Bauchi, 16 April 2020 – A network of community health agents that has helped Nigeria curb polio is taking on a new task: deploying its early detection know-how to raise the alarm on suspected COVID-19 infection as the virus continues to spread.

In recent weeks, COVID-19 has spilled over to regions beyond the capital cities of many African countries, calling for a decentralized approach to help prevent further propagation. The World Health Organization (WHO) has urged countries to bolster emergency responses at the subnational level.

In Nigeria, the work of a 7128-strong network of community health agents on polio and other diseases is now being leveraged. The community workers use Auto-Visual AFP Detection and Reporting – also known as AVADAR – a phone-based application with video clips in several local languages to educate families and help in the timely detection of polio.

Although the application does not have features for other diseases including COVID-19, the community informants have received training on COVID-19 case definition and symptoms to improve their skills in educating families on preventive measures, as well as early detection and reporting of suspected cases of the virus in their communities.

While a separate application for COVID-19 is being developed, the community health workers can make free calls through a closed user group platform to notify district surveillance officers about suspected cases.

“I spend most of my day in the field, going from house to house looking for polio cases and other diseases, but in the past month I have also been using part of my time to sensitize households on the new disease called COVID-19. I have not found any case yet,” says Fatsuma Sani, a community health worker in northeast Nigeria.

Expanding surveillance

The long-running armed violence in northeast Nigeria has devastated basic health service infrastructure. Community health workers like Ms Sani are critical in early disease detection and response.

“The addition of COVID-19 to the activities of the (community health workers) is based on the assessment of their critical contribution to (polio) and other disease detection and reporting in the zone,” said Dr Adamu Ibrahim, the WHO acting coordinator for Nigeria’s North East zone.

He explained that between 2018 and 2019, community health workers in Adamawa, Borno and Yobe states reported 591 polio cases and 4068 measles cases. “Their involvement is therefore an expansion of the surveillance network and an opportunity to increase community awareness on preventive measures on COVID-19 in the zone.”

WHO is supporting the Nigeria Centre for Disease Control to formalize collaboration with the community health workers on COVID-19 detection in states already affected by the virus. In northeast Nigeria the community health agents work in 36 localities.

No suspected COVID-19 case has been reported by any of the community health workers, however, educating the community on key preventive measures is ongoing. Dr Audu Idowu, a WHO coordinator for Borno state said: “We are indeed beginning to witness the impact of their work in the communities with more people practicing regular hand washing, social distancing including the avoidance of large gatherings.”

Part of the challenge facing the community health workers are safety concerns from their families. “My husband is very worried about my safety, but I try to assuage his fears that I practice safety measures,” says Ms Sani.

“This is not an easy task in times like these, but it is the sacrifice I am making to keep my community safe.”