As COVID-19 continues to spread across West Africa, the temporary suspension of routine health interventions, including some activities to help eliminate neglected tropical diseases (NTDs), has meant that many people are not accessing essential prevention and treatment services. This is particularly challenging for hard-to-reach communities, such as migrant and mobile population groups.
In Cameroon, nomadic groups mainly live and travel through the Northern and Western regions. Traditionally, these groups consist of pastoralist herdsmen of Fulani origin, who migrate from neighbouring countries Nigeria, Chad and Niger. For those that settle in Cameroon, internal migration between different regions, mostly towards places situated on riverbanks, is common throughout the year.
Living in remote, dispersed, and inaccessible settlements means that nomadic groups have less access to formal health services. As they travel at various points throughout the year, they are also often missed during routine outreach community health interventions, especially for mass drug administration campaigns which often occur during the dry season when they are travelling to other regions. This has been highlighted in research led by Sightsavers which showed that many members of the nomadic community were not reached during the implementation of a new treatment strategy for river blindness in three ‘hotspot’ communities in the West region.
Community volunteers can play a crucial role in reaching nomadic communities. They are nominated by their communities to distribute treatments and are often considered to be trustworthy and knowledgeable individuals to whom other members can turn to for information.
However, the marginalisation of nomadic groups has become more apparent during the COVID-19 pandemic. Back in April, one of our community volunteers called me to find out if the Sightsavers team was going to visit nomadic communities as part of a planned research project. When I informed him that our research activities were currently suspended due to the pandemic, he replied: “Madam how can there be this kind of sickness and we do not know about it at all, and even how to prevent it? What is the sickness all about?”
He went on to say: “We are not using telephones like you to be well informed, and you should be the ones to teach us on something like this.”
For me, this was a stark reminder that information and outreach activities were not reaching these groups. I explained to him what COVID-19 was, its transmission, signs and symptoms, and told him to contact the district health centre for more information.
A key challenge is that many of the government-led communication initiatives such as posters, banners, radio and TV messages and helpline numbers for prevention advice, exist mainly in Cameroon’s two official languages, French and English. These languages are largely unfamiliar to nomadic communities. Posters and banners are posted mostly in health facilities, town halls and public places, and are only accessible to those people who live nearby to the cities and who visit hospital facilities.
Given these challenges, there is a clear and urgent need to enhance and improve communications and prevention strategies to ensure that the needs of the nomadic population at large are considered and included in the fight against this pandemic.
Community volunteer networks in the nomadic population could be used to help distribute messages. This would involve training community volunteers to raise awareness within their communities and nomadic camps, and provide information on the signs and symptoms of COVID-19, transmission routes, and prevention measures. In this way they could provide close-to-community information and help to dispel misinformation about the cause and transmission of the virus, which we know is circulating around the region. Using NTD networks for the COVID-19 response has also been encouraged by the World Health Organization and partners to enhance community engagement.
Community volunteers are nominated by their communities to distribute treatments and help to ensure that vital drugs are distributed in even the poorest and most remote places.Community volunteers
Firstly, all messages which are sent out by Cameroon’s ministry of health should be translated into the Fulani local languages (Fulfude and Pidgin) with help from language experts. Posters and banners should also be adapted to ensure they are more culturally appropriate, using relevant images and language, through the support of social scientists and communication experts.
Secondly, the translated messages should be made available to the community volunteers so that they can move from camp to camp, passing on messages safely via megaphones while still adhering to social distancing measures. These messages could also be sent out to local radio stations in the languages of nomadic groups. Where radio signals are less active, mobile caravans (vehicles equipped with megaphones) can be used, and messages posted in community entry points, the huts of camp leaders, community market spaces, mosques, and village squares.
Finally, there is an urgent need for tailored community-led strategies for disease prevention and control. These approaches have been shown to encourage participation between nomadic groups and settled communities. Community engagement using community volunteers can play a vital role here, as an effective and acceptable approach to engage local communities. Community volunteers understand their community’s dynamics and customs, and, as they are the main connection between their community and the health system, are crucial to ensuring that no one is left behind.
Sightsavers holds Independent Research Organisation (IRO) status. Our immediate goal is to generate evidence that our programme teams can use to improve lives around the world.Visit the research centre
As we move towards a phase of recovery from the COVID-19 pandemic, we are looking at how we can adapt our work so that we can resume much-needed treatments and surgeries in a safe way. As part of this, the needs of minority and marginalised groups must be considered in the planning and development of community health interventions.
The isolation of these groups risks delays to early detection, testing, diagnosis, contact tracing and care seeking, and increases the risk of outbreaks in these populations and in the surrounding communities. Undertaking these approaches, and fast, will further strengthen community acceptance for disease control efforts to help save lives, now and in the future.
Kareen Atekem is a research coordinator based in Sightsavers’ Cameroon Office, where she is leading a research project to accelerate the elimination of river blindness using alternative treatment strategies.
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