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A free-to-use Covid-19 app is the best way to reach marginalised communities

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Dr Gill Black is co-founder, co-director and head of Health Participation at the Sustainable Livelihoods Foundation, an independent, not-for-profit research and engagement organisation in Cape Town operating since 2002. She is an associate researcher at the Ethox Centre, University of Oxford. She has 15 years of post-doctoral experience as a field-based immunologist.

Priorities have been set to address Covid-19 in South Africa. But a dedicated effort to engage marginalised communities on the disease and its prevention is absent. There is an urgency to fill this gap through a focused, accurate and reliable mobile intervention. The time is now.

The trajectory of the Covid-19 pandemic in South Africa is uncertain as the true number of Sars-Cov-2 infections nationwide is unknown. However, the number of new infections and new deaths is creeping upwards daily and this highlights the critical need to protect our vulnerable populations from contracting the virus. As with other countries globally, there is deep concern about the susceptibility of our elderly residents and those with underlying health challenges.

Three of the biggest health challenges for South Africa are tuberculosis, HIV and TB/HIV co-infection. Nationally, TB is the number one cause of death due to infectious disease and it poses a particularly significant health risk to HIV-infected persons. The high prevalence of HIV in South Africa is now augmenting the country’s unease about the spread of Covid-19.

There is not yet enough evidence about how Sars-Cov-2 behaves in the context of HIV to understand the implications of a dual viral infection. There are promising reports that antiretroviral therapy (ART) may reduce the chances of serious respiratory illness. However, ART will not prevent a coronavirus infection or the transmission of the virus to others.

It is likely that those with co-morbidities — such as HIV infection and diabetes — have an elevated risk of Covid-19 disease. As the pandemic tightens its grip on South Africa, the need for daily visits to local clinics and hospitals for reasons that are not linked to Covid-19 remain absolutely essential for thousands of marginalised people receiving treatment for TB, HIV and other chronic illnesses.

Community engagement that is socially and culturally perceptive, and which allows for interaction, has been shown to amplify community responsiveness to infectious diseases in many low- and middle-income countries (LMIC) including South Africa. Amid misconceptions and misunderstandings about Covid-19, continuously fuelled by fake news and propaganda, there is escalating urgency to protect marginalised South Africans from the disease through a dedicated community engagement initiative. Under the now extended lockdown restrictions, it is imperative that the South African government recognises the central importance of focused community engagement in the prevention of viral transmission and death.

Traditional approaches that enable the interactive engagement of community members in public health are currently impossible. However, mobile technology offers pragmatic possibilities for fast, widespread and two-way community engagement.

In the short term, the South African government should put its weight behind the development of a freely downloadable and data-free Covid-19 Community Engagement app as an accurate, trusted and reliable go-to source of key public health information and feedback. The app should provide both written and visual information that is accessible to marginalised community members.

Key information should include who is most at risk of disease, Covid-19 symptoms, tools for users to identify their risk profile, ways to self-protect from Covid-19, usefulness, useability and availability of face masks, where to go and what to do if experiencing Covid-19 symptoms, explanation of terms such as social and physical distancing, self-isolation and quarantine, advice on social distancing, self-isolation and quarantine in township settings, and direct and free access to help-lines. Availability of the app in all languages spoken in South Africa would be critical. Calibrating the app with information that is specific and relevant to the provinces being engaged would also be essential.

A Covid-19 Community Engagement app should be developed collaboratively with core input from a task team of community engagement professionals, social scientists and bench scientists, public health experts, community leaders and mobile technologists. It would need to be endorsed by provincial and national health departments including the National Institute for Communicable Diseases (NICD) and academic institutions in SA. National and local NGOs and CBOs would play a vital role in dissemination of the app and familiarising community members with how to use it.

For such a mobile intervention to have any chance of success, it would need to be interactive, giving users the opportunity of feedback with regard to their knowledge about Covid-19, practices of social distancing, self-isolation and quarantine, experiences of seeking care for Covid-19 and other urgent health matters during the pandemic. The app should also request user suggestions on how community responsiveness could be better supported during the pandemic, and where support and information are most needed.

Long-term measures: A community engagement nerve centre for South Africa

In the longer term, the community engagement sector in South Africa should establish a national nerve centre for community engagement in public health, disease outbreaks and health science research to mobilise and unite a critical mass of community engagement professionals, scientists and public health specialists across the country.

A community engagement centre would enable the establishment of a dedicated online communication platform for the sharing of resources and ideas about what is possible and effective in different socioeconomic and cultural contexts in South Africa. It would also provide a platform for the interaction of community engagement specialists working in other LMIC contexts to share their experiences of best practice in the majority world.

It would provide a central location for access to existing toolkits that are available through established national and international institutes and organisations such as the NICD, the World Health Organisation, the Centres for Disease Control and the Global Health Network. A community engagement centre could be a place for South Africa to build upon, learning from international contexts about what can be done in marginalised communities during infectious disease outbreaks. It would enable the development of national guidelines for community engagement during outbreak events and support the establishment of community advisory networks in local settings across the country.

Multi-sector buy-in and financial backing

These short and long-term measures can only be achieved through the collective action of experienced community engagement professionals, clinicians, scientists, strong technical support teams and the committed buy-in of national and provincial departments of health.

Sponsorship by mobile service providers and the long-term support of national and international funding agencies are fundamental to the achievement of these goals.

In conclusion

Urgently needed community engagement in Covid-19 could be achieved through the rapid multi-sector development of a reliable and trusted mobile app that is interactive and calibrated to the needs of those who live in marginalised settings in South Africa.

South African public health would benefit — both in the short and long term — from the establishment of a nerve centre for community engagement to synergise knowledge among a critical mass of community engagement professionals, scientists, public health experts, technical support specialists and concerned community members.

The time is now! DM

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