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Step up the fight against Covid-19

COMMENTARY
By Kalangi Kiambati | November 12th 2020

After months of strategically combating the spread of Covid-19, it seems that the country is experiencing a second wave of infections. What is more worrying is the high mortality rates. 

Kenyans seem to have let their guard down and resumed normal lives, including holding large gatherings and freely travelling from towns to the rural villages. The recent political campaign rallies have only exacerbated the spread of the disease. It seems now, that the disease has penetrated even the remotest of villages and focus can only shift to ensuring that communities learn how to deal with positive cases of the disease.

However, if the cases continue to increase, many health facilities are likely to get overwhelmed with the number of people seeking health care for not only Covid-19 but also other common illnesses. With increased potential for exposure to the virus, many more expert healthcare providers are going to have to isolate themselves for weeks at a time, further reducing the capacity for health facilities to effectively deliver services.

This, coupled with the perennial challenges of lack of equipment and inadequate remuneration, will leave many rural community members dangerously exposed. The worst-case scenario would be cases of sick people avoiding health facilities for treatment of other life-threatening conditions, including chronic conditions such as diabetes and Hiv/Aids, further compounding the health challenges at the community level.

The only hope in ensuring a near-normal delivery of healthcare services in the face of the challenges posed by this global pandemic will be community health workers. Kenya’s community health personnel consist of Community Health Assistants (CHAs) and Community Health Volunteers (CHVs). Their contribution is two-fold. First, they will play a critical role in educating the communities on the need to observe the set guidelines in order to prevent the spread of the disease.

Practices such as frequent hand washing and the proper wearing of a proper mask are alien to many rural communities. With the disease increasingly spreading, community health workers will come in handy in sensitising community members on the proper steps in washing hands and the proper way to wear and, if need be, wash a proper mask.

Second, they will help to identify potential positive cases and facilitate isolation or hospitalisation in accordance with the laid down procedures. With the government requiring mild cases to be managed at home, community health workers present the only hope for effective follow-ups on the progress of people recovering at home. Since they are residents of the communities they serve, they are viewed as credible sources of information and will provide the much-needed linkages between the community and the county and national health management teams. This will in turn ensure better monitoring and evaluation of the health situations for better response.

Despite their critical role in facilitating access to health care information and services, many community health workers are not adequately facilitated and as a result, many communities still do not have adequate community health services. A 2018 community health services evaluation indicated a 59 per cent national coverage with some counties recording coverage of as low as 17 per cent.

Normal kits

The country has 1,569 out of the expected over 10,000 and 86,025 out of the expected 103,000 CHAs and CHVs respectively. Although CHVs do not expect any monthly income, they will need a lot of facilitation, including the provision of masks, sanitisers and even personal protective equipment as situations might require.

Unlike other conditions, Covid-19 management requires a lot of resource mobilisation for both community and other health workers to adequately deliver their services. The CHV Covid-19 response kit will no doubt be more expensive than other normal kits. Additionally, it is important to select and train as many CHVs as required to serve each community health unit.

Using Kenya’s Community Health policy 2020-2030 it will be possible for county governments, in conjunction with the relevant community health management teams, to effectively build capacity for both CHAs and CHVs to step up the activities aimed at not only preventing but also managing any covid-19 positive cases at the community level to avoid any unnecessary overwhelming of referral facilities.

-Dr Kalangi is a communications lecturer and trainer, Kenyatta University.

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