Community Health Workers supporting community sensitization and awareness of COVID-19
Working with partners to prevent deaths and illness due to COVID-19 in Sierra Leone
Freetown, Sierra Leone - Saidu Turay is a Community Health Worker (CHW) in the densely populated Kroo Bay Informal Settlement which is in the middle of Freetown. Apart from encouraging community members on how to prevent and seek treatment for malnutrition, diarrhea, Acute Respiratory Infections and malaria, Saidu plays a critical role in raising awareness and removing fears, which are usual reactions to the episodes of health pandemics and natural disasters which have affected Kroo Bay in the last years.
“Almost every year the community deals with floods. A few years ago, our battle was with the Ebola Virus Disease. Now Covid-19 is with us,” says Saidu, as he takes a trip down memory lane, reminiscing on the past and present pandemics which continue to affect a community which is already challenged with poverty and many health concerns.
Although there have been no cases of COVID-19 among this population of 20000 people, contacts of cases from nearby communities have been identified and isolated.
Saidu, together with his team of nine other CHWs have been hard at work – on one front supporting with contact tracing, and on another ensuring that the flurry of rumours and misconceptions about COVID-19 do not deter access to health services especially by pregnant women, lactating mothers and caregivers of children under five years of age.
According to the United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME) Report 2020, the COVID-19 pandemic has resulted in major disruptions to health services, threatening to undo decades of hard-won progress for women and children. The survey, which was conducted across 77 countries, found that almost 68 per cent of countries reported at least some disruption in health checks for children and immunization services. In addition, 63 per cent of countries reported disruptions in antenatal checkups and 59 per cent in post-natal care.
“When people started hearing about COVID-19 in Sierra Leone, there were a lot of fears, anxieties and uncertainties, which resulted in many people not visiting the Community Health Centre to seek treatment and support. Among us the CHWs, we also had fears and information gaps about how we could continue with our usual house to house visits without exposing ourselves to risks of the disease,” says Saidu as he explains his experiences of people’s health seeking behaviours during the pandemic.
Thanks to a recent training on Interim Guidance on Community Based Reproductive, Maternal, Newborn, Child, and Adolescent Health Care during COVID-19, steps are being taken to improve continuity of health services in the context of COVID-19 pandemic.
This comprehensive training, which has been rolled out with technical support from UNICEF, targeted 1540 Community Health Centre Managers from across all districts, who have in turn cascaded the training to all the 13500 CHWs across the country.
The CHWs such as Saidu have now received new knowledge and skills on how to continue with their daily work, while applying appropriate Infection Prevention and Control mechanisms to minimise risks to themselves and their patients. Saidu leads by example – always having his face mask on during the visits, and ensuring that during discussions, a good physical distance is maintained between himself and the clients.
“As CHWs, we have the confidence and trust of the people because we have been working in this community for a long time. The assurances we have given them about the need to continue to access maternal and child health services during this difficult time of a pandemic have been well received,” says Saidu as he prepares to make a tour of the community he loves dearly.
Saidu’s first visit of the day is at the house of Ngozi Johnson, a first-time young mother of a two months old baby girl Memunatu. The visits by Saidu and his teammates have been pivotal in allaying the fears that Ngozi initially had about visiting the Health Centre for Antenatal care, delivery and for post delivery services, including immunisation for baby Memunatu.
Keeping Ngozi and baby Memunatu in constant contact with health delivery services remains one of the most important strategies to prevent deaths and illness due to COVID-19 and other preventable and treatable childhood illnesses. To do this, keeping CHWs motivated and at the frontline of primary health delivery in under-served communities remains a critical and ongoing intervention by UNICEF.
Since the outbreak of COVID-19 in Sierra Leone, a discussion about the prevention of this new disease, has become a part and parcel of the procedures during support visits to families. This additional engagement with households means Saidu and other CHWs must spend a little extra time at one household, thereby limiting the number of visits they can do in a day.
“Keeping this cadre of committed men and women present and supported to respond to outbreaks such as COVID-19 is an ongoing priority for UNICEF in Sierra Leone,” says UNICEF Representative, Dr. Suleiman Braimoh. “During times of health emergencies such as COVID-19, more resources are required to ensure that we increase to the current force of Community Health Workers. This will help to ensure that regular services are not disrupted, while also bringing in cadres to help with health emergency response.”
To reduce close contact, Saidu gives Ngozi instructions on how to check on the body temperatures of the baby, while he records the findings and advices on the follow up actions required. He also takes down Ngozi's mobile telephone number, explaining that case management and follow ups are also being done via mobile phones as opposed to in-person visits to reduce in-person contact. Saidu explains that this new approach of connecting with the patients, though necessary in the context of COVID-19, has brought about additional operational costs.
Saidu is happy that his efforts are paying off. His greatest hope to get more resources so that the number of CHWs can be expanded especially during times of health emergencies. With more CHWs on the ground, Ngozi and other mothers can continue to receive the guidance and encouragement they require to access regular health care support from the Community Health Centre, while also getting information to protect themselves from the disease outbreak.