Community engagement is key to coming out of lockdown and fighting COVID-19.
Nobody is safe until we are all safe’ said Mike Ryan, the WHO’s top emergency expert[i], in a press conference in March explaining the need to support the most vulnerable countries responding to the Covid-19 pandemic. This same principle must be applied here in the UK. Unlike other emergencies, an outbreak requires a public health response that engages, and addresses the needs of, each and every member of the population. Without this, pockets of the population who don’t or can’t engage will be missed which increases their risk of infection and death but also allows the virus to continue to circulate. Ensuring that everyone is involved, has buy-in, and adopts healthy behaviours, is key to the successful containment of an epidemic. This is especially important as we ease ourselves out of lock-down measures.
This means that all parts of the population have to actively help shape the response especially the most vulnerable and marginalised in society including those living in prisons, institutions, people living with disabilities or women suffering domestic violence. In humanitarian relief we call this a ‘people centred approach’, partnering with people and communities to identify their needs, help design, implement, and monitor programmes. This sounds stupidly simple or wildly complicated but it is both.[ii]
Civil society mobilisation is key. The good news is, this is a phenomenon occurring in all humanitarian crises, whether a tsunami, earthquake or conflict, communities rise to help each other and we’re seeing this in the UK. Already 600,000 people form the NHS volunteer army,[iii] and community groups are reporting double the number of people volunteering than previous years[iv].
How then, do these groups, with all their frontline understanding, feedback into local and national strategic-operational planning, and response?
Unfortunately, the government has driven a top down, fragmented and ambiguous response to this crisis, with little promotion of how civil society platforms can effectively engage with public health and political decision-making.
The assumption that traditional community engagement mechanisms are adequate for this crisis is erroneous. The sheer number of bodies the public has to engage with (including NHS Trusts, Clinical Commissioning Groups, local authorities and government Select Committees) create barriers for driving engagement but they themselves lack cohesion. In a public health crisis, mechanisms need to be adapted, innovative approaches established, with pro-active outreach to communities, to engender trust and engagement to effect timely adjustments in the response. Furthermore, there needs to be a shift in thinking by those leading the response to allow communities to be heard and influence change.
Previous Ebola crises repeatedly highlight the need to pro-actively invest political space for communities to help shape a response to halt an outbreak. In the Democratic Republic of Congo until organisations worked with communities to make burials safer and not to impose strict measures that ignored local customs to say goodbye to their loved ones, did communities start to call upon safe burial teams that helped reduce outbreaks from funerals. For example, transparent instead of opaque body bags were used.
Europe may be passing the peak of its first wave of the COVID-19 pandemic, but as we consider how to come out of lockdown and prepare for a possible second wave or more[v], we must strengthen the dialogue and democratic engagement with our communities to contain the virus. This phase will be more complex, multi-layered, and multi-sectoral therefore public trust is key. That entails a shift from a top-down to a bottom-up approach.
The UK government needs to invest in local capacity-building for community organisations to scale up and fill gaps. To date, it has allocated only £750million to charities supporting COVID-19 response[vi], where the estimated loss of income over April to June is £3.7 billion[vii]. Councils need to develop listening platforms, conduct outreach, and needs’ assessments to understand how at-risk groups are affected, and how they wish to, or are able to adopt healthy behaviours. Furthermore, the government needs to articulate transparently how the response strategy will be developed and how the public can engage and shape its development.
If we don’t engage now, we risk excluding key groups at a time just as we need their consent and active participation to successfully come out of lockdown measures and contain the virus, or risk reversing the gains we have made. Now, for the sake of our collective health, we must come out of this crisis as one country leaving no one behind.
[i] WHO COVID-19 virtual press conference – 25 March 2020. https://www.who.int/docs/default-source/coronaviruse/transcripts/who-audio-emergencies-coronavirus-press-conference-full-25mar2020.pdf?sfvrsn=abe86e92_2
[ii] This includes those living with disabilities, mental health conditions, the elderly, the homeless, those in residential settings, prisons, adolescents in deprived areas, children who are neglected, women suffering intimate partner violence or those in institutionshttps://www.bmj.com/content/369/bmj.m1557
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