MSF COVID-19 Southern Africa Operational update
ESWATINI
Context:
108 confirmed cases. 1 death. 12 recovered. (03/05). A COVID-19 national lockdown remains in place.
Activities:
MSF provides support to the Ministry of Health (MoH) by assisting with infection control and triage at health facilities. We are also part of technical advisory groups to the Ministry of Health and are implementing adjusted models of care for patients living with HIV, TB and non-communicable diseases in order to reduce their risk of infection. Teams are doing health education in communities daily.
MALAWI
Context:
Malawi has 38 confirmed cases and 3 fatalities (03/05). While a 21-day lockdown was set to begin on 18 April, it has been delayed by a court injunction. There are particular concerns for the most vulnerable groups during the lockdown. Strikes by healthcare workers (due to lack of PPE) and by junior prisons officers and protests concerning lockdown in locations across the country have caused significant disruption, particularly impacting continuity of health services. Reduced numbers of patients are accessing out-patient and in-patient services in Nsanje where MSF runs a project focussed on treating advanced HIV disease.
COVID-19 activities:
MSF is implementing COVID-19 responses in line with three active projects: one focussing on female sex workers, a project focused on providing healthcare to prisoners and the Nsanje advanced HIV disease project.
The female sex worker project is supporting the Ministry of Health (MoH) COVID-19 response in three districts where we work: Neno, Dedza and Nsanje. The project focuses on continuing provision of services to female sex workers in the community and health facilities, and the provision of prevention messages and measures to prevent COVID-19 transmission among female sex workers and in the community. This has includes:
- sensitisation with health messages on COVID-19 adapted for specific audiences,
- installation of hand-washing points in hotspots, and
- technical and direct assistance around COVID-19 patient flow at health facilities and infection prevention and control (IPC).
In Chichiri Prison, Blantyre, there were 1,897 inmates as of 27 April. Decongestion has been a slow process with very few prisoners being released and the process remains underway. MSF’s prison project is supporting prison authorities by:
- intensifying health promotion for inmates and visitors,
- setting up screening at entry points and within the prison,
- installing hand-washing points in cells,
- training prison staff and clinical staff on COVID-19 and technical support with IPC,
- clinical screening/triage and management of potential mild-to-moderate COVID-19 cases,
- isolation and referral for severe cases, and
- donations of PPE and IPC materials, medicines and ambulance equipment to enable referral
- an area has been designated within Chichiri Prison for isolation
- distribution of cloth face masks to all inmates and staff.
For the Nsanje project the main COVID-19 activities include:
- general health promotion activities,
- training for healthcare workers in and installation of hand-washing points in eight supported health centres and Nsanje district hospital,
- providing technical support on health centre screening set-up, and
- supporting the set-up in Nsanje district hospital with:
- screening and triage,
- out-patient department consultations,
- environmental health measures essential for COVID-19 and standard precaution measures (waste management, IPC, morgue upgrade),
- set-up and improvement of in-patient case management isolation ward.
The project will provide direct support for COVID-19 patient flow and management (pre-screening, screening and triage, consultation, ambulance service, isolation ward) in the hospital, including setting up the ward with IPC, PPE, management of the COVID-19 system (triage and isolation), and the provision of cloth masks to staff, patients and visitors.
Adaptations to MSF activities:
Projects in Nsanje and the female sex worker project push to increase access to six month long refills of medications while we also temporarily halt healthcare worker mentoring activities in health centres and Nsanje district hospital. In Dedza and Zalewa areas the comprehensive one-stop services at health facilities are available (HIV and sexual reproductive health) and in all sites a basic emergency package is available at distribution points in the community (condoms, lubricants, oral self-testing, PEP, emergency contraception and single dose treatment for sexually transmitted diseases among survivors of sexual violence). The team also ensures patient follow-up by phone.
MSF has also adapted its activities to the measures dictated by the necessity of containing the spread of the virus, for example by suspending the “Teen Clubs” in Chiradzulu, where HIV-positive children and teenagers could access counselling, consultations and testing in a dedicated environment featuring recreational activities. Our cervical cancer activities have also been limited to admitting the most urgent cases.
MOZAMBIQUE
Context:
Mozambique has 79 confirmed cases of COVID-19 with 0 deaths (03/05). Testing is prioritized for suspected cases with severe symptoms due to limited tests and swabs. The vast majority of confirmed cases so far are in Cabo Delgado and linked to the oil and gas companies there. A state of emergency has been declared until the end of April and is likely to be extended. Use of protective masks is mandatory in all public transport as well as in crowed places. Due to the state of emergency many companies are recording losses and some have decided to suspend employment contracts, with the rest adopting measures that range from collective vacations, working from home and reduction of workload to rotating work regimes.
COVID-19 activities:
MSF teams are participating in COVID-19 coordination meetings and technical working groups offering technical advice. In Maputo MSF supports IPC and patient flow implementation in Hospital Polana Caniço in order to protect healthcare workers. Our team has also visited some of the main health centres in the city together with the MoH in order to assess their readiness to correctly identify and manage suspected cases. In Beira we continue with preventive measures, triage, patient flow, organising training (30 clinical staff trained). In Pemba we have supported the MoH with the installation of the isolation centre at 18th of October Health Centre while also providing training, preventive measures, triage and organising health promotion activities on COVID-19 at the Pemba Health Centre.
Adaptations to MSF activities:
In all projects, our patient flows have been adapted in line with physical distancing and reducing health facility congestion as much as possible. Staff are working from home when possible and/or on rotation. In Maputo a team of six medical and logistics staff has been detached from our regular project to exclusively support the city’s main COVID-19 isolation facility. This team has been trained in IPC both by MSF and the National Institute of Health. In Beira, we have selected MSF staff to support MoH while in Pemba, a health surveillance working group meets daily focusing on travellers, tracing contacts, quarantine and data collection from primary healthcare and community transmission. Due to difficulties procuring PPE we are now exploring local production of certain items, like masks and gowns.
SOUTH AFRICA
Context:
South Africa has more than 6,783 confirmed cases of COVID-19 and 131 deaths and over 2 549 people have recovered (03/05). The country remains under lockdown but some of the strict lockdown conditions will be lifted from 1 May, allowing limited return to economic activity in some sectors.
COVID-19 activities and adaptations:
In Khayelitsha in the Western Cape, our team (75 staff) is responding in partnership with the Department of Health (DoH), with prevention, triage, case management and co-morbidity care activities and initiatives. In collaboration with the DoH, MSF is preparing the set-up of field hospital for the management of moderate COVID-19 patients as an extension of the Khayelitsha district hospital. T
Other activities include support to contact screening and testing, as well as support to a mass provincial community screening and testing campaign in all areas of Khayelitsha, with more than 2,000 people screened so far (11 people tested positive). The team provides ongoing support to the patient flow and screening system at primary healthcare level. After initially supporting the provincial COVID-19 call centre, this activity is now closed.
MSF made significant contributions to adapting care for people whose underlying medical conditions put them at heightened COVID-19 risk – especially people living with HIV and TB. Our the team supports strategies aimed at eliminating non-essential clinic visits for TB/HIV patients, including assisting with triage/screening and patient flow in clinics, assisting the DoH with a telephonic counselling strategy and conducting routine counselling sessions over the phone, and supporting the delivery of chronic medication from facilities to about 2,000 patient’s homes. Prevention activities include digital, facility-based and community-based health promotion, water, sanitation and hygiene interventions at facilities and community hotspots, as well as the provision of cloth masks.
In Eshowe in KwaZulu Natal, our team (80 staff) is collaborating with the DoH, with activities spanning prevention, triage, case management and decongesting strategies for health facilities for people living with TB and HIV. Prevention activities include community-based health promotion, focusing on businesses that are still open, welfare grant gatherings and working with traditional healers’ practices. Water, sanitation and hygiene points have been established in the town and during periods when welfare grants are distributed. Triage activities include help desks in health facilities, where MSF staff do health promotion as well as screening, with those screening positive referred within the facility for testing. We support patient flow in facilities and four MSF nurses are supporting the DoH team with community screening and testing.
To safeguard TB/HIV patients at this time, 35 medication pick-up points are being set up in communities and a call centre has been established to confirm the addresses of 17,000 people on chronic medication. MSF staff are supporting the pre-packing the medication parcels and we have organized that 27 MDR-TB patients will receive treatment and care at their homes.
In Tshwane our team (25 staff) provides a comprehensive package of healthcare services in four shelters for the homeless –including primary healthcare services, mental health services, social services, health promotion and water, sanitation and hygiene services. Mental health, water and sanitation, social work and health promotion are also being provided by MSF to seven other shelters. Health promotion activities include the distribution of cloth masks to all people in the shelters. The team visits two shelters per day and MSF is exploring supporting methadone provision in shelters, as heroin withdrawal has emerged as a major healthcare gap.
MSF’s normal clinic activities and HUB servicing vulnerable migrants, remains closed due to the lockdown measures, as the number of people who are able to attend has decreased significantly.
In response to needs in Johannesburg we established a team (7 staff) to supports the three biggest shelters for the homeless in the city with bi-weekly visits. Services include screenings for COVID-19 and TB, as well as voluntary HIV testing. Cloth masks are distributed and a health promotion team shares COVID-19 information among shelter residents while supporting other community-based organisations with training. Outside the shelters, a team of two nurses and two drivers supports the DoH with community-based contact tracing, screening and testing.
In Rustenburg our team (55 staff) focuses on community health promotion and facility triage activities, including staffing of community screening tents outside two community health centres. As SGBV cases tend to increase during periods such as COVID-19 lockdown, our team has been actively supporting the national SGBV call centre with counselling tools, since call volumes to the hotline have increased.
ZIMBABWE
Context
Zimbabwe has 34 confirmed coronavirus COVID-19 cases and 4 deaths (02/05). Zimbabwe extended its COVID-19 lockdown since 19 April. Previous restrictions continue, but additional essential services are now allowed, most notably, the mining sector. There is limited road and air travel, only open to returning residents and cargo. Returning residents are quarantined for a 14-day period. Screening and testing continues, though at a much slower pace.
COVID-19 activities:
The MSF team has moved to focus on the following COVID-19 response components in recent days to limit the spread of the disease within three pillars:
- Community based intervention – prevention, health promotion and surveillance activities
- Advice and installation of basic screening referral units at health facilities as well as health promotion activities
- Testing, isolation and contact tracing including GIS-mapping – for better risk assessment and visualisation of hot spots
These pillars have been established at Wilkins and Beatrice Road Infectious Disease hospitals in Harare. MSF provides technical assistance in Bulawayo in reaction to the sudden increase of COVID-19 cases in the city. MSF staff including nurses, health promoters and drivers have begun working with the MoH and our professionals provide technical assistance where required.
Adaptations to MSF activities:
MSF continues services for projects such as the Gutu HIV and TB project in Masvingo, and the Manicaland project on non-communicable diseases, which provides diabetes drugs and care to rural communities in Chipinge and Mutare. Our teams are concerned about reports of people who have been turned away when they travelled to facilities to collect their chronic medication.