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Spotlighting Gambia s roadmap towards enhanced COVID-19 action

Country: Gambia Source: World Health Organization 06 March 2021 Amid a global pandemic the Government of Gambia in partnership with World Health Organization (WHO) under the technical partnership of WHO/AFRO championed an ongoing survey, aimed at revealing the attributes of mortality prior and during COVID-19 era. The survey covers from 2018 to 2020 and is instrumental in devising mechanisms relevant to reduce mortality in the COVID-19 era. Twenty-one (21) data collectors and 7 supervisors were trained between 23-24 December 2020 at National Aids Secretariat Conference Hall. Senior Researchers such as Mr. Lamin Manjang were involved during training of data collectors. Data collection commenced from 30 December and it ends on 9 January 2021 Data returns will also be obtained from the health facility registers and monthly data summaries from regional health management in all 7 health regions. Primary health care, key villages and circuits will be targeted. Digital media, tablets and apps will be used to relay data through the Demographic Health Information System s (DHIS 2) platform. Data analysis for the survey will be completed by end of January 2021. Periodic counts of mortality data by age, sex, date of death, place of death and place of usual residence will be generated to compare trends for three (3) years. Plea to initiate health mentorship program on cardiopulmonary resuscitation (CPR) The WCO supported training and mentoring of 17 healthcare workers (3doctors and 14 nurses) from Edward Francis Small Teaching Hospital (EFSTH) on cardiopulmonary resuscitation (CPR), at EFSTH s boardroom, on the 7th December 2020. Similarly, another training was held for 43 health workers (12 doctors and 21 nurses) from both the private and public health workers, drawn from across the country, on 29th December 2020 at Tendaba. The trainees were equipped with adequate knowledge and skills to perform high quality CPR, ensuring survival of patients. Areas covered during training included chain of survival, rescuer basic life support (BLS) sequence, proper ventilation, high quality CPR, and precautions in CPR. Dr William Addison- WHO consultant facilitated during the training. Equipping Healthcare workers for new COVID-19 treatment centres In anticipation of opening new COVID-19 treatment centres, the WHO supported training of health workers in the management of mild and moderate COVID-19 patients on 28th December 2020 at Tendaba. Participants were drawn from all over the country. Theory and practical sessions were used. Clinical characterization of COVID-19, management of mild and moderate cases of COVID-19 and oxygen therapy were covered. In total 12 doctors and 21 nurses were equipped with knowledge and skills to manage mild and moderate COVID-19 cases. Dr William Addison- WHO consultant and Dr Abubacarr Jagne- Head of COVID-19 case management were facilitators. The trained health workers will be important in setting up other COVID-19 treatment centres and referring patients in need of more specialized critical care. Enhancing critical care for COVID-19 Patients A training was done to equip health workers with knowledge and skills for effective management of severe and critical cases of COVID-19 was conducted at Edward Francis Small Teaching Hospital, Banjul, from 2nd-3rd December 2020. This consisted of both theoretical and practical sessions at the EFSTH s boardroom, ICU and the COVID-19 treatment centre (sanatorium). Twenty (20) healthcare workers (HCW) (6 doctors and 14 nurses) were drawn from the COVID-19 treatment centre (Sanatorium). Participants excelled in therapy, management of severe, critical and critically ill cases of COVID-19 and the general management of the critically ill patients. They could demonstrate on how to prepare for oxygen therapy, select the appropriate oxygen delivery devices and provide appropriate level of supplementary oxygen monitor oxygen therapy. Capacity Building on mechanical ventilation for COVID-19 patients A tune of 19 health personnel comprising 5 Doctors and 14 nurses converged on 23rd December 2020 EFSTH s boardroom, theatre, ICU and the COVID-19 treatment centre (sanatorium) for a training on mechanical ventilation. Consultations between Ministry of Health (MOH) and WHO identified inadequate capacity in non-invasive and invasive ventilation. About 20% of COVID-19 cases are either severe or critical and the mortality in this bracket is high. Capacity buiding of health workers makes it easy for initiation of oxygen therapy, basic principles of mechanical ventilation, non-invasive and invasive ventilation, sedation in the ICU, endotracheal intubation and general care of critically ill patients. WHO s unwavering support towards infection prevention and control Collaborations between WHO and MOH spearheaded a three (3) day training of trainers (TOT) on COVID-19 infection prevention and control (IPC). The training was done from 02nd-4th December 2020 at Ferafenni. Participants came from North Bank East (NBE) and North Bank West (NBW). Eight (8) participants comprising of 1 medical officer, 5 nurses, 1 Public health officer and 1 IPC office were trained. Four (4) participants came from each region. After the training, participants were now able to supervise IPC activities, ensuring safely for health workers and patients at both private and government health facilities within their regions. Decentralizing skills on infection prevention and control (IPC) measures Health practitioners took part in an infection prevention control (IPC) step-down training program, held from 17th 19th December 2020 for 3 regions: Western Region1 (WR1), West Region 2 (WR2) and Lower River Region (LRR). Similar trainings were done for North Bank East, North Bank West and Central River Region during the same month. Subsequently a total of 122 health workers benefited from the decentralized training in all the 6 regions. The training was to strengthen the capacity of health care workers to adhere to recommended IPC practices in managing COVID-19 and non-COVID-19 patients. The health workers are were fully equipped with relevant knowledge to protect themselves and the patients from COVID-19. Initiating COVID-19 prevention behaviors through comprehensive research The WHO and other United Nations (UN) RCCE committee members supported the development of a concept note and data collection tools to assess people s knowledge, attitudes and practices on COVID-19 at community level in The Gambia. There is concern of non-compliance with recommended public health measures such as use of face masks, practice of social distancing, and frequent hand washing practice with soap or use of A total of forty-two (42) data collectors (6 per health region) and 14 supervisors (2 people/health region) will be trained on the data collection process and tools. Data collection will run between 25-30 January 2020. Data cleansing, entry, coding analysis and report writing will run from 31 January-05 February 2021. An assessment report will be submitted to the UN RCCE and the national RCCE committee for validation by 14 February 2020. The findings will inform COVID-19 RCCE prevention measures across in all regions of The Gambia. Steppingstone: Development of (SOP) Guidelines The WHO complemented the National Surveillance Core Group by providing technical support during development of Standard Operating Procedure (SOP) guidelines for the collection and transportation COVID-19 samples, between 2nd-9th December 2020. MRC Keneba and Basse laboratories are conducting COVID-19 tests. WHO and MOH agitated for collection and dispatching samples within the limited scope of these laboratories. Only Western Region 1(WR1) and Western Region 2 (WR2) were actively collecting COVID-19 samples for testing. Other 5 regions: Central River Region (CRR), North Bank East Region (NBER), North Bank West Region (NBWR), Lower River Region (LRR), Upper River Region (URR) were minimally collecting COVID-19 samples. The SOPs will improve detection of COVID-19 cases, identifying contacts, take samples and dispatch them for testing in good condition, through innovations and strategic efficiency. The guidelines are ready for validation by government and they will be shared with all health facilities. Donations: Complimenting government efforts in fighting COVID-19 WHO wrapped 2020 by handing over donations from AFRO to the MOH-National Pharmaceutical Services. The donations included MDT anti-leprosy 240 blisters of MB Adult blisters (MBA), 48 blisters of MB Child blisters (MBC), and 6 blisters of PB Child blisters (PBC) whose expiry date is between July 2023 and March 2024. Other Medical Supplies provided include 41 Cartons of 100 pcs isolation gowns, 28 Cartons of 5 x27 pcs face shields, 13 cartons of 1000pcs particulate respirators, 2 Cartons of 160 pcs safety goggles. Also, 44 Cartons of examination gloves, 15 boxes of 1000 pcs of top gloves, 21 Cartons of 2000 pcs surgical masks, 2 Cartons of 1000 pcs Disposal Sampling Kits, 9 Cartons of 400mg albendazole tablets, and 20 cartons of Fermon Labo were provided. The medical supplies will go a long way in complementing government efforts towards COVID-19 response activities and to keep health workers safe during line of duty. Launch of The Gambia s National Immunization Technical Advisory Group of The Gambia (The Gambia-NITAG) The WHO/AFRO/IST/WCO in collaboration with WAHO (West African Health Organization) supported the milestone development of launching of Gambia s National Immunization Technical Advisory Group by Dr Ahmadou Samateh, the Hon Minister of Health of The Gambia, the officiating guest on 18 December 2020. Mr Bakary Tijan Jargo represented the WR/WHO. The newly found body have a mandate to provide recommendations on vaccine and immunization policies, strategies in accordance with the National Health Strategic Plan including the EPI Comprehensive Multi-Year Plan. The board also referred as Gambia-NITAG, consist of health practitioners from different health organizations comprising Government line Ministries, WHO, UNICEF, WAO and Action Aid. During the launch, terms of reference of NITAG were developed and members were trained on their roles and responsibilities. NITAG is expected to guide the MOH in identifying and monitoring important EPI data and the latest scientific immunization recommendations and advancements. The WHO AFRO will also provide extra financial support towards COVAX. Human resources staffing needs, a key necessity All MOH s public health facilities received support from WHO Country Office (WCO) in updating the staffing norms- standards that regulate individual specific tasks, between 28 31 December 2020 at the Malaria Control Programme boardroom. Updating of staffing norms will address challenges related to inadequate numbers of health workers and unbalanced skill mix. Twenty (20) health practitioners selected from health posts at village, minor health facilities, major health facilities, district hospitals, general hospitals and the teaching hospitals reviewed current staffing norms. The health workforce training needs assessment of 2005 staffing norms was used as baseline during reviewing of staffing norms. The updated staffing norms informed conditions affecting staff from fully assisting communities in most effective, affordable and acceptable manner. Momodou Ceesay, Health Economist from WHO rendered the needed technical support. Enhancing COVID-19 response mechanism FILEThe WHO in tandem with MOH carried out an assessment of COVID-19 response structures such as incident management system (IMS), from 21st to 25th December 2020. This was done amid a high risk of second wave of COVID-19 transmission. A total of 7 regional health offices including 9 official points of entry (PoE) were visited. Kinafing, Bwian, Bansang, Farafenni general hospitals, and Soma and Brasse district hospitals were visited. Gaps identified included non-implementation of IMS structure at national and regional levels, limited contact tracing due to insufficient funds, absence of exit screening at the airport PoE, gaps in knowledge on COVID-19 treatment were noted. This resultant inspired the government to implement the IMS structure where WHO/Africa CDC/other partners would support critical treatment in all regions. At airports, PoE staff would compulsorily conduct exit screening and partners should fast-track their procurement process.


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