SWITCHING ON COMMUNITIES TO DEFEAT COVID-19

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?