A pandemic of suffering follows on the heels of COVID-19 in poor countries, and children suffer most.
By Nicholas Kristof
Below is en excerpt of a piece originally published in The New York Times. Click here to view the full piece.
We think of Covid-19 as killing primarily the elderly around the world, but in poor countries it is more cataclysmic than that.
It is killing children through malnutrition. It is leading more people to die from tuberculosis, malaria and AIDS. It is forcing girls out of school and into child marriages. It is causing women to die in childbirth. It is setting back efforts to eradicate polio, fight malaria and reduce female genital mutilation. It is leading to lapses in vitamin A distribution that will cause more children to suffer blindness and die.
The U.N. Population Fund warns that Covid-19 may lead to an additional 13 million child marriages around the world and to some 47 million women being unable to get access to modern contraception.
The greatest impact of Covid-19 may be not on those whom the virus directly infects, but on those shattered by the collapse of economies and health and education systems in developing countries. Many schools and clinics are closed, medicines for AIDS and other ailments are sometimes unavailable, and campaigns against malaria and genital mutilation are often suspended.
“The indirect impact of Covid-19 in the Global South will be even greater than the direct impact,” Dr. Muhammad Musa, executive director of BRAC International, an outstanding Bangladesh-based nonprofit, told me. “The direct impact, as tragic as it is, affects those infected and their families. The indirect impact has economic and social consequences for vastly more people — with jobs lost, families hungry, domestic violence up, more children leaving school, and costs over generations.”
As the COVID-19 pandemic wears on, more and more people around the world are struggling during lockdowns and economic shutdowns.
By Dr. Muhammad Musa
This piece was originally published here in The New Humanitarian. It has been reposted below.
The coronavirus could nearly double the number of people facing acute hunger, according to the World Food Programme. Recent data collected by BRAC reveals that many families across the Global South can only sustain their food needs for seven days or less; many are trying to cope by eating less.
Top-down measures to curb the spread of the virus – dramatic steps like lockdowns and bans on large gatherings – pose an immediate threat to families in the poorest communities.
Even in developed countries, local opposition to top-down decrees is undermining the impact of public health initiatives. Resistance to these mandates will only grow if they are not tempered with solutions and leadership from the hardest-hit communities.
The key to turning this resistance around, and dealing with a pandemic long term, lies in the Global South. What’s needed is a renewed commitment to community engagement, rather than top-down mandates. The Global South has great experience on which to draw. Here are three examples that have proven effective.
First, local leaders – elected, civic, or religious, in various combinations depending on the community – must be consulted when creating public health strategies. Their concerns must be heard and addressed. In the Rohingya refugee camps in Bangladesh, for instance, many Rohingya religious leaders are working with BRAC to use their platforms to share life-saving information and dispel myths about COVID-19.
This is an age-old principle of community development, but in the rush to stop the spread of the virus too many officials around the world forgot about it and simply issued decrees. In India, for instance, when the government called on 1.3 billion people to stay home for three weeks, millions were left stranded, without work, and potentially hungry.
Second, existing community networks must be engaged. Community health workers are a great example: These are trusted, trained workers who live in the communities they serve. They can be especially persuasive in informing residents and convincing them to adopt needed measures such as mask-wearing, social distancing, and hand-washing.
Half of BRAC’s 100,000 frontline staff and volunteers across 11 countries are community health workers. During the pandemic, we’ve found they’ve been vital in working with local leaders to raise awareness about COVID-19 and to enact preventive measures.
Non-governmental organisations and other civil society groups have a crucial role to play. They are a vital link between centralised policy conversations and grassroots networks.
Third, hard-won experience with health crises is a powerful asset. In West African countries with a history of Ebola, for instance, adopting social distancing and other public health measures has been far easier. People who went through that emergency – both decision-makers and the public – understood more quickly what was at stake and what was needed. People knew where to turn for trusted information and how to respond.
COVID-19 isn’t the first public health crisis we’ve seen, and it won’t be the last. Large populations depend on daily wages to put food on the table. Economic activity and public health measures must co-exist.
We need to involve local leaders in crucial public health decisions to develop interventions that work. Solutions that rise up are better than those that drop down.
Dr. Muhammad Musa is a physician, public health expert, and Executive Director of BRAC International, a Bangladesh-based NGO.
The partnership will support state-of-the-art solar-powered phone chargers to strengthen health systems in remote areas
KAMPALA, UGANDA — BRAC Uganda and John Snow R&T Institute, Inc. win the request for proposals by Little Sun, and will receive a total of 648 Little Sun Charges, state-of-the-art solar-powered phone chargers, to strengthen health systems in remote areas without access to electricity during the COVID-19 pandemic. The chargers will be delivered to local teams of Community Health Workers and Technicians in Uganda and Ethiopia.
COVID-19 has brought to light the many challenges confronting health systems around the world. In addition to national limitations in medical equipment and testing capacities, people living in remote areas lack sufficient access to medical care and in Ethiopia alone, 95% of all rural health posts are non-electrified.
Digital Health technologies employing app-based digital tools on smartphones can help overcome these challenges. For successful implementation however, reliable access to electricity is vital.
“Digital health is changing and improving the quality of health provision at the last mile but it can’t work without keeping smartphones charged. We’ve learned from Community Health workers across Africa that a powerful, portable solar phone charger is a game changer. This is why we are very excited to partner with BRAC and JSI to make sure their staff have the access to energy they need to provide their important health care work, especially now during the pandemic,” says Mason Huffine, Little Sun’s Director of Humanitarian Affairs.
BRAC and JSI convinced the team with their program proposals and will each receive 324 Little Sun Charges to equip their frontline health care workers with solar to power their efforts in Uganda and Ethiopia.
“Health extension workers are usually stationed at their health post, and reside in the Kebele [neighborhood] they serve, so that they will be close to the community at all times. But rural Ethiopia has little or no access to electricity and interruptions are frequent. This means our health extension workers sometimes have to travel up to 10 kms to the next urban area just to charge their phones. The portable solar chargers will save them valuable time and energy that can be used to deliver health services to women and children,” says Anteneh Kinfe, eCHIS Team Leader John Snow R&T Institute, Inc.
“The 324 phone chargers will be distributed to a local all-women team of Community Health Workers and Technicians in Northern and Eastern Uganda. They operate in distant and hard to reach places without power. The solar charger from Little Sun is a help-in-time. They provide solar energy and ensure that our community health workers can provide uninterrupted and much needed health services to households at the last mile,” says Dr. George Owuor Matete, Country Director, BRAC Uganda.
The Little Sun Charge combines Digital Health care with reliable solar energy – a promising and sustainable combination that can make a real difference in the provision of health care in everyday life, but especially during the pandemic. The Little Sun Charge was specifically designed with a large solar panel and high capacity battery to power any kind of smartphone.
BRAC operates community health worker (CHW) programs in several countries across Africa and Asia, providing its essential health care model with a focus on maternal and child health, infectious diseases, nutrition, family planning and non-communicable diseases. Since 2007, BRAC has provided healthcare services to 3.2 million people in Uganda with an emphasis on women of reproductive age and children under five. Currently, BRAC manages a robust network of more than 4,000 CHWs in 72 of 125 districts across Uganda.
In 2015, BRAC began working with Living Goods and Medic Mobile to build a custom digital health platform for its CHWs. The platform features patient profiles, task management support, point-of-care decision support, forms-based data collection, and analytics for data-driven performance management. BRAC supervising staff use the collected data to monitor and supervise CHWs more efficiently and have developed a cloud-based IT system to digitize all programmatic operations, administrative tasks, and supply chain management. The app was built using the open source Community Health Toolkit, a global public good being adopted by a growing number of governments and NGOs.
Notes to the editor
About Little Sun
Little Sun delivers affordable and renewable energy to those without access to power while mobilizing climate action globally. Founded in 2012 by contemporary artist Olafur Eliasson and engineer Frederik Ottesen, Little Sun integrates the world of art and design with pragmatic clean energy solutions. The non-profit brings light to the most vulnerable communities worldwide who are off the grid, both in Sub-Saharan Africa and worldwide, focusing on school children, refugees and people affected by natural disaster. Over the past five years, Little Sun has become the light of choice in the humanitarian sector and is actively engaged in supporting Digital Health programs with access to energy. In addition, Little Sun runs various social development projects, livelihoods and entrepreneur programs, educational programs, health system-strengthening programs and productive use of renewable energy projects (PURE). Learn more at www.littlesun.com.
BRAC is a global leader in developing and implementing cost-effective, evidence-based programs to assist the most marginalized people in extremely poor, conflict-prone, and post-disaster settings. These include initiatives in education, healthcare, microfinance, women and girls’ empowerment, agriculture, human and legal rights, and more. BRAC’s vision is a world free from all forms of exploitation and discrimination where everyone has the opportunity to realize their potential. In 2020, BRAC was named the number one NGO in the world by NGO Advisor for the fifth consecutive year. Founded in Bangladesh in 1972, BRAC currently operates in 11 countries in Asia and Africa, touching the lives of over 100 million people.
About BRAC USA
Based in New York, BRAC USA is the North American affiliate of BRAC. BRAC USA provides comprehensive support to BRAC around the world by raising awareness about its work to empower people living in poverty and mobilizing resources to support its programs. BRAC USA also works closely with its international counterparts to design and implement cost-effective and evidence-based poverty innovations worldwide. BRAC USA is an independent 501(c)(3) organization.
Rabea Koss & Romane Guégan
BRAC’s Hasina Akhter shares insights from her work responding to COVID-19 in the largest refugee settlement in the world.
By Hasina Akhter
This piece was originally published here in Devex. It has been reposted below.
Addressing the needs of the largest refugee settlement in the world is daunting enough. Now, the challenge is compounded by the coronavirus pandemic. The combination is a crisis within a crisis.
The largest refugee settlement in the world is in Cox’s Bazar, Bangladesh, where around 900,000 Rohingya refugees from Myanmar are sheltering. As of June 30, 50 cases of COVID-19 had been confirmed in the Rohingya settlements, but the full extent of infection is not known. The pandemic is widespread in Bangladesh — with more than 260,000 cases confirmed — and the tightly packed conditions of the camps make their residents especially vulnerable.
To address this extraordinary set of circumstances, BRAC — the largest nongovernment responder to the humanitarian crisis in Cox’s Bazar — has developed a three-pronged approach that reflects its experience creating programs in the global south by listening to those most in need. The approach may prove instructive to aid workers facing other challenging settings around the world.
Prioritizing primary health care
First, one of the lessons we learned from the West African Ebola crisis was the importance of maintaining essential primary health services.
More than 11,000 people died from the 2014-2016 Ebola outbreak, but the closure of health facilities resulted in thousands more preventable deaths. Pregnant women who lacked medical care, for instance, were found lying unconscious outside of closed maternity centers. The COVID-19 pandemic similarly threatens the availability of primary health services and, with them, more lives.
Amid the pandemic, 11 health facilities we run in the Cox’s Bazar refugee camps, including two primary health care centers and nine health posts, are open. Each has a maternity unit providing essential health care to pregnant and lactating women, while also making contraceptives available to help reduce the risk of pregnancy and limit the number of babies being delivered during the health crisis.
To maximize safety at maternity units, each patient must call in advance to book an appointment, at which time a midwife asks questions to determine if the patient has symptoms of COVID-19. When screened patients arrive, they must immediately wash their hands, their shoes and sandals are sprayed with disinfectant, and they are met by midwives in personal protective equipment. The clinics are also sprayed with bleaching powder on a regular basis.
By maintaining and scaling primary health services, responders facing the pandemic in the most challenging situations can reduce excess preventable deaths.
Innovating to adapt preventive measures
Second, aid groups should prioritize adapting preventive measures for challenging contexts, such as facilitating hand-washing without running water in environments where water is scarce.
Masks are also a critical preventive tool. Amid global shortages of personal protective equipment, one innovative solution has found a way to provide masks for refugee families.
Through a program funded by UN Women and led by BRAC, women in the camps of Cox’s Bazar are learning to make reusable cloth masks, enabling 127 refugee women to earn income to support their families while sewing masks for camp residents. Mask-making began in April and operates in women’s centers in two camps, with hygiene measures maintained to keep the women safe from the virus. Together, refugee women have made more than 30,000 masks.
By adopting creative and cost-effective preventive solutions that enable hand-washing and mask-wearing in even the most under-resourced contexts, we can save countless lives.
Spreading essential knowledge through community-based outreach
Finally, the need to educate the public is essential and ongoing. This has two key components: conveying vital information about COVID-19 and dispelling myths that can become dangerous.
In Cox’s Bazar, we must draw on the expertise of the refugee camps’ community health workers, who are part of the largest nongovernmental pool of community health workers in the world. These health workers, who live and work in the communities they serve, are trained to make regular visits to households, provide basic health information and screenings, and link the households to institutional care.
Since the onset of COVID-19, community health workers have played a critical role in sharing information about how the virus spreads, educating refugee families on its symptoms, and instructing them on what to do if they get sick. Community health workers know the ins and outs of the refugee settlements and how people communicate within them, enabling them to dispel rumors and myths about the spread of the virus.
Responding to COVID-19 in an already dire humanitarian crisis is an unprecedented challenge. Refugee needs are extraordinary without a pandemic, and COVID-19 only adds to the complexity. But by using lessons learned from experience providing health services, engaging refugees in taking preventive measures, and drawing on the network of community health workers, we can help create the conditions needed to defeat the pandemic.
Hasina Akhter is area director for BRAC in Cox’s Bazar, Bangladesh. She currently oversees the organization’s multisector response to the Rohingya refugee crisis. She previously served with BRAC as country director for Uganda, where she led BRAC’s holistic suite of development and humanitarian interventions in the country, including a response to the Ebola outbreak and a portfolio of activities to support South Sudanese refugees.
Global leaders from across the BRAC family discuss COVID-19 response
Join global leaders from across the BRAC family as they discuss our response to the COVID-19 pandemic, informed by nearly 50 years of experience helping communities recover from emergencies. Moderated by Lord Mark Malloch-Brown, the webinar features Dr. Muhammad Musa, Executive Director of BRAC International; Asif Saleh, Executive Director of BRAC Bangladesh; and Hasina Akhter, Area Director for BRAC’s humanitarian response in Cox’s Bazar, Bangladesh.
Discover how Ruth is saving lives in her community
BRAC’s community health worker program is among the largest in Uganda. BRAC trains women to provide basic care to pregnant mothers and children in their community and refer patients to nearby clinics for further care. With a focus on mothers and children under five, community health workers save lives and reach families in remote communities that otherwise would not have access to critical care.