When COVID-19 emerged, countries whose fragile health systems would struggle to cope with a large-scale outbreak feared the worst. Liberia, in West Africa, was one such nation. In March, as the first coronavirus cases were reported there, the government formed an urgent plan of action.
Thanks to funding from UK aid, the Ascend West and Central Africa programme – led by Sightsavers in a consortium with the SCI Foundation, the Liverpool School of Tropical Medicine and Mott MacDonald – is working with the Liberian government to tackle high rates of neglected tropical diseases (NTDs) in the country. When the World Health Organization recommended that NTD activities should pause globally due to COVID-19, Sightsavers and other development partners worked with the Liberian government to address the crisis.
In the months that followed, the staff, structures and expertise of the country’s NTD programme, which Ascend supports, were utilised to stop coronavirus spreading. This included a huge network of community-based health workers and volunteers who temporarily suspended their work on NTDs and other health issues to join the COVID-19 front line.
The Ascend West and Central Africa programme aims to protect millions of people in 13 countries from neglected tropical diseases.About the programme
Nimba, Grand Kru, Maryland, Lofa and Grand Gedeh counties – home to 1.4 million people – were deemed to be particularly at risk of COVID-19. Some of these areas were already reporting cases, while others bordered countries where the virus was taking hold, making them vulnerable. Yet people in these areas had little or no knowledge about coronavirus.
To support these counties through the first phase of the crisis, Ascend West and Central Africa focused on two main areas: training, deploying and supporting contact tracers, and raising awareness of COVID-19, how it spreads, and how transmission can be prevented by changing behaviours.
Lee Tompeamie Danno, county risk communication and health promotion officer at the Liberian Ministry of Health, helped to coordinate activities in Nimba. He says one of the greatest challenges when efforts began was the lack of coronavirus awareness among the public.
Lee says: “Community members did not understand the use of masks, for example, in public places, even [when] hand washing and social distancing. But, equally, we know that behavioural change is not an event, it’s a process. So we continuously engage them so they can… [protect] them, their family, and the community at large.”
A huge public awareness campaign was created to ensure as many people as possible were reached. In Liberia, radio jingles were created, and existing ministry posters and flyers were updated. Both were tailored to local contexts and dialects, to communicate the importance of social distancing, face coverings, hand washing and social distancing.
Community volunteers, chosen for their experience in working on other health campaigns, were trained as community mobilisers. They put up posters and flyers around their communities, held socially distanced community meetings and safely went to people’s doors to talk to them about the reality and the risks of coronavirus. If they saw anyone displaying COVID-19 symptoms, they would refer them for testing.
“Their training covered COVID-19 prevention, detection, and prompt responding,” says Lee. “They carry messages from house to house on what is COVID-19, how does it spread, what are the signs and symptoms, and what are the preventive measures you can do as a person? If a person is suspected in the community [of] having any signs and symptoms, how will they detect? What can they do as a community member with the community chief and elders to respond immediately?
“What makes me proud and satisfied… is that the support given to the county health team from Sightsavers has helped us to have… approximately 85% of our community dwellers understanding the preventive measure about COVID-19. If we go to the rural areas, you’ll find out that a lot of people have buckets… and locally made materials to wash their hands. Most of them… [now] use masks to have their social activities.”
Community health assistant Nelson Gallah is part of Lee’s team. When he began working on Nimba’s COVID-19 response he encountered many dangerous misconceptions about the virus.
“The community didn’t use to believe that there is coronavirus,” he says. “When we come the first day to give them the education, some people said coronavirus is not real, that the government brought it in.”
By taking a consistent approach and repeating the same messages, Nelson says people who were cynical at first began to change their views. Minds have also been changed by other community members who have heeded the messages of the campaign and are determined to ensure their neighbours, family and friends understand, and stay safe.
“We’ve faced challenges in the community because there are people who sometimes completely refuse [to accept the messages],” says Nelson. “[So] we continue to talk to them, [telling them] that this thing is real, better take the preventative measures.
“On and on we are giving the health talks, the awareness to the people. They’re getting to understand. We can see people, [when] they sit down, [they] sit apart from one another. [They are] also using masks, washing their hands frequently.”
Ephreriam Keah, who lives in Cooper Farm in Nimba, says Nelson has made a huge difference in the community.
“From the time when Mr Gallah came, he explained a lot of things to us about this coronavirus. I want to thank and give appreciation about what they’re doing for us and continue to do. When we are not informed… in our community [we] will come down with coronavirus.”
Ephreriam’s neighbour, Teizu Wolobah, agrees. She remembers when the area was devastated by Ebola and knows only too well the importance of taking COVID-19 seriously.
“I learned about coronavirus from the health workers and radio,” she says. “Before they delivered their messages to us I did not know about the virus. After telling us about the virus I put my washing-hands bucket outside, the Ebola bucket I had. I let my children and other people around to wash [in] it every day.
“I talked to my family and friends and said we should be careful because when Ebola came it killed many people. This other virus we’re talking about could kill more than Ebola.
“[I encourage people] by talking to them and showing them how to use masks, how not to stand in a group. You should have distance.”