Living Goods’ work in maternal, newborn and child health, family planning, and immunization is more important than ever before. Community-based care is essential, particularly in highly-constrained systems. We also know that the mortality threat of easily treatable diseases like malaria can quickly increase while already limited resources are laser-focused on the COVID-19 response. During past outbreaks and other health crises, existing illnesses and conditions are often neglected, leading to a massive loss of life.
We cannot allow this history to repeat.
We anticipate the disease burden to quickly escalate in the countries where we work. We are encouraged that our government partners have quickly put aggressive controls in place to slow the spread of the disease, and we expect these to rapidly ramp up. We are hoping for the best when it comes to the toll COVID will take on African communities and health systems, but we are preparing for the worst.
Although reported COVID cases in our areas of operations started later than in other parts of the world and numbers remain low—with more than 363 infections in Kenya and 78 in Uganda at the end of April—there is evidence of community spread. And, as we’ve seen in other parts of the world, we anticipate that infections are significantly higher due to limited testing, asymptomatic cases, and people who never seek health services when they are ill. With only 55 ICU beds in Uganda and 518 in Kenya, we expect the health system and formal facilities to face extreme strain—making the sustenance of effective community-based care more important than ever before.
At a national level, we are partnering deeply with both the Kenyan and Ugandan ministries of health to ensure that essential health delivery continues during this challenging time. We have been coordinating deeply on the development and dissemination of prevention mention messages for CHWs, helping to develop national guidelines that enable CHWs to safely deliver services, supporting digital outreach via SMS messages to CHWs in and beyond our networks, sitting on technical working groups across both ministries, and more.
Within Living Goods’ own operations, we have also developed the following approach so that we can continue maintaining health services in the communities where we work.
What we’re doing to respond:
Protecting CHWs & Living Goods Staff.
- Training Living Goods-supported government CHWs in adjusted “low and no-touch” protocols so that they can safely continue their core work and supervisors in remote performance management techniques.
- Living Goods is providing the CHWs we support (directly or through BRAC) with PPEs including gloves, masks, and portable sanitizer so that they can safely support COVID prevention work and other limited services. We’re also advocating that governments include CHWs in their PPE procurement calculations.
- Increasing compensation to the CHWs we support to reflect their increased workload and risk, as well as the likelihood that their other sources of income have been disrupted. We’re also continuing our engagement with governments we’ve had all along about the importance of compensating all CHWs. This is more important now than ever.
- Assisting in the implementation of daily symptom checks for government-supported CHWs, Living Goods staff, and their families.
- Integrating new COVID workflows into our existing SmartHealth app and adjusting existing workflows to account for the new no-touch
Maintaining Essential Health Service Delivery.
- Providing CHWs in our catchment areas with free and essential health commodities including ACTs, paracetamol, amoxicillin, and zinc/ORS in formulations appropriate for sick children.
- Living Goods will provide these through our supply chain to ensure national supply chains remain stocked.
- Increasing cell phone data and airtime stipends to the CHWs we support to make up for the additional bandwidth required for remote communication.
Interrupting COVID-19 Transmission.
- We have now trained all Living Goods staff and the CHWs we support in COVID prevention, early case detection, reporting procedures, and personal safety measures. In addition, we are providing similar training to an additional 12,700 CHWs across 7 Kenyan counties where we currently operate or where we plan to work soon.
- Creating an e-learning platform for Living Goods-supported CHWs, our staff, and those of partners and government, to minimize travel and contact while simultaneously exploring how we might support training for national COVID responses.
- Working to develop an effective two-way SMS messaging platform to reach the CHWs we support with COVID-related information, with the potential to be scaled nationally in the future.
- Assisting in government efforts to deploy physical information, education, communication (IEC) materials (e.g., posters) in CHWs’ communities, and helping to train CHWs in IEC strategies, reaching 15,700 CHWs in Kenya and 7,700 in Uganda by the end of April.
- Exploring options for customizing and testing an automated SMS/messaging self-help tool for patients who suspect they may have COVID. This service would guide patients through self-diagnosis and triggers a remote or no-touch household consultation from a government-supported CHW as
- Where needed, supporting governments at the national and sub-national levels to integrate COVID data into their existing health databases.
- Supporting government in procuring and deploying sanitation improvements for CHW and their communities, including handwashing stations. In Kenya, we have provided triage tents at health facilities to enable better separating people with suspected COVID symptoms from other patients, an effort we hope to extend to Uganda.
Supporting MOH and Local Government Efforts.
- Seconding staff to health ministries in Uganda, Kenya, Burkina Faso, and Sierra Leone to support their responses.
- To-date, we have seconded more than a dozen staff with nursing backgrounds to support Uganda’s COVID hotline plus two at senior technical levels directly to the MOH; six dedicated technical resources have been seconded in Kenya; and two staff each in Sierra Leone and Burkina Faso are supporting their respective Ministries of Health. We expect this support to expand as government needs grow.
- Supporting Ministries in devising guidelines that enable CHWs to play an effective role in national and local responses, as well as guidance on their communications strategies.
- Coordinating locally and globally with other health organizations to share COVID data, best practices, etc.
We fundamentally believe that effective, digitally-driven community-based primary health saves lives. It is essential for quelling this pandemic and future pandemics, and to building stronger more resilient health systems.
We will continue to keep you apprised as our plans take shape. We are proud and humbled to be part of this community. We are in this together.
Photo: This illustration, created at the Centers for Disease Control and Prevention in the United States, reveals ultrastructural morphology exhibited by coronaviruses.
Priorities for the Global COVID-19 Response
We worked closely with our colleagues at the Community Health Impact Coalition to draft a joint position paper, which outlines our shared priorities around protecting health care workers, interrupting the virus, maintaining existing health care services in the face of this crisis and shielding the most vulnerable from socioeconomic shocks.