Rural Health Mission Nigeria (RHEMN) is a non-governmental organization based in Gombe northeast Nigeria. The organization supports access to quality healthcare in hard-to-reach remote communities and develops advocacy platforms to influence policy that strengthens primary healthcare systems.
The covid-19 pandemic has significantly challenged global health. In Nigeria, covid-19 came at a time that the health system is faced with insufficient financing, medical supply gaps, service delivery challenges, and a lack of an adequately trained workforce. These challenges are preventing significant improvements in healthcare delivery, especially at the primary healthcare levels. Globally, there have been 229,373,963 confirmed cases of covid-19 including 4,705,111 deaths reported to WHO. The NCDC has reported 202,704 confirmed cases of covid-19 with 2,264 deaths in Nigeria. As the situation increasingly becomes tough, the government continues to prioritize its response to contain the effect of the virus, putting pressure on the existing services. The Nigeria center for disease control strategies focused on training and capacity building, risk communication systems, partners’ coordination, community engagement, public communication, contending uncertainty, addressing misperceptions, and managing misinformation. However, these strategies are faced with several challenges including; distrust in government, poor infrastructure in primary health facilities, cultural norms, and religious resistance among others.
To support ongoing government efforts to stall or stop the community’s spread of the virus, RHEMN launched the “covid-19 response project” in July 2020 to support government response to the pandemic. The project was supported by the public affairs section of the US Embassy Abuja. This project focused on 3 basic aspects of the response including risk communication, provision of hand hygiene infrastructure, and capacity building for the primary health workforce.
- Capacity building: We believe that with training and capacity building, community health workers will play a significant role in reducing and mitigating the impact of covid-19 at the community level. Several studies have demonstrated the significance of implementing high-quality infection prevention and control strategies to reduce the spread of the covid-19 virus in the community. Infection prevention and control (IPC) is a practical, evidence-based approach that prevents patients and health workers from being harmed by avoidable infections including covid-19. IPC occupies a unique position in the field of patient safety and universal health coverage. Preventing the spread of infections reduces healthcare costs, prevents unnecessary harm, and supports high-quality people-centered health services.
The organization trained over five hundred primary healthcare workers on infection prevention and control in Gombe state. The trained health workers were tasked to serve as IPC focal persons in all the primary healthcare facilities in the state. Through this, the IPC network of Gombe state was formed to respond to any other public health emergency in the state aside from COVID-19 including Lassa fever and other infectious diseases. The presence of infection control focal persons in all the primary healthcare centers will strengthen the response capacity of the system in case of any future public health emergency. In addition to the physical training, the organization also launched an online training package on infection prevention and control for wider access by health workers to adapt to the new challenges. Over 500 health workers enrolled and completed the online modules which focused on infection prevention and control.
- Hand hygiene: Hand hygiene is one of the most effective and timely actions to prevent the spread of infection in the health facility. Hand hygiene reduces the transmission of microorganisms, increases patient safety, and decreases healthcare-associated infections (HAIs). If HCWs do not clean their hands at the right moments, using the proper methods, they can transmit infection-causing microorganisms through their hands from one patient to another. A recent study conducted in northeast Nigeria revealed that there are gross inadequacies in the practice and promotion of hand hygiene in government-owned primary health facilities which undermines the quality of care rendered at those facilities. Most times, lack of compliance to hand hygiene practice is due to insufficient hand hygiene infrastructure at service areas. With the coming of covid-19, The practice of hand hygiene became even more important not only for health workers but for everyone in the community. This cheap and cost-effective intervention is faced with a gross shortage of infrastructure and poor water supply in primary healthcare centers which is the first point of contact of the entire health system.
To address these challenges, RHEMN constructed motorized water and soap dispensing handwashing machines in over 120 primary healthcare facilities in Gombe state to promote and support the practice of hand hygiene in PHC facilities. This is to make hand hygiene facilities available and accessible to both patients and health workers in the hospital. In addition, the organization trained all the health workers on the proper techniques of medical hand hygiene according to WHO guidelines. The organization also distributed hand hygiene posters and printed standard procedures in all the health facilities. The health workers were also trained on the step-by-step techniques of how to make alcohol-based hand rubs or hand sanitizers to address supply challenges.
- Risk Communication: A consequence of poor risk communication and heightened risk perception can lead lack of adherence to public health guidelines during a pandemic. The covid-19 have brought an unprecedented time with rapidly evolving information and guidelines. The Nigeria center for disease control (NCDC) rolled out strategies to contain the spread of the virus including; public communication, contending uncertainty, addressing misperceptions, and managing misconceptions. The risk communication response was threatened by social-cultural, religious resistance, and distrust in the government due to high-level misconception and perception surrounding the covid19 pandemic. To effectively contain community transmission, it’s important to include members of the community in all public health messaging.
RHEMN’s “covid-19 response project” produced over 200,000 information, education, and communication (I.E.C) materials across over 200 communities in Gombe state. These materials include posters, flyers, and pamphlets which were distributed to all the primary healthcare facilities. The materials contain detailed information in both English and Hausa language about prevention and control of covid-19 to improve understanding and appreciation of risk communication.
In addition, the risk communication team hosted weekly covid-19 information live chat on social media and other conventional media partnering with local radio houses.