Engaging Communities in Self Care for COVID19 Response: What will it take?
By Angela Nguku, Executive Director White Ribbon Alliance Kenya and Kristy Kade, Deputy Executive Director, White Ribbon Alliance Global Secretariat
Since COVID19 was declared a global pandemic, self-care behaviours have been strongly encouraged in Kenya by government officials, health experts and the larger development community.
“Wash your hands for at least 20 seconds with soap and running water”
“Rub your hands with an alcohol-based hand sanitizer very often”
“Stay home, follow curfew”
“Avoid crowded places”
“Wear a mask”
“Keep a social distance of at least one and a half metres from each other”
Yet, many people have not seen the value and the benefits of embracing these seemingly simple, but life-saving actions. In fact, adherence to government-recommended self-care measures is decreasing, even as the disease continues to spread across the country.
Effective emergency management requires timely, coordinated planning and communication across a myriad of stakeholders, most especially communities. However, during crisis moments, such as the one we find ourselves in now, community perspectives are too often left out of helping to shape the response.
Rather most policymakers and health planners assume they already know and understand the resonant messages and communication channels, as well as community motivators and barriers to practicing self-care. Given they are dynamic and ever changing, this is simply not the case. Without direct engagement of communities in the design and development of policies and programs—during emergencies and not—they risk missing their intended mark.
Take the curfew order. After being put in place, more than 300 women and adolescent girls reported to local WRA members in Bungoma, Kajiado, Kisumu, Nairobi and Narok counties that they were unable to secure transport to reach health facilities while in labour. Moreover, they were verbally and physically harassed by local police while trying to walk there. Many never reached the facility but gave birth in quarantine centres or having returned home. There was no notification or process put in place to exempt those who are pregnant from curfew or to help them obtain an advance permit from local police to seek care.
Insufficiently considered and implemented, without any mechanism for feedback, the ‘stay at home’ order is not perceived by women as a positive, preventative self-care message. Instead it is viewed as a top-down, misguided mandate that endangered them. It has fostered scepticism about recommendations at-large as well as the appreciation by those in charge of the realities of everyday people’s lives.
Many may read this piece and think ‘it is an emergency; things are bound to be overlooked and missed’. But the reason things like this happen during conflict and crisis, is because the means and mechanisms for meaningful community engagement are not prioritized or invested in during times of non-emergency.
As part of the campaign What Women Want: Demands for Quality Healthcare from Women and Girls more than 1.2 million women and girls from 114 countries–over 100,000 from Kenya alone–shared their top priority for quality maternal and reproductive healthcare services. For many of these women, the simple act of being asked for their views was a first.
Their top demands: respectful and dignified care; water, sanitation, and hygiene; medicines and supplies, such as blood; more and better supported midwives; and health facilities within reach. Underpinning each of these demands: the desire to be heard.
In this time of COVID19, their demands take on even greater resonance. Addressing any one of their demands will help mitigate the current crisis and leave us better prepared for future health emergencies. Indeed, having met these very same demands earlier could have lessened the current crisis.
Today, the campaign is releasing a bold advocacy agenda to realize women’s and girls’ demands. At the top of this agenda, is a call that cuts across demands, transcends health and development topics, that rises above emergency measures: a call to listen to women. Government leaders, donors, and development partners in Kenya and everywhere must institute and resource transparent, functional mechanisms where communities’ self-articulated needs are routinely captured and used to set and monitor policy and program priorities. There will be better health outcomes during emergencies and every day.
COVID19 has shined a much-needed spotlight on self-care as the root of the healthcare system. However, community engagement is the root of self-care. We do well to remember and prioritize accordingly.