The COVID-19 pandemic continues to keep us under stress. Recent months have clearly shown that many countries grapple with the second wave of infections and that trying to stop a virus at the national border is a futile effort. More than ever it becomes clear how vital an intact healthcare system is for achieving other sustainable development goals. International development partners are taking action, expanding their activities and planning new programs to mitigate the impact of the pandemic. GFA project teams are engaged in our partner countries to assist in containing the pandemic itself and to cope with immediate economic impacts. The German Ministry for Economic Cooperation and Development (BMZ) launched the One Health program working on the interface of human and animal health and the environment. Pandemic prevention receives necessary financial recognition as experience in pandemic prevention shows that fatality numbers are lower where investments in public health utilities and in community health are kept up.
Our Health department has a long history of working in pandemic prevention and in health system support. Our doctors, public health specialist and health economists work hand-in-hand. My colleagues assure me that health workers and a strong backbone of capable institutions will manage the fight against the COVID-19 pandemic. This is why we would like to share positive experiences in this newsletter. Let me wish you all a happy festive season within the given Covid-19 circumstances.
Stay safe and in good health,
Anja Desai, Managing Director
The current COVID-19 pandemic surprised the world and is affecting countries in an unforeseen way. GFA’s Health department together with its clients and partners is actively participating in projects tackling COVID-19. Some of our partner countries in West Africa are still rebuilding their health care systems, weakened after reoccurring Ebola outbreaks in recent years. GFA’s strong and continued regional presence, strategic partnerships and experiences from earlier epidemics serve to strengthen the response to COVID-19 today. Past pandemics have motivated leading funding agencies to focus on epidemic preparedness. This offers GFA the opportunity to act quickly and locally to specifically focus on containing the current pandemic. This newsletter provides an overview of selected projects GFA is implementing to contribute to the global fight against COVID-19.
From pandemic preparedness to pandemic response in the ECOWAS region
During the Ebola outbreaks that severely affected Liberia, Guinea and Sierra Leone, the urgent need for an integrated regional response to epidemic diseases and an improved epidemiological surveillance system in West Africa was recognized. Surveillance is vital for rapid cases detection and containing the spread of a pandemic. As a response, the Commission of the Economic Community of West African States (ECOWAS) represented by the West African Health Organisation (WAHO), identified capacity building for disease surveillance and prevention, response and resilience to epidemics and emergencies as a priority within its member states. Therefore, the German Development Bank (KfW) signed an agreement with WAHO for the implementation of the project Strengthening Epidemiological Services and Health Systems in the ECOWAS Region. The current phase focuses on Burkina Faso, Côte d’Ivoire, Niger and Nigeria. The project aims at strengthening epidemiological surveillance through the improvement of regional and referral laboratories. As soon as the COVID-19 pandemic was declared, WAHO actively assisted all its member states in scaling up their readiness and capacity to respond to the pandemic. The assistance included the provision of necessary equipment and supplies as well as the setup of effective information dissemination strategies. Training of healthcare staff was another core activity.
In light of the fact that diagnostic testing for SARS-CoV-2 is critical for COVID-19 surveillance and response, WAHO together with GFA organized two trainings on COVID-19 Laboratory Diagnostic Steps. The trainings were held in French and English with more than 450 participants. The objective of the training was to describe relevant laboratory diagnostic concepts as well as to guide participants to find relevant information through appropriate references and websites. Specific topics within the training included sampling methods, sample transport, extraction methods, and applying tests. In addition, testing strategies adopted by different countries within the region were discussed and compared. The trainees were predominantly laboratory staff from public health institutions involved in COVID-19 testing in all countries of the region. In months to come, numerous virtual and in-person trainings have been scheduled, including the delivery of state-of-the-art equipment and renovations to help the West African laboratory network to reach ISO15189 accreditation and ensure good surveillance of and response to future epidemics.
COMMUNICATING THE RIGHT INFORMATION TO THE PUBLIC
During the COVID-19 pandemic, the provision of accurate, timely and frequent information in a language understandable for most of the population via reliable channels is of major importance. The volume of information associated with the rapidly evolving outbreak has placed particularly heavy demands on risk communicators. Information on the pandemic is constantly changing and guidelines are updated on a daily basis. As events evolve so frequently, the public is flooded with information that is often inaccurate, outdated or flat-out wrong. GFA on behalf of GIZ is therefore strengthening an official WAHO online risk communication portal as part of the project Pandemic Preparedness in the ECOWAS region with associated websites from reliable sources. To that end, GFA is specifically upgrading the platform to allow the up- and download of specific risk communication materials such as templates, posters and webinar videos. The information on the website is provided by the Regional Center for Surveillance and Disease Control (RCSDC) and is geared towards ECOWAS risk communication experts. Many young people perceive their level of risk as low, and are of the opinion that COVID-19 carries greater risk for older people. GFA is developing posters, and easily understandable templates and capturing messages approved by RCSDC and GIZ that are disseminated on the mentioned platform. These messages include, e.g.:
“It’s not an age thing – young people can also get sick.”
“Protect your family by following accurate guidance.”
“Take a step back.”
“Stay at least one meter distance from others.”
LEARNING ONLINE IN TIMES OF SOCIAL DISTANCING
As a result of the pandemic it is safe to assume that the nature of face-to-face trainings and workshops will be modified either temporarily or permanently. The importance of social distancing as a non-pharmaceutical intervention suggests online interactive training and educational endeavors. In 2019, GFA has developed two training-of-trainers (ToT) blended learning courses, Emergency Risk Communication and Communication and Coordination, implemented in French and English with key staff of relevant institutions in 15 ECOWAS member states. Based on a Moodle platform, the courses are hosted by the Regional Public Health Institute (IRSP) in Benin, and can be accessed by anyone.
Tutorials on self-registration are produced and distributed via the IRSP learning platform and social media so that as many people as possible can be reached. In the near future, online modules on One Health will be converted into a blended learning course.
STRENGTHENING NATIONAL HEALTH SYSTEMS IN THE UKRAINE
People suffering from non-communicable diseases (NCDs) are especially vulnerable and affected disproportionally by the COVID-19 outbreak. In the Ukraine, NCDs were
responsible for 91% of all deaths in the country in 2016. However, the Ukrainian health system is not yet well prepared to prevent, diagnose or manage people at risk of living with NCDs. As part
of the Swiss Cooperation Programme Ukraine (2020-2023), the Swiss Agency for Development and Cooperation (SDC) is supporting the implementation of the project Reducing Risk Factors for NCDs in
five pilot regions. A GFA-led consortium with the University Hospital of Geneva (HUG) has co-developed the project design and is coordinating the implementation process, started in November 2020.
The aim of the SDC investment in health is to provide the Ukrainian population with more equitable and sustainable access to quality and affordable primary healthcare services. The focus is on
disease prevention and management, health promotion and adoption of healthier lifestyles.
The project aims at achieving outcomes that target different parts of the Ukrainian system at all levels. For instance, secondary schools, the public health system and communities are strengthened in their capacity to reduce NCD risk behavior. To this end, the project implementation unit will develop and produce information materials to support NCDs prevention in schools. The behavior change campaigns focus mainly on children and young people. This is meant to build on future generations by considering them change agents in their families and communities who should instigate generational changes in behavior. In order to align the content towards the target group, children and students are taking part in the development and design of the materials. Another example on how the project will contribute to disease prevention and health promotion is through a national NCD professional platform for specialists working on NCD prevention and control. This will be a web-based source of evidence-based information and tools on NCDs, including an education page with training materials and e-learning opportunities developed by the project and other sources. So far, a national and professional platform like this is not available in Ukraine.
On behalf of SDC, GFA has in recent months worked with local authorities to support the reform of the Ukrainian mental health system and to establish the Mental Health for Ukraine (MH4U) project. SDC is supporting the re-allocation of funds within existing projects implemented by GFA to assist in the public health response to the COVID-19 crisis. The pandemic is not only a challenge to physical but also to mental health. People affected experience fear, severe constraints and uncertainty. Primary care staff face high levels of stress and burn out risks. People who already lived with a mental health disorder before the pandemic often suffer from an intensification of their symptoms due to the loss of support networks. Social distancing badly affects those who depend on the care of others. Many psychotherapists have switched to online sessions, but these modes of communication are not suited for all types of service users. Another vulnerable group are those people staying in a long-term care facility. Infection control is a huge challenge for staff and service users alike, often leading to COVID outbreaks. The MH4U project has responded to this situation by developing resources for Ukrainian citizens and health professionals that help them better cope with related psychological stress. The project translated practical advice on how to deal with quarantine situations from WHO and other international sources and offered them online on MH4U websites. In addition, the project developed online courses and webinars about psychological support and burnout prevention for health care staff at primary care and long-term care institutions. For those who need a listening ear during these stressful times, the project funds are used to support and promote a telephone helpline with trained psychologists who can provide psychological first aid.
PRIMARY HEALTH CARE AND COMMUNITY-BASED INTERVENTIONS AGAINST COVID-19 IN TOGO
The Kara region in Togo hosts the GIZ-funded project for Strengthening the Health System, Reproductive Health and Sexual Rights (ProSanté). The overall objective of
this project is to improve the access of the population to health care services, particularly regarding sexual and reproductive health and rights. The main activities implemented by GFA and the
Liverpool School of Tropical Medicine (LSTM) are improving health services in terms of the quality of care provided, strengthening cooperation between different sectors and civil society with the
Since the launch of the project in 2018, improving the quality of care in 30 health centers through training health care professionals and the implementation of a voluntary quality management system has been the priority. At the same time, the project aims at stimulating the use of improved services through numerous activities locally involving communities. With the emergence of COVID-19, the project has adapted its activities to the pandemic. A total of 767 staff from all regional health facilities were trained on national COVID-19 directives and the psycho-social management of cases. During the same period, 143 supervisions were carried out in health facilities to follow up on specific COVID-19 measures. Other activities included communication on COVID-19 through radio programs in different national languages, and 3,500 community actors being trained and mobilized in awareness raising concerning COVID-19, including very remote areas. Most of these COVID-19 interventions have only been possible due to a very good understanding of the situation in the field and effective resource management.
BLOCKCHAIN TECHNOLOGY: A STUDY TO SUPPORT GAVI´S MISSION
Gavi, the Vaccine Alliance, spends over one billion US dollars on vac-cines every year. Supply chain and cash support system improvements are critical to safeguarding these investments. GFA is currently carrying out a KfW-funded study to identify points at the country level of Gavi-supported countries that could be improved with blockchain software. The study has two phases, with phase 1 consisting of desktop research to present the use of blockchains and recommend pilot use cases. KfW and Gavi are to discuss phase 1 results with the recommended pilot countries to finalize the choice of country for a pilot. Subsequently, GFA will carry out phase 2 with an in-country analysis and detailed project design. GFA has completed phase 1 and presented results to Gavi and KfW. The analysis by the GFA research team found that blockchain technology could usefully add value to aspects of vaccine supply chains and cash support systems in-country – in particular regarding track & trace capabilities, data use and approval processes – to the benefit of the respective country and Gavi’s overall mission impact. Blockchain databases are shared, trusted, public ledgers that no single user has control of, but every user can inspect. This gives them certain advantages over centralized databases. It should be noted that a blockchain per se is not a stand-alone solution, as software will have to be integrated into the relevant technology stack and adapted to in-country circumstances. Various prototypes were analyzed during phase 1 of the study, including KfW’s own cash-flow management blockchain software, TruBudget. KfW and Gavi are currently discussing the study’s results with the countries recommended for pilot projects.
ENSURING RAPID INTER-INSTITUTIONAL COMMUNICATION IN WEST AFRICA
Since 2017, GFA on behalf of GIZ has assisted the Economic Community of West African States (ECOWAS) Commission in facilitating its communication with its member states as part of the Pandemic Prevention in the ECOWAS project. The ECOSuite platform for communication, collaboration, workflow, business process management and customer relationship management established at the ECOWAS Commission will provide interconnectivity between relevant actors in this region, e.g. the West African Health Organisation (WAHO), the Regional Center for Disease Control (RCSDC) and the Regional Animal Health Centre (RAHC). If you have to rely more on virtual communication channels, as it is the case during the Covid-19 pandemic, ECOSuite is a valuable tool with relevant functions. These include virtual meetings, instant messaging and document exchange between regional and national institutions. GFA trained key staff to use ECOSuite, and will provide further training to use this IT-based platform.
SUPPORTING SOUTH AFRICA´S RESPONSE TO THE COVID-19 PANDEMIC
Within its framework of the ongoing KfW HIV and AIDS Prevention program on community HIV counselling and Testing (HCT) services, the German Government has committed an amount of three million Euros to support the National Department of Health in South Africa in the response to the Covid-19 pandemic. The funds are made available in particular for the procurement of laboratory equipment and personal protective equipment (PPE). The funding allowed the expansion of diagnostic laboratory capacity of the National Institute for Communicable Diseases (NICD) to cope with the huge demand of SARS-CoV-2 testing and to conduct population surveillance. The latter represents an important tool to monitor the epidemic in South Africa. The funds were further used to counter the lack of PPE such as N95 masks, gloves, sanitizer, and goggles to improve working conditions for health staff and community health workers. This is crucial to avoid infections among staff during the performance of their duties.