Infection Prevention and Control (IPC) is a major challenge for health care systems around the world, particularly in low-income countries. Guinea-Bissau is one of the world’s lowest ranking countries on the Human Development Index (HDI value for 2019 is 0.480) positioned at 175 out of 189 countries. Despite prior experience with health emergencies—outbreaks of cholera, measles, meningitis, Zika and preparedness for Ebola—the country has a fragile national health system. Like many countries around the world, Guinea-Bissau wasn’t adequately prepared for the COVID-19 pandemic. The country was particularly at high risk for transmission on account of inadequately trained health workers, minimal local capabilities to implement IPC components and limited legislation around IPC protocols.

WHO’s Country Office (WCO) recognized the precariousness of Guinea-Bissau’s public health system and the urgent need to strengthen IPC to prevent COVID-19 transmission. Working closely with the Ministry of Health (MoH) and the High-Commission for COVID-19, WCO was instrumental in achieving three significant IPC-related outcomes: establishing a national-level IPC team, training health care workers in IPC protocols and monitoring essential IPC activities.

Establishing a national-level IPC team

At the start of the pandemic, Guinea-Bissau did not have an IPC program or Standard Operating Procedures for its core components. To address these gaps, WCO developed IPC implementation protocols and aligned the national IPC COVID-19 response plan with relevant WHO recommendations. To roll-out this response plan nationwide, a sufficiently large multidisciplinary team was required.  Given constraints in local capacity, WCO put together a multidisciplinary team comprising several external experts with prior experience in health emergencies. This became the National IPC taskforce, also known internally as ‘ETN de PCI’. Through this IPC taskforce, WCO built local capacity to implement a national-level response plan for COVID-19.

Building capacity of health workers

Once the national IPC taskforce was established and trained, WCO enabled this training to filter down to frontline health workers, particularly those working in health care facilities (HCFs) across the country. Approximately 1400 of 2942 registered health workers received WHO training on core IPC components—sterilization, hospital waste management, hand washing—to prevent health care-associated infections. WCO additionally identified and trained regional IPC supervisors across 11 health regions, and established IPC focal points in 69 public health facilities to monitor IPC indicators and update the national IPC taskforce. WCO team members led all training sessions, enabling 52% of Guinea-Bissau’s health workforce to be trained in IPC.

Monitoring essential IPC activities

To ensure compliance with IPC protocols, among both taskforce members and health workers, WCO

monitored essential IPC activities in 71 of 139 public health structures in Guinea-Bissau, on a weekly basis. WCO noted a significant improvement in IPC indicators between weeks 25 to 44—demonstrating stronger adherence to protocols and stringent implementation of core IPC components. WCO is also working closely with the MoH to monitor cases of COVID-19 infection among health workers using a risk assessment form that draws from WHO's guidelines. Through this process of risk assessment and monitoring, WCO is building national capacity to track, evaluate and modify IPC activities according to the degree of risk observed. 

To deliver on all three of these outcomes, WCO worked closely with several development partners, including UNICEF and IOM. UNICEF contributed technical, logistical and financial resources towards IPC activities. IOM, together with WCO, carried out IPC assessments at crucial Points of Entry in the Bissau Autonomous Sector and some official PoE in other regions. These assessments highlighted various requirements, including the need for training on IPC to prevent COVID-19 transmission, and WCO subsequently trained over 70 workers.

IPC is critical to any health care system, and even more sso during a crisis, as the COVID-19 pandemic has evidenced. WCO’s efforts in the region—building a national IPC taskforce, training health workers in IPC and establishing monitoring mechanisms for IPC indicators—hold the promise of accelerating universal health coverage in Guinea-Bissau. IPC programs have gone from strength-to-strength across Guinea-Bissau’s health care facilities, serving well not just in response to the COVID-19 health crisis, but also in preventing and managing health care-associated infections. Through these efforts, Guinea-Bissau’s health system is better prepared for future health emergencies.

Photo caption: Triage at Clinic Madrugada in Guinea-Bissau.

Photo credit: WHO