Recovery, Renewal, Resilience

TMB Issue 38 discussed the importance of community involvement in tackling disease outbreaks and presented the recommendations set out by the Independent Panel for Pandemic Preparedness and Response. This briefing offers examples of good practice in community participation during the COVID-19 pandemic. Consider:

• Tanzania: local government co-produced infection control measures with business leaders based in markets to integrate leaders’ understanding & knowledge of the challenges of implementing such measures
• Nigeria: the “community informer model” was employed by local authorities for COVID “surveillance, tracing and monitoring” – community informers are key trusted individuals in a community (e.g. faith leaders)
• Pakistan: community volunteers “set up quarantine wards, manufactured and provided free protective suits for medics”, and distributed food to vulnerable people
• India: Community volunteers came together to investigate and identify unknown (“hidden”) COVID-19 fatalities. The volunteer group comprised of expert physicians and data analysts who developed comparisons of official health data and other reports. This encouraged a review of the national death audit process and resulted in improvements in the process so that COVID-19 deaths were accurate and transparent
• USA: Volunteers built a public “Testing Site Locator” app which visualized the geographical location of testing centres to support collection of testing centre-related information and dissemination at the national level. This supported people to locate the nearest available testing centres and also the “health system to plan and distribute centres more effectively”

The pandemic, and previous disasters, have evidenced that communities play a crucial role when preparing for, responding to and recovering from, crisis. Communities and civil societies should be “partners early on in the design, planning, implementation, and assessment of preparedness and response efforts on all levels”, particularly at the local level. We have covered community participation and co-production with communities in various briefings, see TMB Issue 38; Issue 34; Issue 33.

Vulnerable groups of people are those that are disproportionately exposed to a risk. This can change dynamically and it is not a simple process of dividing populations into two groups of 'vulnerable' and 'not vulnerable'. Amid the pandemic, vulnerable groups have emerged from a diversity of communities. They are not only older people, those with ill health or disabilities, or homeless persons, but also people from a range of socioeconomic groups who might 'struggle to cope financially, mentally or physically' with crises precipitated by the pandemic. Consider:

• If the definitions and categories we use to identify vulnerable people, and consider their needs, adequately represents their lived experiences - whether their vulnerability existed prior to COVID-19, has been exacerbated by it, or has been newly created by it?
• Identify the people behind the 'vulnerable' label - who are they, where are they, and why are they vulnerable? - to increase our understanding of the person and the conditions or environment (root causes) that may be making them vulnerable to certain risks
• If there are different levels/spectrums of vulnerability, do we need to organise vulnerability with respect to different forms of risk (e.g. immediate risk to life, risk to mental health, social/financial security, geographic location)?
• Assessing those who may have been defined as vulnerable prior to COVID-19 and the conditions associated with this vulnerability, those who have become newly vulnerable as a direct result of COVID-19, and what factors lead to these people/groups becoming vulnerable
• The risk of under-supporting those who face severe risk if we rely only on our previous (to COVID-19) assumptions or understanding of vulnerability
• Whether re-defining vulnerability may support more effective recovery and renewal strategies e.g. classifying vulnerable groups according to risk levels/spectrums, creating vulnerability indexes and identifying the root cause of each
• Recovery strategies should aim to provide transactional aid to alleviate the negative effects of vulnerability exacerbated or caused by the pandemic
• Renewal initiatives should address the root cause of vulnerabilities through transformational initiatives that aim to prevent people from becoming vulnerable

In Pune, an 'Action Plan for Hotspot Areas' was developed in which the local police force supported implementation of contact tracing and wide-spread testing, water and sanitation support, food and shelter planning and public awareness. Teams carried out local door-to-door check-ups of all households in the hotspot areas. Consider how to take public health interventions and information into the community:

• Establish dedicated COVID care booths in hotspot areas
• Allot dedicated ambulances in case serious cases are detected
• Designate, specific localised teams within the hotspot area, including police, medical staff and community engagement officers to conduct thorough, localised door-to-door check-ups of all households in the hotspot areas (including virus testing)
• Use teams to distribute medication to those who need it, and to provide discharge public health packages. These may include:
  • A packet of masks
  • Sanitizer
  • Soap
  • Cleaning products
• Ensure comprehensive medical, nutritional, and psycho-social care for those identified as COVID-19 positive
• To maximise identification of cases, adopt standardized systems for testing

Reference: representative of the Australian Department of Justice and Community Safety

In Pune, 7,500 Special Police Officers (SPO) were given specific powers to help manage areas which had seen a rise in COVID-19 infections. They provided an important role in managing the spread of the virus, in partnership with the community and public health officials. Consider how to:

• Implement a standard operating procedures which include the police in public health interventions for COVID-19
• Use efficient reporting structures, and easy-to-use methods of communication (such as WhatsApp) to manage situations in real time
• Utilise the police to help provide essential response services (e.g. to those who are shielding), and in spreading awareness of social distancing and lockdown norms (e.g. by being out in public or by going door-to-door)
• Utilise the increased widespread interactions of the police with the community for voluntary operations supporting COVID-19 interventions