According to Africa CDC, there have been 12,216,748 COVID-19 cases detected out of 125,168,543 tests done as of January 2023 and 256,542 deaths in Africa. The pandemic has added additional pressure to underfunded health systems and disrupted the provision of essential health services threatening years of progress on global health challenges. In Africa, the impact of the pandemic on health systems is more pronounced, aggravating the already constrained health system delivery characterized by an inadequate number of healthcare workers.
As part of the COVID-19 response, Africa-CDC launched the Partnership to Accelerate COVID-19 Testing (PACT) to facilitate the implementation of the Africa Joint Continental Strategy for COVID-19, endorsed by African Ministers of Health on February 22, 2020, in Addis Ababa, Ethiopia. Through the initiative and working with partners, Africa CDC has been able to deploy more than 20,574 Community Health Workers (CHWs) in 29 African countries for the COVID-19 response to conduct active case findings, contact tracing, risk communication and community engagement for vaccine uptake. Africa Public Health Foundation (APHF) was able to raise funds from Rockefeller Foundation to expand COVID-19 testing and contact tracing in Africa by use of CHWs. One of the implementing partners, benefiting from this grant, working in close collaboration with the Ministry of Health in the Kingdom of Eswatini is the Baphalali Eswatini Red Cross Society.
“As Red Cross, we are dedicated to saving lives, changing minds, and empowering communities to sustain themselves. We have been at the front line during the COVID-19 pandemic, working closely with public health officials to deliver our services safely and coordinate our efforts with government agencies and partners.” says, Dr. Elliot Jele, Programmes Manager Baphalali Eswatini Red Cross Society.
We accompanied Dr. Elliot and his team, Colani Shongwe a Supervisor and Community Health Workers (CHWs) Philani Dlamini, Fisiwe Motsa and Tsela Nomvula to a field visit in Mahwalala, Mbabane, a peri- urban area, to see, firsthand, how they are working at the heart of communities. The purpose of the visit was data collection, which is done manually, and to evaluate the knowledge of the community members from previous engagements with the CHWs.
On a rainy day, the team padded through the muddy waters as we walked down towards Boyze Mhlanga’s home, a young man in his 20s. We scrambled to share the few umbrellas that were available, but the rain did not deter us from our mission. Boyze, standing at the door of his mud-walled house and corrugated roof, welcomed us with a huge smile. He had grown up with Philani Dlamini, one of the CHWs, who went ahead to ask him questions about his knowledge of COVID-19, around protection and vaccination. Philani first checked and recorded his temperature and proceed to offer him hand sanitizer. “We do these home visitations for data collection frequently because it is through the information that we get that we are able to ascertain what gaps need to be filled in terms of information and skills.”, says Philani. He adds, “Success to me is when after relaying this information, a community member calls to ask for directions to a testing center or to say the information we equipped them with came in handy to save or explore a situation.”
Boyze, who had not expected such a big team, showed much enthusiasm as he narrated his experience, “There were many rumuors about COVID-19. What it is, and how it is spreading and killing people. My family and I were afraid. When the vaccine was introduced, I was very skeptical and did not want to get it. The visits from the Red Cross CHWs, especially my childhood friend, Philani, equipped me with the right information, and my family and I are getting vaccinated.”
“The CHWs have been instrumental in the fight against COVID-19 because they are known by the communities and the CHWs know the importance of engaging with communities while respecting their cultural and religious beliefs,” says Colani Shongwe, Red Cross Supervisor remarked.
We then embarked on our next visit, about seven minutes’ walk away from Boyze’s. Sibongile Nkambule, a 67 year old lady who had lived in Mahwalala for most of her life, upon seeing us approach her house ran in and came out wearing a mask. She reminded us to keep a distance as that is what she had been trained to do. The CHWs, sharing a hearty laugh, commended her for that. Fisiwe Motsa, a CHW accompanied by her 4 year old son, engaged Sibongile on why we were there. Fisiwe checks her temperature and ensures everyone is sanitised. She requests Sibongile to tell us about her experience with COVID-19. “I am old and my main concern about COVID-19 is, what if I die if I were to get it. I take every measure possible to ensure my family and I are safe. My son got it and he had to isolate himself in his room. We were terrified and by then we did not know of the isolation centers available.” She continues, “I see some of my neighbours not wearing masks and I get concerned. I have pamphlets that I received from the CHWs which I refer to occasionally and share the information with my peers. The CHWs are doing a great job in community sensitization, and I encourage you not to relent but continue with the engagement. I do not own a radio but with CHW visits, I am well versed with what is happening.”
Fisiwe is a young mother who wakes up every day to serve her community. She has a passion to ensure that her community members are well informed on matters of public health especially about COVID-19. As a CHW, she has played a key role in ensuring the right information is disseminated to the community through door-to-door community mobilization. When we visited Mahwalala area, Mbabane, she came with her son despite the heavy rain. The young boy seemed comfortable and at home, a testament to this being a regular thing for him. Even rain cannot deter her from doing what she loves. Fisiwe, always smiling and pleasant informed us, “Being a CHW has been a great experience but resistance from the community sometimes happens and you have to find ways, even if it means going back there severally, to convince them to be vaccinated. I hope my son will one day serve his community just like I”
Our last visit was to Mahwalala Red Cross Clinic, just 3 mins away from Sibongile’s home. By this time, there was heavy downpour and we had to drive the short distance to avoid getting drenched and the earth road was now very slippery. We were received by Nurse Bongekile Ngwenya who informed that she was happy with the work being done by Red Cross CHWs in community engagement for COVID-19 testing and vaccine uptake. “We usually do over twenty COVID-19 tests in a day. We have recently introduced COVID-19 vaccination services in the clinic and the uptake is mainly contributed by the CHWs mobilization efforts.”
As part of the COVID-19 response in the Kingdom of Eswatini the CHWs have been the initial contacts for contact tracing, testing and effectively tailoring public health messages to their communities and aiding Public Health experts collect data. From this visit, it was clear that being part of the demographic allows CHWs to serve as a trusted resource, providing outreach and care as a member of the community, for the community.
Dr. Lul Riek, Regional Collaboration Center Coordinator, Southern Africa, Africa CDC, was happy with the progress that the Kingdom of Eswatini had achieved through the PACT collaboration, “We need to work together to achieve our intended purpose in fighting the COVID-19 pandemic. Africa CDC needs people on the ground to ensure effective implementation and the CHWs are playing a vital role in community mobilization and engagement.”
Even with the impressive work, they are doing, the CHWs are facing several challenges. For instance, they lack adequate resources which will ensure proper data collection mechanisms, the purchase of various equipment and supplies like PPEs, which are available for distribution to the CHWs and community members in need, and logistics to remote areas. Through partnerships with donors who have funded the Africa CDC-led PACT program, there is the implementation of well-coordinated actions and strong partnerships to strengthen the effectiveness of COVID-19 response across Africa. PACT has made it possible to mobilize experts, CHWs, supplies and other resources to test, trace and treat COVID-19 cases in a timely manner to minimize the impact of the pandemic on the African continent.