What impact will COVID-19 have on the world? We will be confronting the genius of COVID-19 for a long time and in many ways. At the time of writing this, coronavirus is increasing its multiple harms day on day. The world peak and many more national and regional peaks have not yet been reached.
We need creative, collaborative and community-based approaches to give us the best chance to preserve lives and livelihoods until a vaccine is available and widely used.
How is global health being dismantled? As Richard Horton, editor of The Lancet, expressed it, “Global health has entered a period of rapid reversal. De-development is the new norm.” In addition, from the grassroots, a reason is simply stated by a Kenyan leader of the Arukah Network: “COVID, COVID, COVID, other diseases don’t count.”
Here are some crucial ways in which COVID-19 is changing global health. Let’s start with immunisations. In July 2020, the director-general of the World Health Organization stated that “The number of children dying from missed vaccinations is likely to far outpace the numbers of people dying from COVID-19.”
Let’s now consider three infectious disease killers: AIDS, tuberculosis and malaria. The Global Fund to fight AIDS, tuberculosis and malaria estimates that COVID will dislocate health systems and could double the number of deaths from those illnesses within twelve months unless urgent action is taken.
Crucial for the world are national economies, their impact on community livelihoods and critically the actual survival of the most vulnerable. The World Bank estimates that COVID-19 will push another 71 million people into extreme poverty, measured at the international poverty line of $1.90 per day.
The term non-communicable disease does not exactly roll off the tongue. However, non-communicable diseases, including cancer, diabetes, and cardiovascular diseases, account for about seven deaths in ten worldwide. That’s 41 million each year. Even in low- and middle-income countries, they account for more deaths than all other causes. In a survey from 155 countries carried out by WHO, approximately half of all patients with hypertension and diabetes will have their treatments either partially or totally disrupted because of COVID-19 dismantling health systems.
Women have so often been deprioritised in global health. This is happening with COVID. It is estimated that 47 million women will be prevented from access to contraception. 7 million unintended pregnancies are predicted to occur over 6 months, some from transactional sex to earn income for the family. Also, sources estimate that an additional 15 million cases of gender based-violence have occurred during every three months of lockdown, a horrifying number to consider.
Fortunately, communities can do quite a lot to address this. For too long in some parts of the humanitarian aid sector, solutions have been suggested and even dumped on poorer communities, as if those who live in comparative wealth know the answers to the realities and feelings of those they are trying to help. The title of a well-known book describes it well. “When helping hurts.”
And it doesn’t just hurt. It creates dependence and undermines the agency and creativity of the very people for whom effective solutions mean the difference between flourishing and destitution.
So one positive outcome that we are beginning to see is the greater role of local leaders, and community-based entrepreneurs, opinion formers and champions.
A quote from one group at the London School of Hygiene and Tropical Medicine expresses this nicely. “Community members, including the marginalised, identify solutions that work best in their situations. They know what knowledge and rumours are circulating. They can provide insight into stigma and other barriers. They are well placed to work with others from their communities to devise collective responses”.
Moreover, community health is of course closely related if not almost identical to primary health care. Primary health care is a brilliant and effective service and system of health care, despite its rather prosaic name.
A quote from the WHO World Health Report in 2008 articulates its essence: “Primary health care brings balance back to health care and puts families and communities at the hub of the health system. With an emphasis on local ownership, it makes space for solutions created by communities, owned by them and sustained by them.”
Countries, especially in Africa, are giving a primary health care renewed priority during the time of COVID. This includes the training of many new community health workers. Kenya is training 100,000. In Sierra Leone, community health workers already outnumber doctors by 95 to 1.
The basic unit of the community is the family: all those living under one roof or sharing the same cooking pot. Therefore, we need to think of home-grown solutions that don’t need visits to hospitals and health centres. They are especially useful when it comes to the growing ‘epidemic’ of Non-Communicable Diseases. It’s quite easy to take your blood pressure or even measure your blood glucose. Of course, we all need information and some simple equipment but in many poorer communities, community or visiting health worker can increasingly provide this.
This approach also helps to demystify and de-medicalise common health conditions that are part of people’s lives.
The use of mobile phones, WhatsApp and other forms of information technology are playing an ever-increasing role. As one community member recently expressed it: “Whether I’m deep in Malawi or deep in the Amazon, all I need is a mobile phone and connection that allows me to talk to a clinician.”
One important community group often ignored are faith leaders. Current estimates indicate that more than four out of five people in the world have a religious faith, more in Africa. Nearly every community in the world has one or more religious centre. Moreover, faith leaders are often the most respected go-to people in a community for advice and information, especially at times of crisis. Therefore, it should be a no-brainer to include them as community leaders and responders. While people may be reluctant to take heed of recommendations issued by government spokesmen, they’re much more likely to trust their local religious leaders.
There are two important provisos. First faith leaders must believe in, follow, and preach the science. Second, they need to avoid defaulting to a position that states that faith and prayer are all that is needed.
COVID-19 is a dangerous and unpredictable foe that will affect the lives of nearly everyone, especially the poorest, weakest and most vulnerable. Nevertheless, situations such as this that require community leadership and creative compassion give us the approaches we need to cultivate.
Feature Image Credit: by Toa Heftiba via Unsplash