Micronesia (Federated States of)
COVID-19 mitigation through community collaboration and outreach in Pohnpei State
BACK
The Federated States of Micronesia (FSM) is an island nation made up of four states. Transportation barriers between islands and rural regions (where most of the population lives) challenge access to health services, resulting in fragmented care. [1] Thus, it is difficult to tackle non-communicable diseases (NCDs), which account for most deaths in the FSM.1 In Pohnpei State, a recent analysis found that 73.1% of the adult population were overweight or obese, and 32.1% had diabetes. [2] Moreover, 60% of the population exhibited three or more of the main NCD risk factors (daily smoking, overweight or obesity, high blood pressure, consuming fewer than five servings of fruits and vegetables per day, low physical activity), while only 1% of the population has no risk factors.
In 2017, the Pohnpei Department of Health Services worked with WHO to create the Dispensary Strengthening Program, an integrated community health outreach service to address NCDs and reach rural communities. This program emphasized community collaboration and involved two phases: microplanning workshops followed by outreach. In the microplanning phase, the Department of Health Services worked with traditional leaders (chiefs) to assess the existing community capacity, identify risks, and develop solutions. Together, they created microplans that would inform the outreach phase. The outreach phase involved household visits by multidisciplinary travelling health teams, who offer preventive services both for NCDs and CDs, maternal and child health services, immunizations, health education, and simple treatments.[3] This program was also implemented in Chuuk State to tackle similar health issues.
With the spread of COVID-19 globally, many countries had to quickly harness existing resources to mitigate the pandemic’s impact. In FSM, all states implemented similar versions of the previously successful outreach service to tackle COVID-19. Particularly in Pohnpei, WHO and UNICEF teamed up with local entities, including the Department of Health Services' Public Health Division, the Department of Education and the Micronesia Red Cross Society (MRCS), to apply the two-phased model to reduce the transmission and severity of COVID-19, with a special focus on patients with NCD conditions (during April and May 2020). Microplanning occurred in all municipalities, as well as churches and schools. Health teams distributed soap and buckets, provided health education to households, and conducted informational campaigns for communities on COVID-19 risk management and prevention. Additionally, volunteers delivered information on service decentralization to patients with chronic NCD conditions to minimize their exposure to the virus while ensuring continuous access to essential treatment and health services. Furthermore, recognizing an increased risk of COVID-19 mortality for people living with NCDs, health teams organized numerous information sessions and raised awareness on critical elements of NCD management.Putting the local government and traditional leaders in the driving seat to reach as many communities as possible was at the backbone of this initiative. WHO played a vital role in forging new relationships between various entities, by facilitating discussions to garner approval for and commitment to the initiative (especially from traditional leaders) and meetings for microplanning. The Department of Health initiated this outreach program, and traditional chiefs were recognized as trusted community leaders with extensive knowledge of the needs and capacities of communities to deal with COVID-19, considering communities' behavioural and cultural habits. Their expertise was essential for microplanning of activities that led to tailored, community-driven and needs-based solutions.
A team of 20 local MRCS volunteers and 10 public health staff formed the health teams that visited 3350 households and delivered medications as well as soap and buckets that were purchased with the support of UNICEF. Additionally, the team set up informational booths at local services and shops, thus enabling communities to have access to continuous and reliable information on COVID-19 management and prevention. Furthermore, a survey jointly run by UNICEF and WHO on COVID-19 preparedness gathered crucial information on households’ capacity for isolation, WASH infrastructure, and COVID-19 knowledge, which informed further COVID-19 preparations and strategies.
In sum, COVID-19 tested Pohnpei's community health outreach program's reliability and showed its ability to address new health issues. This program highlighted the importance of embedding community collaboration in health interventions and encouraging teamwork among different local entities. This contributed to keep the threat of COVID-19 at bay in all FSM states, led to community-oriented solutions, and prevented the duplication of efforts. In the future, it is hoped that government strategies will be aligned with the created microplans, and similar microplanning processes and integrated outreach services will continue to be used to tackle health issues in the other two states, Kosrae and Yap.
[1]. Link to document, accessed on 02 February 2021.
[2]. Link to document, accessed on 02 February 2021.
[3]. https://www.who.int/westernpacific/news/feature-stories/detail/micronesia-extends-comprehensive-care-to-remote-communities, accessed on 02 February 2021.
