Taking Responsible Actions against COVID-19 in Somalia

Background

Several countries have adopted measures to contain the spread of COVID-19, restricting people movement, social distancing and introducing quarantine regimes for their citizens and foreign travelers. Given the highly contagious nature of COVID-19, countries that implemented those strategies early enough have successfully contained the pandemic by reducing its mortality, while those that delayed it, have, unfortunately experienced a significant loss of lives. . Any country’s response to the pandemic would be determined by its level of preparation. While countries with decent health systems are stunned by the pandemic, the concern is how countries with broken health systems such as Somalia will cope with the pandemic.

In Somalia, seven weeks after registering its first corona virus case, health authorities had confirmed a total of 835 infections of COVID-19. The situation demands enhanced teamwork, continued development of awareness messages and effective targeted communications. After a few of initial cases related to travel, community transmission now accounts for the vast majority of cases. Concerns remain over the possible spread of the virus to some 2,000 internally displaced persons (IDPs) living in congested IDP settlements where social distancing is impossible and adherence to infection prevention control measures is challenging (OCHA). So far, the only mitigations that have shown to slow down COVID-19 spread have been very aggressive human movement and interaction restrictions.

As of 5th of May 2020, Somalia has so far reported 835 confirmed COVID-19 cases, 38 deaths and 75 recoveries amid concerns over the rapid spike in cases in the past week.

Problem statement

A scarcity of expert public health professionals and limited testing capacity are hampering progress in scaling up COVID-19 preparedness and responses in Somalia, coupled with inadequate supplies of necessary equipment and limited isolation facilities are also slowing efforts to avert large-scale local transmission. The ability of Somalia’s health systems to cope with surges in demand, especially for those needing respiratory support, is very poor.  In addition, access to people living in hard-to-reach areas and vulnerable groups in IDP camps are already an issue. The culture and living circumstance of the people in Somalia may make them resistant to self-quarantine, social distancing and stay at home measures.  Furthermore, the country does not have a single health research institution that can initiate research data needed to support decision-making and priorities and to build public awareness.  In the absence of critical competence and infrastructure to mitigate, the pandemic, extensive resource mobilization and well-coordinated and evidence based measures should be put in place before the response become too little too late. The primary aim of this terrible scenario of COVID-19 is to avoid -as soon as possible- the collapse of the entire community.

Aims 

a. Develop Responsible Action Plan against COVID-19 as a blueprint for Pandemic Preparedness and Response for the country under Global Health Security Agenda.

b. Provide policy framework for federal, state and regional stakeholders for building capacity to prevent, detect and respond to any events due to COVID_19 or any other novel pathogens with pandemic potential in Somalia.

Objectives

The main objectives are:

To ensure that the current outbreak of COVID-19 is contained and responded timely and efficiently and to prevent its further spread.

To strengthen country and community emergency response to potential events due to COVID-19 including local, regional and national outbreaks that can have a significant impact on the health of Somalia’s population.

To identify the principles and elements of effective emergency preparedness and layout the planning process by which state governments can determine their priorities and develop or strengthen their operational capacities for an efficient response. It also evaluates resource allocation, guiding decisions to ensure that financial investments support implementation.

Quick Impact Interventions

✓ Strategies to protect and shield vulnerable populations: the elderly and those with comorbodities such as hypertension, heart and lung diseases

✓ Self-isolation of people with mild symptoms: Ensure compliance with social distancing to avoid risk of transmission.

✓ Physical distancing: Maintain at least 1 – 2 meter distance, this means keeping at “least 2 arms-lengths” apart people at all times. People should stay at home as possible

✓ Ensure access of affected people to basic services and commodities, including health care, and protection and social service

✓ Ensure well coordinated, informed and timely response through strengthening partnership and coordination structures established at community, and national levels

✓ Monitor data on how public health and social measures (PHSM) meet local COVID-19 conditions and needs; and Engage communities to adapt PHSM to the local context and effectively communicate about risks to sustain public support.

 Recommendations

A: Coordination and partnership

1. Collaborate and Engage with the strong with the different health stakeholders at each operational level primarily private sector entities and design intersectoral cooperation plans for their active participation in the fight against COVID-19.

2. Development of intersectoral cooperation (ISC) operational plans for the fight against the pandemic with the training of health workers on the different tasks and organizational preparedness functions to undertake.

3. Mobilization of the business community to help the government contain the pandemic is vital. The financial contribution by Somali business community and the global diaspora is quick, sustainable and reliable.

B: Risk communication and community engagement

4. Implement national risk-communication and community engagement plan for COVID-19, including details of anticipated public health measures, and bearing rapid behavior assessment to understand key target audience, perceptions, concerns, influencers and preferred communication channels.

5. Identify trusted community groups (local influencers such as community leaders, religious leaders, health workers, community volunteers) and local networks (women’s groups, youth groups, business groups, traditional healers, etc.).

6. To create large scale or social and behavioral change approaches to ensure preventive community and individual health and hygiene practices.

C: Disease Surveillance,

7. Introducing disease surveillance and monitoring system where different stakeholders including the private sector and local communities are actively engaged.

8. Provide robust and timely epidemiological and social science data analysis to continuously inform risk assessment and support operational decision making for the response.

9. Train and equip rapid-response teams to investigate cases and clusters early in the outbreak, and conduct contact tracing within 24 hours andStrengthen public health systems for immediate response and for a lasting recovery

D: National laboratory system

10. Extension of testing facilities and distribute standard operating procedures (as part of disease outbreak investigation protocols) for specimen collection, management, and transportation for COVID-19 diagnostic testing.

11. Establish Hospitals and laboratories in the major cities designated to collect the samples from suspected cases with appropriate biosafety and biosecurity standards. The preparation includes availability of relevant supplies PPE and lab reagents for safe collection, storage, packing and transportation of samples from the designated hospitals to the regional /National Reference Lab.

12. Monitor and evaluate diagnostics, data quality and staff performance, and incorporate findings into strategic review of national laboratory plan and share lessons learned.

E: Infection Prevention and Control

13. Protecting the health workforce and supporting their compliance with the rational use of PPE against COVID-19 whenever necessary and support and follow their advice both at community and health facility level.

14. Provide sufficient IPC materials, including personal protective equipment (PPE) and WASH services/hand hygiene stations and Monitor IPC and WASH implementation in health care facilities and public spaces using the Infection Prevention and Control Assessment Framework.

F: Case management and continuity of essential services

15. Implement early detection, triage, and infectious-source controls, administrative controls and engineering controls; implement visual alerts (educational material in appropriate language) for family members and patients to inform triage personnel of respiratory symptoms and to practice respiratory etiquette.

16. It is required to establish specific hospitals designated for admission and management of suspected and confirmed cases based upon availability of quality isolation wards at federal, state and regional levels provided availability of PPEs, ventilators, medicines/anti-viral, and complete supportive treatment along with backup and contingencies.

17. Establish a dedicated referral mechanism with equipped ambulances and teams to transport suspected and confirmed cases, and for severe cases link technical teams with clinical expert network to aid in the clinical characterization of COVID-19 infection,

18. Disease outbreak information management system must be strengthened with data management and data security mechanism.

19. Financial resources must be allocated for operations of EOC during emergencies with ample supply of PPEs for ensuring protection.

Prepared by:  COVID-19 Health Professionals Support Group

Contact Person:Dr Yasin M NUR, MD, MPH