Guidance Document for a Differentiated Response to COVID-19 Outbreak in Urban and Rural settings
Introduction and background
The coronavirus disease 2019 (COVID-19) outbreak is rapidly evolving in Africa. The continent recorded its first case in Egypt on 13 February 2020. Three months into the outbreak in the continent, all countries have reported COVID-19. The initial confirmed cases were imported through international travel, however, now more than a half of the countries in the region are experiencing community transmission of COVID-19. There are also increasing incidents of cross-border transmission of COVID-19 between countries mainly through long-distance truck drivers and illicit movement through porous borders. The numbers of reported cases and deaths have been increasing exponentially in recent weeks, raising fears that Africa might be the next global epicenter of the pandemic, with severe public health consequences and devastating societal and economic disruptions. This latest trend calls for African governments and all stakeholders, using a whole of government and whole of society approach, to step up their readiness and response measures, focusing on decentralising interventions to subnational levels and to all communities. Recent analyses of the evolution of COVID-19 outbreak in the region show variable distribution of the disease within countries, with differing risk levels. In many countries, the outbreak has mainly affected the capital cities and large urban centres, with most rural communities either free of COVID-19 or reporting sporadic cases.
This distribution pattern, therefore, calls for a differentiated approach in response to the outbreak within a country, with a focus on containing the disease in the rural, relatively unaffected communities, and mitigating the outbreak in the urban setting where transmission is high. This guidance document provides a differentiated approach in response to the COVID-19 outbreak in urban and rural settings. The interventions are customised in each setting based on the local COVID-19 transmission pattern, as defined by WHO
The effectiveness of a differentiated approach is rooted in a robust evidence-based, timely analysis of the outbreak data in time, person and place (geographical context) to help design a risk-based response approach at local level. This should premise on the principles of Integrated Disease Surveillance and Response (IDSR) strategy and basic field epidemiology practices. It should also be noted that urban settings have diverse subpopulations with different sociocultural needs and vulnerabilities, which each require special attention. Some of the major issues are overcrowding and substandard housing, lack of access to safe water, sanitation and hygiene facilities, and economic distress (exacerbated by lockdowns), all affecting uptake of preventive and containment measures. There is also a differential access to medical care within the country, with many rural areas having limited access to healthcare services as opposed to most urban centres. Finally, this guidance should be used in conjunction with specific thematic-area guidelines, guidance documents and standard operating procedures elaborating the implementation of individual interventions.
Guidance Document for a Differentiated Response to COVID-19 Outbreak in Urban and Rural settingshttps://www.afro.who.int/sites/default/files/Covid-19/Techinical%20documents/Guidance%20Document%20for%20a%20Differentiated%20Response%20to%20COVID-19%20Outbreak%20in%20Urban%20and%20Rural%20settings.pdf