O.S Ilesanmi1,2 and O.F. Fagbule3

  1. Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan
  2. Department of Community Medicine, University College Hospital, Ibadan.
  3. Department of Periodontology and Community Dentistry, University College Hospital, Ibadan

The highly infectious nature and lack of a cure for Coronavirus Disease-19 (COVID-19) have caused many individuals to live in dread of this deadly infection1. Numerous public health measures have been put in place by the government for the containment and control of the Severe Acute Corona Virus -2 (SARS CoV-2), the novel virus that causes COVID-19. However, an increase in the number of cases occur daily due to continuous community transmission of the virus2. The prevention of COVID-19 is a task that requires a lot of cooperation from the community members, and the inadequacies of the government’s efforts further calls for the involvement of joint action
across multiple stakeholders in the response against COVID-19.

Globally, as of 24th August 2020, over 23 million persons have been confirmed COVID-19 cases, while 809,422 deaths have been recorded3. An estimated number of nearly 1,186,650 cases and 27,727 deaths have been recorded in Africa, with Nigeria making up almost 5% of documented incidents and deaths3. In line with the World Health Organization’s recommendations, an increasing number of tests are being conducted alongside the decentralization of testing centers2. This has helped in the prompt detection of COVID-19-positive cases. It has also shown that more individuals are increasingly at risk of COVID-19 infection. Though immunity has been estimated to wane over time, literature has proposed that waiting for herd immunity in developing innate resistance to COVID-19 will cause several deaths4. Therefore, prompt interventions from multiple stakeholders are highly required.

Containment and control efforts regarding COVID- 19 are ongoing across countries. The Nigerian government declared a lockdown of educational institutions on 19th March 2020, along with other interventions5. During this period, most of the SARS CoV-2 infections were associated with international arrivals. However, community transmission of the SARS CoV-2 is ongoing, and this pinpoints the need for community-level engagement with stakeholders in the joint COVID-19 response. Community participation (CP) has been defined as a grassroots approach to health service delivery6. It is an approach that develops the capacity of the community in handling complex aspects of health, which exceeds government capacity alone6.

CP is not a novel intervention in addressing infectious diseases and solving health problems6. Studies have identified the role of faith-based organizations, community-based organizations (CBOs), and community leaders as stakeholders in the prevention of diseases. These roles have complemented the efforts of healthcare workers and the national government. Research conducted among female sex workers in Bangkok, Thailand, revealed the association between community mobilization and reduced HIV risk7. CP, through community volunteers, promoted the knowledge of HIV status in Uganda6. Reviews of studies in India and Senegal have reported the impact of community-based organizations in improving knowledge regarding the transmission and symptoms of tuberculosis8. Community leaders have also been reported to enhance awareness of dengue fever associated risk factors9. Improved treatment-seeking behavior has been identified as a notable effect of CBOs in the Roll Back Malaria program10. The role of community health workers and village leaders have been reported to enhance disease surveillance and improve polio outbreak response11. In Water Sanitation and Hygiene (WASH) programs, religious leaders and CBOs in Tanzania have aided handwashing practices and adoption of hygienic behavior12. These findings elucidate guaranteed effectiveness of stakeholders in tackling the COVID-19 pandemic in Nigeria, especially when epidemiological predictions have reported the likelihood that COVID-19 would persist for a long while, with no end in view13.

Benefits of community involvement in the COVID-19 response would include increased uptake of SARS CoV-2 testing and reduced stigmatization among COVID-19-positive persons14. Similarly, an increase in surveillance activities would be recorded due to the involvement of community stakeholders who would serve as COVID-19 focal persons for health professionals14. Stakeholders are resident in the communities, and so would assist in the linkage of mildly symptomatic persons to relevant health authorities. These would enhance the accurate reporting of COVID-19 cases in each community14. Moreover, the increased practice of infection prevention and control measures outlined by the government would result from stakeholder involvement, leading to reduced risk for SARS CoV-2 infections. Overall, CP would be of long-lasting impact in dealing with the surge of the COVID-19 pandemic. Furthermore, CP will move the entire outbreak response from a vertical response approach to a horizontal approach which assures sustainability15.