A health promotion approach to emergency management: effective community engagement strategies from five cases.

Community engagement is crucial for controlling disease outbreak and mitigating natural and industrial disasters. The COVID-19 pandemic has reconfirmed the need to elevate community engagement to build equity, trust and sustained action in future health promotion preparedness strategies. Using the health promotion strategy of strengthening community action enhances the opportunity for better outcomes. There is, therefore, a need to improve our understanding of community engagement practices during crises, scale-up good community engagement initiatives, and improve and sustain people-centered approaches to emergency responses. This paper presents five case studies from the United States, Singapore, Sierra Leone, Kenya and South Africa that demonstrate the potential strengths that can be nurtured to build resilience in local communities to help mitigate the impact of disasters and emergencies. The case studies highlight the importance of co-developing relevant education and communication strategies, amplifying the role of community leaders, empowering community members to achieve shared goals, assessing and adapting to changing contexts, pre-planning and readiness for future emergencies and acknowledgement of historic context.

The effect of increased mobility on SARS-CoV-2 transmission: a descriptive study of the trends of COVID-19 in Zimbabwe between December 2020 and January 2021.

INTRODUCTION: when the first cases of COVID-19 were reported in Zimbabwe in March 2020, the local outbreak was characterised by an insidious increase in national caseload. This first wave was mainly attributable to imported cases, peaking around July 2020. By October 2020, the number of cases reported daily had declined to less than 100 cases per day signalling the end of the first wave. This pattern mirrored the global trends. In December 2020, reports of new COVID-19 variants emerged and coincided with the beginning of the second wave within the ongoing pandemic. This paper reports on the analysis conducted on the new wave of COVID-19 beginning December 2020 to January 2021. The objective of this study was to document the evolving presumptive second wave of the COVID-19 pandemic in Zimbabwe from December 2020 to January 2021. METHODS: this is a retrospective analysis of secondary data extracted from the daily situation reports published by the Ministry of Health and Child Welfare, Zimbabwe and World Health Organization Country Office, Zimbabwe. The period under consideration started from 1st December 2020 to 31st January 2021. RESULTS: there was a 333% increase in the number of confirmed COVID-19 cases starting 1st December 2020, to 31st January 2021. These new cases were mainly attributed to community transmission though there were a few imported cases. There was a 439% increase in the absolute number of deaths; however, the case fatality rate remained low at 3.6%, and comparable to that from other countries. Harare, Bulawayo and Manical and provinces accounted for 60% of the case burden, with the other seven provinces only accounting for 40%. By mid-January, the number of incident COVID-19 cases started to decline significantly, to levels similar to the residual levels seen during the first wave. CONCLUSION: the second wave, which lasted a period of less than 2 months, had a steep rise and sharp decline in the incident cases and fatalities. The steep rise was attributable to increased mobility, with a consequent increase in the chains of community transmission. The declines, noted from mid-January 2021, may be partly attributable to a strict national lockdown, though more in-depth exploration of the drivers of transmission is needed to tailor effective interventions for future control. Differentiated strategies maybe needed according to the case burdens in the different provinces. In anticipation of further waves, the introduction of safe and effective vaccines might be the game changer if the vaccines are widely availed to the population to levels adequate to achieve herd immunity. Meanwhile, infection prevention and control guidelines must continue to be observed.

Achieving SDGs and addressing health emergencies in Africa: strengthening health promotion.

In 1986, the World Health Organization (WHO) convened the first Global Conference on Health Promotion held in Ottawa, Canada. This conference yielded the Ottawa Charter which defined health promotion as the process of enabling people to increase control over, and to improve, their health. A series of conferences followed and in 2005, WHO convened the Sixth Global Conference in Bangkok, Thailand, which yielded the Bangkok Charter for Health Promotion. This Charter for the first time expanded the role of health promotion to include addressing social determinants of health. Ministers of Health from 47 countries of the WHO Regional Office for Africa in 2012 endorsed the Health Promotion: Strategy for the African Region. This Strategy highlighted eight priority interventions required to address health risk factors and their determinants. In 2011, the Rio Political Declaration on Addressing Social Determinants of Health was adopted by Health Ministers and civil society groups to address inequalities and inequities within and between populations. The main action areas were good governance to tackle the root causes of health inequities; promoting participation and ownership; community leadership for action on social determinants; global action on social determinants to align priorities and stakeholders; and monitoring progress on implementation of policies and strategies. Health promotion has been prominent as part of disease outbreak response, including for Ebola and COVID-19. It has been an integral part of improving maternal and child health mortality and morbidity as well as TB, HIV/AIDS and malaria; and lately reducing the impact of noncommunicable diseases, namely diabetes, high blood pressure and cancer. While challenges continue in strengthening health promotion, there have been concerted efforts to place health promotion on the development agenda in countries through Health in All Policies (HiAP), capacity strengthening, monitoring and evaluation, and innovative financing policy options using dedicated tax from tobacco and alcohol, and road use.

A descriptive study of the trends of COVID-19 in Zimbabwe from March-June 2020: policy and strategy implications.

INTRODUCTION: the first cases of COVID-19 were reported in China in December 2019. Since then, the disease has evolved to become a global pandemic. Zimbabwe reported its first case on 20th March 2020, and the number has been increasing steadily. However, Zimbabwe has not witnessed the exponential growth witnessed in other countries so far, and the trajectory seems different. We set out to describe the epidemiological trends of COVID-19 in Zimbabwe from when the first case was confirmed to June 2020. METHODS: data were collected from daily situation reports that were published by the Zimbabwean Ministry of Health and Child Care from 20th March to 27th June 2020. Missing data on the daily situation reports was not imputed. RESULTS: as of 27th June 2020, Zimbabwe had 567 confirmed COVID-19 cases. Eighty-two percent of these were returning residents and 18% were local transmission. The testing was heavily skewed towards returnees despite a comprehensive testing strategy. Of the confirmed cases, 142 were reported as recovered. However, demographic data for the cases were missing from the reports. It was not possible to estimate the probable period of infection of an active case, and case fatality in Zimbabwe was about 1% for the first 4 months of the pandemic. CONCLUSION: the epidemiological trends of COVID-19 experienced in Zimbabwe between March and June 2020 are somewhat different from what has been observed elsewhere. Further research to determine the reasons for the differences is warranted, to inform public health practice and tailor make suitable interventions.

Evaluating implementation of the Ebola response in Margibi County, Liberia.

Implementation of the Ebola response was credited with reducing incidence of Ebola virus disease (EVD) in West Africa; however little is known about the amount and kind of Ebola response activities that were ultimately successful in addressing the 2014 outbreak. We collaboratively monitored Ebola response activities and associated effects in Margibi County, Liberia, a rural county in Liberia deeply affected by the outbreak. We used a participatory monitoring and evaluation system, including key informant interviews and document review, to systematically document activities, code them, characterize their contextual features, and discover and communicate patterns in Ebola response activities to essential stakeholders. We also measured incidence of EVD over time. Results showed a distinct pattern in Ebola response activities and key events, which corresponded with subsequent decreased EVD incidence. These data are suggestive of the role of Ebola response activities played in reducing the incidence of EVD within Margibi County, which included implementing safe burials, social mobilization and community engagement and case management. Systematic monitoring and evaluation of response activities to control disease outbreaks holds lessons for implementing and evaluating similar comprehensive and multi-sectoral community health efforts.

Monitoring and Evaluating the Ebola Response Effort in Two Liberian Communities.

Although credited with ultimately reducing incidence of Ebola Virus Disease (EVD) in West Africa, little is known about the amount and kind of Ebola response activities associated with reducing the incidence of EVD. Our team monitored Ebola response activities and associated effects in two rural counties in Liberia highly affected by Ebola. We used a participatory monitoring and evaluation system, and drew upon key informant interviews and document review, to systematically capture, code, characterize, and communicate patterns in Ebola response activities. We reviewed situation reports to obtain data on incidence of EVD over time. Results showed enhanced implementation of Ebola response activities corresponded with decreased incidence of EVD. The pattern of staggered implementation of activities and associated effects-replicated in both counties-is suggestive of the role of Ebola response activities in reducing EVD. Systematic monitoring of response activities to control disease outbreaks holds lessons for implementing and evaluating multi-sector, comprehensive community health efforts.

Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework.

BACKGROUND: Sub-Saharan Africa (SSA) is facing a double burden of disease with a rising prevalence of non-communicable diseases (NCDs) while the burden of communicable diseases (CDs) remains high. Despite these challenges, there remains a significant need to understand how or under what conditions health interventions implemented in sub-Saharan Africa are sustained. The purpose of this study was to conduct a systematic review of empirical literature to explore how health interventions implemented in SSA are sustained. METHODS: We searched MEDLINE, Biological Abstracts, CINAHL, Embase, PsycInfo, SCIELO, Web of Science, and Google Scholar for available research investigating the sustainability of health interventions implemented in sub-Saharan Africa. We also used narrative synthesis to examine factors whether positive or negative that may influence the sustainability of health interventions in the region. RESULTS: The search identified 1819 citations, and following removal of duplicates and our inclusion/exclusion criteria, only 41 papers were eligible for inclusion in the review. Twenty-six countries were represented in this review, with Kenya and Nigeria having the most representation of available studies examining sustainability. Study dates ranged from 1996 to 2015. Of note, majority of these studies (30 %) were published in 2014. The most common framework utilized was the sustainability framework, which was discussed in four of the studies. Nineteen out of 41 studies (46 %) reported sustainability outcomes focused on communicable diseases, with HIV and AIDS represented in majority of the studies, followed by malaria. Only 21 out of 41 studies had clear definitions of sustainability. Community ownership and mobilization were recognized by many of the reviewed studies as crucial facilitators for intervention sustainability, both early on and after intervention implementation, while social and ecological conditions as well as societal upheavals were barriers that influenced the sustainment of interventions in sub-Saharan Africa. CONCLUSION: The sustainability of health interventions implemented in sub-Saharan Africa is inevitable given the double burden of diseases, health care worker shortage, weak health systems, and limited resources. We propose a conceptual framework that draws attention to sustainability as a core component of the overall life cycle of interventions implemented in the region.

WHO's supported interventions on salt intake reduction in the sub-Saharan Africa region.

Reduction of salt intake is an important and cost-effective way for reducing hypertension and the risk of cardiovascular diseases (CVDs). Current global salt intakes are estimated at around 10 g/day, well above the World Health Organization (WHO) recommended level of <5 g/day. The sub-Saharan Africa (SSA) region has a prevalence of hypertension of 46% among adults aged 25 and over and therefore strategies to reduce salt intake are necessary. This requires an understanding of salt intake behaviors in the population along with government commitment to increase awareness and take actions that would create an enabling environment. It is also important to have the food industry and other key stakeholders on board. A review of the developed WHO's norms and guidelines, technical support provided to countries by WHO as well as country initiatives shows that countries in the African region are at different stages in the implementation of salt reduction interventions. For example, South Africa has enacted legislation to make the food industry reduce the salt content of a number of its products while Mauritius is requesting bakery owners to reduce salt in bread. A number of countries are currently undertaking studies to measure salt intake in the populations. Overall progress is slow as the region experiences a double burden of communicable and noncommunicable diseases, competing health priorities and limited resources for health.

Constructing an action agenda for community empowerment at the 7th Global Conference on Health Promotion in Nairobi.

This report describes an action agenda for community empowerment developed by participants at the 7th Global Conference on Health Promotion in Nairobi. It outlines gaps and barriers in enabling community empowerment; including those related to institutional capacity, institutional relationships to the community, and institutional responses to the social structure of the community. The report features nine recommended actions to enhance community control of health promotion initiatives, develop sustainable resources for community health efforts, and support implementation and build evidence for health promotion effectiveness. Implementing these recommended actions can enhance community empowerment and help close the implementation gap in health promotion.

Schools for health, education and development: a call for action.

In 2007, the World Health Organization, together with United Nations and international organization as well as experts, met to draw upon existing evidence and practical experience from regions, countries and individual schools in promoting health through schools. The goal of the meeting was to identify current and emerging global factors affecting schools, and to help them respond more effectively to health, education and development opportunities. At the meeting, a Statement was developed describing effective approaches and strategies that can be adopted by schools to promote health, education and development. Five key challenges were identified. These described the need to continue building evidence and capturing practical experience in school health; the importance of improving implementation processes to ensure optimal transfer of evidence into practice; the need to alleviating social and economic disadvantage in access to and successful completion of school education; the opportunity to harness media influences for positive benefit, and the continuing challenge to improve partnerships among different sectors and organizations. The participants also identified a range of actions needed to respond to these challenges, highlighting the need for action by local school communities, governments and international organizations to invest in quality education, and to increase participation of children and young people in school education. This paper describes the rationale for and process of the meeting and the development of the Statement and outlines some of the most immediate efforts made to implement the actions identified in the Statement. It also suggests further joint actions required for the implementation of the Statement.