- Africa needs integrated responses to COVID-19 that build on countries' existing strengths and resources.
- Here we propose such a solution for Kenya, based on three factors: young people, technology, and community healthcare volunteers.
- This approach could serve Africa well for the future as well as during the current crisis.
Most recent reports about the COVID-19 response in Africa have focused on the challenges the continent faces due to its fragile health systems and lack of critical care capacity. In the past month, the number of COVID-19 cases in Africa has increased by 43%. According to the Africa Centres for Disease Control and Prevention (Africa CDC), 53 African Union member states have reported 54,027 cases and 2,074 deaths; in Kenya, as of 7 May, the total number of cases reported was 607, and 29 people had lost their lives.
The World Health Organization (WHO) predicts that 29 million to 44 million will be infected with COVID-19 if containment measures in sub Saharan Africa fail. Of those, up to 167,000 would require oxygen; 52,000 to 107,000 would require breathing support; and up to 190,000 people could die from COVID-19 across 47 countries. These findings highlight the need to develop and implement integrated solutions that build on strengths already present in the health systems and societies of sub-Saharan Africa today; solutions that will rapidly halt the spread of COVID-19, allow safe re-entry into economic activities, and maintain constant early detection and management of new cases as multiple waves of COVID-19 infection arise.
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Consequently, we propose an integrated intervention that emphasizes and links existing strengths in the Kenyan society and health system - including community-based healthcare, young people and a vibrant information technology sector - to enhance COVID-19 case detection, isolation, referral and management in Western Kenya.
Community-based healthcare was adopted by the government of Kenya to deliver essential health services in 2007. It is fully supported and financed by Kenya's Ministry of Health. Community health volunteers are the backbone of community-based healthcare. Typically they are older and well-respected community members who volunteer and commit to ensuring that each household in their community has access to basic health services. Community health volunteers are self-driven and altruistic, and often juggle other responsibilities, too. Historically, community health workers have worked with paper-based tools to perform routine household visits. Digital tools are uncommon in this line of work, and digital skills among community health workers are highly variable.
The wisdom of youth
Talented and tech-savvy youth make up a significant proportion of the Kenyan population. The median age in Kenya is 20. For youth today, employment opportunities are low, and have probably been worsened by the recent lockdown measures taken to contain the virus; youth unemployment estimates vary between 7% and 35%. Of the 100 young people we surveyed, close to 50% are young women, while 98% had either college or university degrees in economics, medicine, environmental sciences, public health, information technology or sociology. They had many ideas on how the pandemic should be addressed, including: developing an application that would send automated messages to the public reminding them about hand hygiene, wearing masks and maintaining social distancing; offering counselling services to those affected by COVID-19; and offering home-based care along with immediate links to treatment and follow-up.
Their ideas currently have no platform, and are yet to be taken into account in the current national and regional response. As with many health challenges, solutions are often left to local and internationally renowned experts - a somewhat exclusive process that leaves behind those most affected, and those on the frontlines. This pandemic is an opportunity to question and change that status quo for more impact - and our solution does so by placing young people and community health workers front and centre. The current pandemic response in Africa should tap into youth who are full of innovative ideas that could disrupt traditional thinking and modes of addressing diseases. Young people should be given a platform to express themselves, to solve problems, and to help with implementation efforts. They should be included in dialogue with public health specialists and policy-makers and should be given the opportunity to contribute. Including young people will result in a more sustainable and long-term solution to the current and future pandemics. The youth of today can act as custodians of the pandemic response in order to remind future generations of the lessons learnt, pitfalls, and the best way forward.
Similarly, community health volunteers are often not included in decision-making and the framing of health challenges. We engaged with 397 volunteers who welcome working with young people, the introduction of digital household survey tools, and contributing to decision-making. They are keen to improve their own digital skills to enhance their effectiveness in screening, isolating, testing and managing potential COVID-19 cases at the community level. They recognize the importance of maintaining essential health services - a task they have carried out tirelessly for many years. They are anxious to include technology to accelerate the process of community-generated evidence reaching policy-makers and decision-makers. And they are committed to maintaining their role as their brother’s and sister’s keeper - a key attribute of African society that gives the continent a headstart in navigating the pandemic and adjusting to a new COVID-19 reality.
In the coming weeks, and in partnership with the country's Ministry of Health, every household in Siaya County, Western Kenya, will be screened for COVID-19. Those who test positive will be isolated. At the same time, and in partnership with colleagues working in the current global epicentres, we will train facility-based health workers to care for severe forms of COVID-19, adopting early lessons from Asia, Europe and the US, and adapting these lessons to the local context and resources.
This integrated COVID-19 response in Western Kenya will shift the status quo and prioritize a bottom-up approach to healthcare delivery, pandemic preparedness, response and recovery. We anticipate this integrated intervention will be scalable to other parts of sub-Saharan Africa where community based healthcare has been established and where young people form a significant proportion of the population.