WHO Community-based health care in the context of Covid-19 pandemic

The WHO and UNICEF have issued a joint report and iterim guidance on Community-based health care, including outreach and campaigns,in the context of the COVID-19 pandemic.

Page 32 outlines updated interim guidance regarding community health care and outreach where it pertains to Neglected Tropical Diseases (NTDs):

" WHO recommends five main strategies to address the burden of neglected tropical diseases (NTDs): preventive chemotherapy, individual case management, integrated vector management, veterinary public health, and the water, sanitation and hygiene (WASH) framework. Several NTD interventions underlie each strategy and these use community-based approaches to deliver services to populations where NTDs are endemic (Table 2). Each activity has distinct risk-benefit considerations in the pandemic context.

Specific considerations

• Community-based surveys, mass treatment and active case finding should be temporarily suspended.
• Countries should monitor and re-evaluate at regular intervals the necessity for delaying these activities.
• Community-based vector control and veterinary public health interventions should continue with strict precautions (hand hygiene, respiratory etiquette, physical distancing) observed by all participants in areas where there is no community transmission of COVID-19.
• In areas with community transmission, only essential activities should be continued. For vector control, essential activities should be interpreted as source reduction of vector breeding sites in and around houses. In areas that are affected by dengue and under stay-at-home measures due to COVID-19, families could work together for 30 minutes every week to get rid of potential mosquito breeding sites, clean roof gutters and ensure that all water storage containers are covered. For veterinary public health, the maintenance of mass animal vaccination campaigns, where required, and euthanasia of rabid animals should be regarded as essential. When handling and caring for animals, basic hygiene measures should always be implemented; these include handwashing before and after handling animals, their food, or supplies.
• Community-based WASH activities should continue, with amendments to include key information about preventing COVID-19 in settings where there are no cases of COVID-19. In settings where COVID-19 transmission is occurring, WASH messages should be repurposed to focus on preventing COVID-19 transmission.
• Upon detection in a given geographical area of (a) a sudden increase in the incidence of NTD infections or (b) a significant burden of disease, the decision to resume or commence active case finding or mass treatment campaigns, or both, will require a risk-benefit assessment on an event-by-event basis; the assessment must factor in the health system’s capacity to effectively conduct safe and high-quality health interventions in the context of the COVID-19 pandemic.
• This guidance does not cover ensuring access to diagnosis, treatment and care of NTDs for patients presenting to health care facilities, which should continue to the extent possible. In some settings, the only care for NTDs is through outreach initiatives and some adaptation of previous clinical pathways may be indicated. For example, for people being treated for leprosy, provision of sufficient medicine for 3 months instead of 1 month of treatment could be considered to reduce the number of attendances required. "