By: Joan Nduta and George Ouma, Action Against Hunger
When a child in Mali contracts malaria, a community health worker is often the first to identify the illness. When a mother in Tanzania wants to improve their child’s diet, they turn to a community health volunteer. And when a parent in Somalia wants to learn how to detect malnutrition in their children, a health worker trains them.
No matter the health crisis, community health workers and volunteers are on the frontlines in the world’s hardest-to-reach communities. As COVID-19 spreads, this hasn’t changed: these brave, hard-working women and men continue to be the people communities rely on to stay healthy.
Despite movement restrictions, lockdowns, and social distancing, community health workers are finding ways to promote healthy behaviors, help families prevent malnutrition and disease, and treat children with life-threatening health conditions.
Still, it has not been easy – most community health workers rely on group trainings, home-to-home visits, and close, personal interactions in the communities they serve. Lack of personal protective equipment and fears of contracting the virus have kept some community health workers at home, reaching out to the families they are responsible for by phone instead.
We asked some Action Against Hunger community health workers and volunteers in East Africa what it’s like to be on the frontlines in the midst of a pandemic. Below, hear what they had to say.
ON STAYING SAFE AT HEALTH CENTERS
At Action Against Hunger’s health centers, a variety of measures have been put into place to ensure that lifesaving health and nutrition programs can continue safely. This includes changes to working hours and days to reduce crowds, different nutrition treatment rationing to reduce the number of health center visits needed, social distancing within waiting areas, new handwashing stations in and around the facilities, and providing protective gear to health staff.
“Outpatient nutrition services have changed from weekly to biweekly basis, and the rations given out in supplementary feeding services have changed from biweekly to monthly to prevent overcrowding at the distribution sites.” – Bhakita, health worker in Wanyjok, South Sudan.
“Social distancing must be followed at the health facilities to avoid overcrowding, so the number of days have been reduced. This has impacted me personally, too, because I am paid based on the number of days worked.” – Victor, health worker in Yumbe, Uganda.
ON HOW LIFE HAS CHANGED IN THEIR COMMUNITIES
The United Nations predicts that the COVID-19 pandemic could cause acute hunger to nearly double by the end of the year. Already, community health workers have seen the impact of travel restrictions and the global economic crisis in the villages where they live and work.
Some have seen transportation costs increasing, resulting in delays in food shipments. Others report that markets are closed because they don’t have basic food items or other products available. In Uganda, limited funding and availability of food have already forced the World Food Program to cut back on the monthly food rations provided to refugees. “Before, an individual would get 12kg cereal for one month - now they are getting 8.8 kgs,” says Simon in Yumbe, Uganda.
“The price of basic commodities, such as salt and even soap, has gone up. The lockdown and border closing have caused a shortage of items in the market.” – Andrea, health worker in Malualkon, South Sudan
“Many things have changed, especially our social, cultural and religious activities. You cannot greet each other as before. It is also in our culture people to gather together and discuss social matters but now that has been limited due to COVID-19.” - Gatkek Met in Gambella, Ethiopia
“People cannot sit together or visit each other or look for a job – now it is all hard because the residents in this village often look for casual work. However, when one goes to look for work, they are told there is no job – not because there is not any work, they are scared you might bring the virus to them.” – Selina, in Isiolo, Kenya
ON HOW COMMUNITY HEALTH WORKERS ARE RESPONDING TO COVID-19
Community health workers are more than health staff: they are community mobilizers, educators, and trusted residents of the areas they serve. To prevent the spread of COVID-19, they’re helping to share important messages about health and hygiene, as well as social distancing.
“Our communities need us – we are their TVs and radio. They have no other way to get this information. Once we hear something on the radio, we go and tell them to keep them informed on what the government has instructed, like wearing masks.” – Selina, Kenya.
“We are raising awareness on COVID-19 using megaphones and by playing audio messages that have been translated to local language as we distribute [water, sanitation, and hygiene] supplies in displacement camps,” - Abdulwas in Gambella, Ethiopia.
In Ethiopia, Action Against Hunger is collaborating with government officials to ensure that health workers and nutrition officers at each of our nutrition treatment centers are trained in how to prevent COVID-19 and what to do if they encounter a suspected case. In refugee camps, community health volunteers are the backbone of our outreach: they are ensuring that severely malnourished children are identified and treated and that lifesaving services continue to be delivered.
ON MAKING HOME VISITS
Samuel and Selina are community health volunteers in Isiolo, Kenya, who work together to support 120 families. They used to visit about ten homes a day, but that has now reduced to one – and only for emergency cases.
“As I volunteer, I fear for my life. I don’t know who has the virus, so it’s difficult to support anyone. Now, we go to homes once a week due to the fear of coronavirus. The other day I got a call because a child had diarrhea – I went and helped them very quickly. For the rest we make phone calls,” explains Samuel.
The same is true for Elizabeth, a community volunteer in Mpwapwa, Tanzania: “Life has changed – we no longer do things like we used to, such as household visits, and we have to sit far from each other. This has affected our service to the community because everyone lives in fear.”
ON WHAT HEALTH WORKERS NEED MOST
To serve their communities safely during this pandemic, community health workers need information, training, and protective gear. They also need mental health support: health workers are dealing with new work schedules, increased caseloads due to heightened needs in the community, and the added stresses of potential exposure to the virus and the stigmas and fears associated with it.
“When we are together as volunteers, we help each other. We need masks, soap, sanitizer, jerricans of water – when we train the community, it’s good to have these items so people see and believe what we are saying.” - Selina, Kenya.
“We walk long distances, so we need a bicycle to help with movement, as well as boots and raincoats, because it has been raining.” - Bhakita, South Sudan.
“We need communication materials such as megaphones, T-shirts for visibility to do community education, protective items, and pens and books to record feedback and data.” – Victor, Uganda.
“We need soap and jerricans to get water to teach our people how to wash hands – we know our people, they learn with their eyes.” - Samuel, Kenya.
Across East Africa and in many other areas of the world, community health workers and volunteers play a vital role in the health of children and families – and their positions have taken on even greater importance as the COVID-19 pandemic spreads.
Action Against Hunger does everything we can to train, compensate, and equip our frontline workers with all the tools they need to stay safe and informed while serving their communities – but we need more support to keep that vital work going.