With the Western Cape now being in the lead with confirmed positive COVID-19 cases, the peaking community transmissions are concentrated in the poor and overcrowded townships in the Cape Town metropole. Mrs Vuyiseka Dubula-Majola, Director of the Africa Centre for HIV/AIDS Management at Stellenbosch University, argues that the response to COVID-19 requires partnerships with communities as well as the co-creation of interventions with community-based organisations.
To illustrate the role of community-based organisations, she selected three sub-districts of the Cape Town metropole, namely Khayelitsha, Klipfontein and Mitchell's Plain.
The number of confirmed cases in the metropole has risen to 5167, of which Khayelitsha accounts for 731, Klipfontein for 631, and Mitchell's Plain for 509 (on 11 May 2020 according to the Western Cape Department of Health).
As the number of cases grow exponentially and it becomes imminent that more people will be infected with Covid-19 over the next few weeks, a public health disaster – for both the public and the Western Cape government – is emerging.
Many of the poor already face enormous socio-economic crises with major job losses, food insecurity, and lack of masks as well as clean running water, which makes the possibility of 'staying at home' during lockdown hardly possible if not impossible.
In the early days of the AIDS movement, actions such as building on existing community-resilient structures and strengthening relationships between state health providers and communities were proven to be successful during an emergency.
Community-centred reaction is necessary to ensure access to public health information, understanding of isolation, health rights literacy, and the essential role of communities in monitoring and accountability. Our response to COVID-19 should therefore be more than a medical intervention and should be embedded in communities. As we learnt from the AIDS activists: “Whatever is done without communities, is doomed to fail."
Community-based organisations have joined forces to support public awareness creation, health literacy, and door-to-door health screening for more than one disease.
Communities' resistance to health interventions has been fuelled by fear and misinformation rather than information. As in the case of TB and HIV, the public is inundated with false information about COVID-19, hence community awareness is critical.
When knocking on doors, health activists have to be prepared to answer any number of health-related questions as many people still need information about a variety of health conditions. Each household presents an opportunity for not only COVID-19 screening, but to find people living with HIV or those who do not know their HIV status. While offering HIV tests to some, others have disengaged from HIV care and need to be connected to health care again. Although health needs may differ, messages regarding COVID-19 and HIV have to be crafted carefully to avoid confusion and mixed messages.
In addition, every open door offers an opportunity to screen for TB and diabetes, and make assessments regarding food security, gender-based violence and mental health.
The response to COVID-19 therefore requires mutual partnerships and co-creating interventions with community-based organisations is vital.
It is not unusual to see the same faces, mostly AIDS activists, during health and social justice crises. Some of the stalwart community-based organisations playing a vital role in the COVID-19 crisis are the following:
Movement for Change and Social Justice
The Movement for Change and Social Justice (MCSJ) is a not-for-profit, non-partisan, and non-religious alliance of organisations aimed at improving the health and lives of people in Gugulethu and surrounding areas. They work in Klipfontein, which includes Gugulethu, New Crossroads, Nyanga, Manenberg, KTC, Philippi and Heideveld.
Activist Education and Development Centre
Another not-for-profit organisation, the Activist Education and Development Centre (AEDC), aims to support community-based activists in the Western and Eastern Cape, Gauteng and KwaZulu-Natal. The organisation mainly supports women living with HIV and those affected by inequality in order to improve their economic and educational status. Most of the AEDC and MCSJ activists can trace their roots to the Treatment Action Campaign branches in the Western Cape.
Umoja for Africa
Umoja for Africa is also a not-for-profit organisation who focuses on skills development and sharing between disadvantaged refugee and migrant communities and South African citizens for social cohesion purposes. Umoja has trained AEDC and MCSJ women activists to sew re-usable face masks. They are now sewing 15 000 of these face masks to donate to families in need.
The community outreach areas of AEDC and MCSJ include Khayelitsha (all areas), Klipfontein (Gugulethu and Nyanga) and Mitchell's Plain (Philippi, Samora Machel and Cross Roads). They work in partnership with the Africa Centre for HIV/AIDS Management at Stellenbosch University (who also supplies volunteers with easily identifiable bibs), Medicines Sans Frontières (MSF) in Khayelitsha, and Khethimpilo in Klipfontein and Mitchell's Plain.
The activities of these organisations are aimed at promoting community health by public awareness of and education on wearing and caring for face masks, social distancing, isolation, assessment of other health conditions and referral; awareness of antiretroviral therapy (ART) services available during lockdown such as accessing medicines closer to home; and assessment of food security, distribution of food vouchers and referral to food distribution points.
A multitude of approaches are used, including door-to-door health education about hygiene and the distribution of health pamphlets and condoms. Another is putting up COVID-19 posters at busy areas such as bus stops, spaza shops, shopping centres and taxi ranks.
The volunteers involved are trained by Medicines Sans Frontières (who provides them with hand sanitizers and masks) and Khethimpilo. All volunteers have to undergo a health assessment to ensure their health will not be compromised when partaking in the outreach. So far, only one volunteer had to be withdrawn from activities due to her age and existing health conditions that placed her at risk of COVID-19 infection.
Most volunteers are young activists, some of whom are living with HIV but whose condition is stable thanks to ART. All of them follow the guidelines regarding personal protective equipment when going into the field. They can easily be identified by their maroon reflector bibs with the words “revolving door to health" on the back.