BY LINDA MAFU, HEAD OF POLITICAL AND CIVIL SOCIETY ADVOCACY AT THE GLOBAL FUND
IN Voices ON 12 May 2020
At the International AIDS conference in 2000 I joined an activist community that barreled through the streets of Durban demanding universal access to HIV treatment. At the time, the treatment was only accessible to the rich – it cost more than US$10,000 to treat one person per year.
As terror caused by AIDS swept through Africa in the 1990s, there emerged an activist community that demanded action to save friends and family from dying. The community sought to break the silence and to shame those in power who were indifferent to AIDS. It is that community that I marched with that July day in 2000. That movement, which brought together communities from across Africa and beyond, has been credited with accelerating progress against HIV and saving millions of lives.
The same urgency, action and resilience by communities are also saving lives in African countries as the fight against COVID-19 collides with the fight against other life-threatening diseases such as HIV, TB and malaria. Communities are offering their services as primary caregivers, advocates, and as the links between the formal health care system and the marginalized people.
Many have projected that the new coronavirus could infect and kill hundreds of thousands in Africa and other regions that are less resourced. If these areas are to evade the catastrophe, it will be in no small part due to the contribution of communities, which are using lessons from the fight against epidemics such as HIV, TB, malaria and Ebola to fight COVID-19.
In South Africa, more than 30,000 community health workers move door to door, taking down people’s travel histories, temperatures and other risk factors, identifying the coronavirus infections before they come to health care facilities. In Ethiopia, the country has deployed its 40,000 community health workers – who provide education and primary care for existing illnesses like malaria – in cities and remote villages to monitor new cases, educate community members and promote hygiene in the fight against COVID-19. In Nigeria, community health workers engaged in the fight against polio have taken on COVID-19 detection. Decades of investments in community health systems are paying off in the fight against COVID-19.
We have also seen communities quickly adapt to attend to old pandemics despite the lockdowns imposed because of COVID-19. In Benin, as people can no longer gather in community centers to collect the mosquito nets that protect their families against malaria, community leaders and more than 5,000 health workers are distributing the nets door to door. In Uganda, health workers are visiting HIV-positive mothers and pregnant women to make sure they continue to receive the medicine they need to prevent passing the virus to their babies. Other countries are looking to borrow these approaches to ensure the fight continues against HIV, TB and malaria while tackling the new threat of COVID-19.
The recent Ebola outbreaks in West and Central Africa highlighted the importance of community involvement to link national or global responses to communities suspicious of outsiders; community health workers and local leaders were critical in negotiating access for international health workers to fight the outbreak. Those insights that utilize communities’ local, social and cultural structures are coming in handy in the fight against COVID-19. In DRC, which is also battling an Ebola outbreak, trusted town criers and radio stations share critical information about how to protect against the new virus.
As COVID-19 spreads, we have seen incidents where authorities in some countries have violated the rights of marginalized populations such as men who have sex with men and sex workers. Such acts have the potential of driving such populations underground, away from the health services they need in the fight against COVID-19, as well as other diseases. To tackle that challenge, we must ensure that these communities continue to play a central role in the development and delivery of health services.
As communities organize themselves to take the lead in prevention of the new coronavirus through health promotion and care, screening and tracing of contacts, they are making a clear case for more investments in community health systems. They are underlining the fact that to defeat COVID-19, as well as other future pandemics in low- and middle-income countries it will take a whole-community approach. It will take a village.