Continuing vital health services in Guinea-Bissau during COVID-19

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In village of Sarameta, Bafata region, Guinea-Bissau Nenedjo Camara, a 21 years old mother of 2 children, is installing over her bed the mosquito net she received when she was pregnant from her first child. All four members of the family sleep in the same bed and share a single mosquito net, 11 April 2019. Photo: UNDP Guinea Bissau/Gwenn Dubourthoumieu

As lockdowns, curfews and transport disruptions prevent many vulnerable people from getting healthcare, communities are stepping into the breach. Community health workers and volunteers are ensuring their peers, friends, and neighbours are protected from disease.

“In previous bednet distribution campaigns, we used to identify the families before setting up the distribution points,” said Ivannildo Vieira, a community health worker, “but this year, because of COVID-19 restrictions, it was decided to do door-to-door distributions in order not to gather people in a single distribution area.”

Helping communities protect themselves from diseases like malaria in Guinea-Bissau is no simple task. Located on West Africa’s coast, Guinea-Bissau is one of the world’s poorest and most fragile countries. Malaria is the leading cause of death among pregnant women and children under five. Malaria prevention measures have been complicated by a rapid increase in the number of COVID-19 cases.

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“This year, because of COVID-19 restrictions, it was decided to do door-to-door distributions in order not to gather people in a single distribution area,” said Ivannildo Vieira, a community health worker. Photo: UNDP Guinea Bissau

“This campaign is extremely important because not everyone has the financial means to buy bednets”, says Dalesio Da Silva. As part a community team based in Prabis, Biombo region, Dalesio is responsible for delivering bednets to families in his neighbourhood.

“Before launching the campaign, we participated in a three-day training,” he says. “We also went to the communities to sensitize people on the importance of this distribution campaign.”

The new door-to-door strategy ensures physical distancing, with teams of community health workers and volunteers distributing nets to people’s doorsteps in their local communities. In total, approximately 18,000 people, comprised of 5,000 community health workers and 13,000 volunteers, have distributed more than 1.3 million bednets, supported by UNDP and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

“When we arrive at the people’s door, we respect the one metre distance,” said Maimuna Djalo, who is also part of the community health worker team.

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The new door-to-door strategy ensures physical distancing, with teams of community health workers and volunteers distributing nets to people’s doorsteps in their local communities. Photo: UNDP Guinea Bissau

“In addition, we wash our hands before proceeding with the distribution as the virus can also be transmitted by the hands. And when we distribute the mosquito nets, we also reinforce COVID-19 prevention messages.”

The community distribution teams wore COVID-19 personal protective equipment, including WHO-approved locally manufactured triple layer masks. To ensure households are informed on the correct use of the bednets a nationwide communications campaign has been launched, with messages shared to people’s mobile phones and across 20 radio stations, in all nine local languages. These messages highlight how to correctly use the nets, how to protect yourself from malaria and also integrate key health information on COVID-19 prevention. In addition to ensuring all households receive bednets the teams are also distributing to hospitals and health centres, ensuring a net for every bed.

Distributions have now been carried out across all 11 regions in the country, covering a target population of close to 2.3 million people.

For Mansata Injai, they have proved timely.

“A few days ago, I was at the hospital because I had contracted malaria, this is why I am so grateful to receive these mosquito nets,” she said. “I am thankful, very thankful. We used to spend the nights trying to keep mosquitos away because we have children.”

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Mosquito nets drying. Distributions have now been carried out across all 11 regions in the country, covering a target population of close to 2.3 million people. Photo: UNDP Guinea Bissau

In 2018, Africa had 93 percent of global malaria cases and 94 percent of malaria deaths. Yet only about half of all people at risk of malaria in Africa were protected by an insecticide-treated bednet. The climate crisis threatens to further compound the situation, particularly for poor and vulnerable communities. With more people becoming vulnerable to infectious and non-communicable diseases, greater effort and investments will be needed to ensure that lifesaving bednets and effective treatments reach those most in need.

As COVID-19 has led to economies stumbling and unemployment soaring, the need to protect those most at risk of malaria has become even more urgent. The latest survey results of Global Fund-supported programmes across 106 countries show widespread disruptions to HIV, TB and malaria service delivery as a result of the COVID-19 pandemic, with 73 percent of malaria programmes reporting disruptions.

WHO is also urging countries to safely maintain essential malaria control services. Estimates show that under the worst-case scenario, the tally of malaria deaths in sub-Saharan Africa in 2020 would reach 769 000, twice the number of deaths reported in the region in 2018. This would represent a return to malaria mortality levels last seen 20 years ago.

Communities have been at the forefront of the fight against HIV, TB and malaria for decades and are continuing the fight in the face of COVID-19. UNDP, with support from the Global Fund, is working closely with communities and civil society groups to ensure a robust and inclusive response.

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In total, approximately 18,000 people, comprised of 5,000 community health workers and 13,000 volunteers, have distributed more than 1.3 million bednets, supported by UNDP and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Photo: UNDP Guinea Bissau

In line with UNDP’s Strategic Plan 2018–2021 and its HIV, Health and Development Strategy 2016–2021: Connecting the Dots, UNDP partners with the Global Fund, governments and civil society to support and strengthen multi-sectoral national responses to malaria, by providing integrated policy, programme and capacity development support. To date, this has resulted in 79 million cases of malaria being successfully treated and 75 million bed nets distributed.

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