Adapting Health Programs During COVID-19

On March 11, 2020, the World Health Organization (WHO) labeled COVID-19 a pandemic. This quickly affected many areas of daily life, including people's access to healthcare. By April 1, 2020, the WHO advised that community health surveys and campaigns for neglected tropical diseases (NTDs) be put on hold to prevent the spread of COVID-19. Health agencies around the world had to stop their operations. Soon, it became evident that plans needed to change; instead of just thinking about restarting after the pandemic, organizations had to start figuring out how to work during it.

This article looks into how the U.S. Agency for International Development (USAID) managed its Act to End NTDs | East program during these uncertain times. This program aims to eliminate five diseases (lymphatic filariasis, onchocerciasis, schistosomiasis, soil transmitted helminthiasis, and trachoma) and works in thirteen countries across Africa, Asia, and the Americas.

#How COVID-19 Affected Health Programs

Each of the thirteen countries supported by Act | East experienced COVID-19 differently. In the early days of the pandemic, Europe and the Americas saw the highest case numbers, while Africa had very few. Because of this, countries had different levels of testing and reporting, making it difficult to get an accurate picture of the situation.

To comply with WHO guidelines, Act | East suspended all community activities and in-person meetings on April 10, 2020. This decision greatly impacted those at risk for NTDs and everyone involved in the programs.

During this suspension, a lot of concerns emerged. The health and safety of Communities and health workers became a priority. There were worries that health systems might get overwhelmed due to COVID-19, leading to shortages of supplies and workers. There was also fear that public resistance to COVID-19 measures could harm other health initiatives. The community had anticipated setbacks in controlling NTDs and a rise in illness and death from them.

On July 27, 2020, WHO issued new guidance that encouraged countries to start activities again based on assessment of local risks. Many papers have discussed how health programs went back to work during COVID-19, and this article adds to that discussion.

#Act | East's Response

This article will discuss how Act | East adjusted to the COVID-19 pandemic and how it adapted to changing conditions afterward. It will also look at how the suspension of activities affected mass drug administration (MDA) coverage and disease surveys. Finally, it will analyze how the pandemic impacted budgeting and resource allocation.

The study aimed to describe the changes made by the Act | East program in response to COVID-19. The main focus was on the management, Budgets, and coverage of programs. The authors used a method called outcome harvest evaluation, which helped in collecting and analyzing data from interviews and documents to identify and understand outcomes.

Data for this study came from various sources, including interviews with staff, documents detailing program operations, and program data on activities. This information was collected and analyzed for the time period between March 2020 and September 2021.

#Adapting to Change

#Restarting Activities

Act | East worked closely with health agencies and USAID to restart activities that had been paused. They created a restart package template to help document the factors affecting the restart, like COVID-19 conditions and government decisions. Over time, this process became more streamlined. By March 2021, all supported countries had guidelines on how to conduct MDA and surveys safely.

#Community-Level Adaptations

When restarting activities, the focus was on ensuring safety by implementing measures for physical distancing, hygiene, and using face coverings. This required changes in how drug distribution and training were conducted. Health agencies in each country adapted their policies to fit local contexts, often by following WHO guidance.

Some significant changes included shifting from school-based distribution to house-to-house delivery because schools were closed. Drug distributors also changed how they interacted with community members to keep everyone safe. Training sessions also had to adapt, with larger groups split into smaller ones and sessions often held in larger rooms.

However, implementing safety protocols like physical distancing proved challenging during MDAS due to social gatherings that occurred naturally in communities.

#Gathering Feedback and Innovations

As programs restarted, feedback from community members became essential. Act | East encouraged teams to listen to community concerns through listening sessions to improve participation. This type of communication helped adapt protocols and ensured that services aligned with community expectations.

In some places, community trust in health workers facilitated a smoother resumption of activities. However, in other areas, there was hesitation in participating, showing that flexibility and collaboration were critical.

#Communication Changes

Communication shifted significantly during the pandemic, with in-person meetings becoming less frequent. Act | East turned to virtual communication, including video calls, emails, and messaging apps. This change, while necessary, did come with challenges, as some staff members found it hard to adjust to less personal interactions.

An advantage emerged in broadening communication to include new partners and stakeholders involved in the COVID-19 response. Health agencies saw increased collaboration with district health offices, adding layers of confidence about safety measures within the community.

#Impact on Partnerships and Engagement

Strong relationships with health ministries were crucial during the pandemic. Effective communication helped to manage the strain that working alongside different organizations could create. While increased communication fostered a deeper engagement with partners and stakeholders, it also added to the workload for many teams.

#Program Coverage and Success

Resuming MDAs and disease surveys relied heavily on the community's trust in the safety of services. The Democratic Republic of the Congo and Mozambique were among the first to resume activities and found a high level of comfort among households with the protocols that had been put in place.

While many people embraced the return to services, others took longer to become willing participants. The overall results indicated that once activities restarted, they were carried out at a pace similar to pre-pandemic times.

#Budgeting and Resource Allocation

COVID-19 significantly affected program budgets and expenditure. Costs for MDAs and surveys saw wide variations from country to country. Some countries experienced budget reductions for activities, while others faced increased costs due to new requirements such as additional safety measures.

Focus group discussions revealed that the financial impact of transitioning to virtual meetings was generally positive for budget allocations. However, staff noted that the transition would still require resources such as protective equipment and hygiene supplies.

#Study Conclusion

The scrutiny and challenges of working during a global health crisis created a unique context for the Act | East program. The lessons learned from adapting to COVID-19 offer useful insights for health programs in future emergencies.

With a flexible approach to operations, Act | East managed to maintain momentum in addressing NTD elimination and control. The early concerns about setbacks proving to be significant have dissipated as many activities resumed successfully.

As countries continue to navigate their paths toward combating NTDs, it’s essential to remain adaptable and ready to respond to new challenges. By learning from the past and focusing on community engagement and effective communication, health programs can emerge stronger and more resilient in supporting public health initiatives.

#Looking Forward

As systems in place become normalized, there is potential for ongoing improvements in how health programs operate. Emphasis on virtual communication and adaptability could shape the future landscape of health service delivery.

Health programs must be prepared to handle strategic planning and resource allocation that can face emerging health challenges. While previous fears of disruptions may not have come true for Act | East, ongoing vigilance is necessary to ensure that programs are not derailed by future public health emergencies.

By maintaining clear guidelines, ensuring community trust, and fostering strong partnerships, health programs can effectively move forward together. The experiences shared throughout the pandemic serve as valuable lessons for building a more resilient healthcare system capable of responding to any situation.