As the COVID-19 pandemic unfolds, Cameroon has been afflicted with one of the highest numbers of confirmed cases in sub-Saharan Africa, with approximately 6,143 cases confirmed and 197 deaths. The outbreak poses many challenges, particularly in the country’s many refugee camps, which were largely excluded from the government response plan due to limited resources.
The Start Network’s Migration Emergency Response Fund (MERF) funded one of the first projects in the country to help mitigate the spread of COVID-19 and work to complement existing responses. In expectation of the fact that over 140,000 refugees and nearby communities would likely require support, given the increased vulnerability of refugees living in overcrowded camps with limited access to health services, Start Network members took an anticipatory approach to respond to the situation.
Since the end of March, the agencies awarded funding—International Medical Corps UK, Plan International and Solidarités International (SI)—have been working in Cameroon to implement not only their first project centred around responding to COVID-19, but also their first MERF-funded three-month projects in the country.
“We’re quite interested in this response because it was the first one the Start Network funded around COVID-19 and was the first project on this in Cameroon, so there's so much learning” said MERF Programme Manager, Melina Koutsis.
The MERF team caught up with the agencies during their mid-project review to hear more about lessons learned, the importance of adaptation and being at the vanguard of response to the new coronavirus in Cameroon.
5 KEY INSIGHTS FROM IMPLEMENTATION IN CAMEROON
1. ADAPTATION (AND COLLABORATION) IS KEY:
Originally, the agencies proposed a variety of activities as part of the response including training health personnel and community leaders, awareness raising sessions around good hygiene practices, and the distribution of WASH kits and installation of handwashing stations. Given the circumstances, it became obvious that certain adaptations had to occur as to how the activities were carried out in order to meet the deliverables. Though slight, these adaptations have proved important to the efficacy of the projects.
Adeline Shiyka of International Medical Corps UK in Cameroon, described the process they undertook when adapting sensitisation activities as small, common sense measures that proved equally effective. “We adapted our door-to-door sensitisation because we recognised there was a lot of risk with having individuals come to people’s homes while people are supposed to stay at home. So we decided that, instead of coming to their doorstep, to use the megaphones and stay in the street and then sensitise along the neighbourhood instead of going to the house.”
Other agencies reported other minor changes to their activities that have kept the projects practical and on-track.
- Normally large workshops held for project kick-offs and sensitisation have now been transformed into smaller meetings. Though these take more time as it means several, smaller meetings with fewer people, it has ensured the activity can be implemented safely and effectively.
- Hygiene promotion initiatives were held outdoors and demonstrations of handwashing stations were held for fewer people at several times.
- There were reductions in the number of trainings, as well as smaller groups of attendees, in order to practice social distancing measures.
- Mass media activities have largely been adapted to take place over community radio or via megaphone instead of via other mediums such as cinema sessions where in-person attendance was required.
Chief among the adaptations made were the measures taken around procuring WASH kits. Coordinating with key agencies like UNHCR meant a collective decision was taken to avoid risk due to the poor use of kettles for toilet purposes and raises the potential spread of waterborne diseases like cholera whilst increasing the number of communal handwashing stations within the camp.
Ghilsain Temgoua of Plan Cameroon also fed back that adaptation and flexibility around how they implemented the WASH aspect of the response was key in their thinking. “Previously we’d planned to install WASH kit facilities, but given the situation, we are going to see how we can install the WASH facility for all refugees instead of giving the individual kits”.
2. NOTABLE BEHAVIOUR CHANGE
Behaviour change is notoriously difficult to influence and capture, particularly during short-term interventions. However, International Medical Corps observed in one of the refugee camps in which it operates that fewer and fewer people are greeting with handshakes, as well as fewer people praying together in groups. Meanwhile, Plan observed changes in both the camps and host communities, stating that people seem more conscientious about the COVID-19 pandemic on the whole. Social distancing and increased handwashing were also noted as obvious changes in behaviour that were witnessed.
Julia Maciocia, SI CMR’s Reporting Officer, emphasised the role agencies were playing in driving key messages about COVID-19 to reinforce the need for these actions. “I think it’s important to reiterate the severity of the pandemic. It is especially relevant for our staff to communicate on COVID-19 as the government has loosened some of the restrictions. So, we have to repeat and accentuate on the severity, but we’ve seen some difference in the way people are organising themselves and how social distancing is put in place even for the community here who are not used to social distancing with one another.”
3. KEY CHALLENGES EXPERIENCED
All agencies noted various challenges experienced while implementing, but a universal challenge was the limited availability of face masks and respirators while demand was very high, as well as export restrictions and regulations by China, the main country producing the items. Widespread supply-chain disruptions have meant that the supply of those critical PPE commodities has been bottlenecked, making procurement difficult. This was considered a point where increased, international collaboration and shared learning could be of benefit. International Medical Corps is part of UN-led working groups to resolve COVID-19 issues.
“We’d like to know how other countries are coping with the shortage of face masks and respirators. Because for health personnel there are requirements from WHO, and locally we cannot procure it,” commented Dr Jean Mukenga of International Medical Corps UK in Cameroon. “We understand that the WHO/UN-led pipeline will provide a solution, but at the moment it is not yet delivering quantities. International Medical Corps has therefore invested in building its own supply pipeline for critical commodities, is currently prepositioning supplies in Dubai UNHRD and is releasing those to country programs. The transportation from the UNHRD prepositioned hub to country programs is supported by the WFP aviation services.”
Being ‘first’ to respond within a certain context and within a new normal has also been a challenge as there is no previous learning which can be drawn upon and no roadmap for how to adapt and implement in the current environment. “I think one of our challenges was to adapt our response in terms of the behaviour change and how to train our community mobilisers to respond to the rumours and the false information around the COVID-19” said Julia Maciocia, SI CMR’s Reporting Officer.
“I think that’s a big challenge because we also have the responsibility to inform our staff on what COVID-19 is and to not spread false information, so we are trying to come up with a system with false information tracking and to respond to it and have our staff (COVID-19 focal points) in the field and we’re trying to have as much communication as we can. A lessons learned or some kind of tool to see how other organisations are dealing with that problem and for us to get informed as humanitarians would have been useful.”
4. TOOLS DEVELOPED
Whilst agencies are coping with the gap in lessons learned and tools to help aid their own projects’ activities, they also recognise that they are on the forefront of innovating and creating these themselves.
Dr Mukenga of International Medical Corps UK stated, stated “We have developed a quantification tool that can be used to estimate the number of masks and other items (PPE) for a project. This tool was developed in-house by the International Medical Corps COVID-19 taskforce technical team based on WHO rational PPE guidance. We have also developed in collaboration with government and WHO, communication tools e.g. IEC materials (fliers, posters) that are used during awareness raising and sensitisation activities around COVID-19, these materials can be also adapted in other contexts.
Plan also mentioned the development of their Knowledge, Attitudes and Practices (KAP) survey tool, which has been done at the beginning of the project and will also be done at the end, can be shared and will inform future potential MERF alerts and responses to COVID-19.
5. SHARING LEARNING
Agencies were keen to share tools with others to use as a template and encourage improvement and context adaptation that would further aid COVID-19-centric responses with refugees and host communities. Neighbouring communities have been included in the projects in order to mitigate for any potential stigmatisation and all actors are coordinating closely. “This is the first time we are putting into place a project on COVID-19 and I think it’s an opportunity for a lot of lessons learned for the adaptation of the rest of our activities on different projects” said SI’s Julia Maciocia. Highlighting the level of coordination between teams she said, “We’re in contact a lot for this project as we are trying to adapt our ways of working and communicating on this issue.”
Being community-led, especially around the sensitisation activities was also a key piece of learning agencies were eager to share with others. “What we have learned is to directly ask the communities as this came up within our conversations with our staff. The first priority is to have as much communication as possible. Our first questions are ‘what do you know?’ and ‘what have you heard?’ instead of ‘what remedies have you heard in the villages?’ We do not want to put words into their responses. That’s what we replicated in most of our intervention and sensitisation in a broader sense around this quite new way of working.”