An opinion blog by Dr. Gill Black, Co-director, Sustainable Livelihoods Foundation
COVID-19 in context
Today, South Africans are experiencing their 15th day of COVID-19 lockdown. To date, the national health system has reported 1 934 confirmed infections, 18 confirmed deaths and 45 recoveries. The trajectory of the epidemic in South Africa is uncertain as the true number of SARS-Cov-2 infections nationwide is unknown. However, the number of new infections and new deaths is creeping upwards daily and this highlights the critical need to protect our vulnerable populations from contracting the virus. As with other countries globally, there is deep concern about the susceptibility of our elderly residents, and those with underlying health challenges.
Three of the biggest health challenges for South Africa are tuberculosis (TB), HIV and TB/HIV co-infection. Nationally, TB is the number one cause of death due to infectious disease and it poses a particularly significant health risk to HIV infected persons. The high prevalence of HIV in South Africa is now augmenting the country’s unease about the spread of COVID-19. There is not yet enough evidence about how SARS-Cov-2 behaves in the context of HIV to understand the implications of a dual viral infection. Whereas there are promising reports that antiretroviral therapy may reduce the chances of serious respiratory illness, it will not stop a coronavirus infection or the transmission of the virus to others. It is likely that those with co-morbidities – such as HIV infection and diabetes – have an elevated risk of COVID-19 disease. In the meantime, the need for daily visits to local clinics and hospitals for reasons that are not linked to COVID-19 remain absolutely essential for thousands of marginalized people receiving treatment for TB, HIV and other chronic illnesses.
Community engagement that is socially and culturally perceptive, and which allows for interaction, has been shown to amplify community responsiveness to infectious diseases in many low and middle income countries (LMIC) including South Africa. Amid misconceptions and misunderstandings about COVID-19, continuously fuelled by fake news and propaganda, there is escalating urgency to protect marginalized South Africans from the disease through a dedicated community engagement initiative. Under the now extended lockdown restrictions, it is imperative that the South African government recognises the central importance of focussed community engagement in the prevention of viral transmission and death.
Traditional approaches that enable the interactive engagement of community members in public health are currently impossible. However, mobile technology offers pragmatic possibilities for fast, widespread and two-way community engagement.
What is needed for COVID-19 Community Engagement in South Africa
- Short term measures: A COVID-19 Community Engagement app
In the short term, the South African government should develop a freely downloadable and data free COVID-19 Community Engagement app as a trusted and reliable ‘go-to’ source of key public health information and feedback. The app should provide both written and visual information that is accessible to marginalized community members:
Key information should include:
- who is most at risk of disease
- COVID-19 symptoms
- tools for users to identify their risk profile
- ways to self-protect from COVID-19
- usefulness, use-ability and availability of face masks
- where to go and what to do if experiencing COVID-19 symptoms
- explanation of terms such as social distancing, self-isolation and quarantine
- advice on social distancing, self-isolation and quarantine in township settings
- help-lines (on-line, via WhatsApp, and toll free numbers)
The COVID-19 Community Engagement app should be:
- data free
- developed collaboratively with core input from community engagement practitioners and mobile technologists
- informed by medical and scientific experts
- endorsed and disseminated by
- the provincial and national health departments including the National Institute for Communicable Diseases (NICD)
- academic institutions in SA
- national and local NGOs, and CBOs
- available in all languages that are spoken nationally
- calibrated with information that is specific and relevant to the provinces being engaged
- disseminated by NGOs and CBOs through their existing community networks
The COVID-19 Community Engagement app should enable feedback on:
- community knowledge about COVID-19
- community experiences of social distancing, self-isolation and quarantine
- community experiences of seeking care for COVID-19
- community experiences of seeking care for other urgent health matters during the pandemic
- community ideas for community responsiveness during the pandemic
- Long term measures: A Community Engagement Nerve Centre for South Africa
In the longer term, community engagement professionals should establish a national nerve centre for community engagement in public health, disease outbreaks and health science research with the aim of:
- mobilizing a critical mass of community engagement professionals, scientists and public health specialists across the country
- establishing a dedicated online communication platform for community engagement professionals, scientists and public health specialists to share resources, experiences and ideas about what is possible and effective in different socio-economic and cultural contexts in South Africa
- enabling the interaction of community engagement specialists working in other LMIC contexts to learn about best practice in the majority world
- drawing upon toolkits and other resources that are already available through established national and international institutes and organizations such as the NICD, the World Health Organization, the Centres for Disease Control and the Global Health Network
- using the knowledge of established international community engagement bodies such as the Social and Behaviour Change Communications programme
- implementing the learning from infectious disease outbreaks such as Ebola in international contexts
- developing national guidelines for community engagement during infectious disease outbreaks
- establishing community advisory networks in local settings across the country
- Multi-sector buy-in and financial backing
These short and long-term measures can only be achieved through the collective action of experienced community engagement professionals, clinicians, scientists, mobile service providers, strong technical support teams and the committed buy-in of national and provincial departments of health.
The long term support of national and international donors and funders is also crucial.
Better community engagement in COVID-19 could be achieved through the multi-sector development of a reliable and trusted mobile app that is interactive and calibrated to the needs of those who live in marginalized settings in South Africa.
South African public health would benefit from the establishment of a nerve centre for community engagement to synergize knowledge among a critical mass of community engagement professionals, scientists, public health experts, technical support specialists and concerned community members.
The time is now!
Dr. Gill Black is co-founder, co-director and head of Health Participation at SLF. She has been facilitating community engagement in health and health science since 2010. In her community engagement practice, Dr. Black builds on 15 years of post-doctoral experience as a field based immunologist and has developed a specialist interest in facilitating reciprocal learning between health scientists and marginalized community members. Gill has worked in several low and middle income countries including Kenya, Brazil, Malawi and Thailand. She has lived and worked in South Africa since 2002.