndrome (MERS) and many others.
It is also a garish call for the world to relearn and hopefully remember once again that infectious diseases are a grossly neglected dimension of global security. Therefore, going forward, they need to be given adequate attention because they arrive unexpectedly.
From the onset of it, most African governments responded by raising awareness and restricting entry of the virus from other countries with the 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.
On the present pandemic, the Director-General of World Health Organisation (WHO), Dr. Tedros Adhanom Ghebreyesus, on 25 March 2020 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.
This action is recommended in our communities to strengthen their health system because it is mostly hard to reach the communities who always suffer when it comes to the outbreak of such air borne diseases. And the most disturbing issue among all is that they lack adequate information on how to fight such diseases as and when they arrive.
The control of this deadly pandemic is first by prevention of transmission, early detection, contact tracing, isolation, treatment of new infections, and safe handling of body fluids and the remains of those who died. These things can only happen through closely inclusive collaborative work, that involves all individuals and households in our communities or simply what one can refer to as “A community Approach”.
The guiding principle here 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.
The skills from the health professionals come in to supplement our responsibility to be clean and healthy. In other words, cleanliness is the first principle that needs to be reminded to our communities as a basic issue to preserve our lives.
It has empowered individuals who have the primary responsibility for maintaining their own health and that of their communities. Government steps in to provide the overall support enabling environment and resources beyond the capacity of communities. This is because governments are solely responsible for every one’s life and I believe, that upon drawing the country’s national budget, every citizen is budgeted for.
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 titles such as political leaders, kings, chiefs, technical officials, cultural and religious leaders on the different levels in the communities.
The community structures and systems should be activated in all countries especially high risky areas so that the routine governance of society integrates COVID-19 control measures into its routine activities among people. This should become the foundation of Community Health Systems for Integrated People-Centred Primary Healthcare that will prevent the entry of the virus into the community as well as to enable prompt identification, isolation, testing and treatment when necessary.
As a matter of fact, this cannot be done by the government or the Ministry of Health alone. On such a level where COVID-19 has reached, it has now become everyone’s responsibility to detect the symptoms of the virus among ourselves and thereafter report to the relevant health officials or even better to handle it yourself with the help of guidelines laid down by WHO and the Ministry of Health.
Examples of practical activities by rural communities may include: sharing correct locally understood information and ensuring that measures announced by the government and the Ministry of Health are followed, that communal water sources are protected and water is available equitably using effective ways of sanitisation, hand-washing, that hygienic practices take place in households, those who show symptoms and fall sick are isolated and reported, and thereafter social support is provided to the affected individuals.
Communities all over the country especially in the hard to reach or distant areas will be in charge of their destiny as the first line of defence against epidemics and take care of their health within Integrated People-Centred Primary Healthcare that takes care of everyone in the community.
The challenges and opportunities brought by COVID-19 should be used to activate and institutionalise this approach so that after the current crisis it becomes the routine component of the public health system that puts the priority on health promotion and disease prevention. In fact, sanitisation, washing of hands and distancing ourselves while coughing is important.
Therefore, it is imperative that they remain operational throughout the communities to strengthen the health conditions of people living in those communities.
Indeed, the whole of society approach goes beyond these epidemic control and goes up to ensuring that mothers attend to antenatal, children are immunised, the nearest health facilities have the required medical supplies and human resources, 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 are enforced etc.
The community approach can work perfectly for most of the hard to reach and or rural areas in making sure that the right information regarding this new pestilence is disseminated to the community members as well as guiding them with the proper guidelines as laid down by WHO and the Ministry of Health.
The government or the ministry responsible should also design the roles for community leaders and health professionals working in those areas, in the same way they have already demonstrated unmatched leadership by taking charge and issuing various directives on COVID-19 control across the country. ***