Africa: Unsung Heroes in Africa's Covid-19 Response

Thirty-two-year-old Mariam Traoré, a community health worker in Mali, starts her day with a COVID-19 self-check, including body temperature and other symptoms such as cough, sore throat, loss of smell or taste. If all is good, Ms. Traoré then gears up with a mask and face shield before leaving her house in Yirimadio, a district on the outskirts of the capital Bamako. She remembers to carry enough gloves to protect herself and others when visiting patients across her local town.

The WHO defines Community Health Workers (CHWs) as lay people who live in the communities they serve and who function as a critical link between those communities and the primary-healthcare system. In Africa, they provide low-cost interventions for common maternal and paediatric health problems such as pneumonia, diarrhoea, undernutrition, malaria, HIV, measles and now COVID-19. They also assist with immunization.

By going door-to-door providing integrated community case management, and now during the pandemic providing COVID-19 specific interventions, community health workers continue to be an integral part of the healthcare system on the continent. However, their roles vary from country to country.

In Mali, community health workers often treat community members with malaria, pneumonia, diarrhoea, and provide immunizations and family planning services. There are 30,000 Community Health Workers in Mali alone and more than a million across sub-Saharan Africa, all working to reduce barriers to healthcare, particularly to women and children.

As part of her job, Ms. Traoré pays daily visits to her patients in their homes, majority of them children. When she is unable to make these visits, patients either come to her house or she advises them over the phone.

"I typically visit up to 32 homes a day. However, when there are many children requiring my attention, I may not be able to visit as many homes. Currently, because of the COVID-19 pandemic, I have to constantly change my Personal protective equipment (PPE) between each patient to protect them and myself against infection," Ms. Traoré said in an interview.

Ms. Traoré learned to provide a suite of healthcare services from Muso, a global health non-profit organization that works with Mali's Ministry of Health to design and test proactive community health systems.

Need PPE

Just like any other healthcare professionals, community health workers also required PPE to be able to safely serve their patients without being exposed to potential health risks, especially during the pandemic.

"Before the pandemic, I would educate women on the various family planning options available to them. I would go to where these women are and seek to talk to them alone for their own privacy and confidentiality," says Ms. Traoré. "However, without PPE and with social distancing, it's harder to have those private conversations without other members of the family hearing what we are discussing."

When COVID-19 first hit Mali in March 2020, many of these community health workers could not visit patients in their homes as they were viewed as potential vectors for the disease and they lacked the necessary PPE.

The WHO says severe disruption to the global supply of PPE was putting lives at risk from COVID-19 and other infectious diseases. Healthcare workers rely on PPE to protect themselves and their patients from being infected. But shortages are leaving doctors, nurses and other frontline workers such as community healthcare workers, dangerously ill-equipped to care for COVID-19 patients, due to limited access to supplies such as gloves, medical masks, respirators, goggles, face shields, gowns, and aprons.

"Without secure supply chains, the risk to healthcare workers around the world is real. Industry and governments must act quickly to boost supply, ease export restrictions and put measures in place to stop speculation and hoarding. We can't stop COVID-19 without protecting health workers first," said WHO Director-General Dr Tedros Adhanom Ghebreyesus.

It was estimated that there was a 203% increase in COVID-19 infections amongst health care workers in Africa because they lack proper PPEs.

Muso's contribution

Muso is one of the organizations that stepped in to provide free PPEs to community health workers in Mali, including Ms. Traoré. Muso is a member of the award-winning COVID-19 Action Fund for Africa (CAF-Africa), a collaboration of more than 30 organizations dedicated to supplying PPE to community health workers on the frontlines of Africa's COVID-19 response.

The CAF-Africa coalition was launched in August 2020 and is the only known global effort exclusively mobilizing resources to equip African community health workers with PPE. It also collaborates with ministries of Health to ensure local governments are equipped to protect CHWs as they take a larger role in national responses to COVID-19.

Without secure supply chains, the risk to healthcare workers around the world is real. Industry and governments must act quickly to boost supply, ease export restrictions, and put measures in place to stop speculation and hoarding.

Christian Rusangwa, the director of Technical Assistance at Muso and a partner of CAF-Africa, says Muso's first intervention was to protect community health workers.

"We provided them with PPE so that they could continue their work, and so that patients with Malaria could still get their rapid tests and those with pneumonia could still get the care they needed," said Mr. Rusangwa.

CAF-Africa has donated over five million pieces of PPE to Mali, including 5,472,000 face masks, and 22,529 face shields.

CHW in Uganda

In Uganda, CAF-Africa partnered with other organizations such as BRAC and Living Goods to donate 6.6 million pieces of PPE to the Ministry of Health in October 2020.

Following the donation, Uganda's Prime Minister, Dr. Ruhakana Rugunda, launched a new national strategy that would depend on the country's community health workers to fight COVID-19 at the community level.

Ms. Muyingo Prossie, a community health worker in Busimbi Village, Miyana District in Uganda, recalls when the pandemic first hit her country, she did not have the adequate PPE to see all of her patients.

"We were told to pause testing for malaria and giving family planning services," said Ms. Prossie. "Many people were left without health services and just had to wait."

This was a painful reality for Ms. Prossie who, like Ms. Traoré, understands how critical her role is in community health.

"Ever since I became a community health worker in my community, no woman or child has died during delivery," Ms. Prossie said.

She understands that many of her patients do not want to be exposed to COVID-19 or they are too frail to leave their homes, so she often gears up and attends to them in their homes.

"I cannot just leave them without care," says Ms. Prossie.

As Africa continues to navigate its COVID-19 response, community health workers like Ms. Prossie and Ms. Traoré, will continue serving on the frontlines, ensuring all members of the community receive the care they need.

"So, I will put on my mask and I go to them," concludes Ms. Prossie.

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