The role and contribution of civil society and community actors in COVID-19 prevention and control: the case of the COMVID COVID-19 movement in Burkina Faso

Implementation of the ‘Communities are committed to Eradicate COVID-19’ movement

The establishment of the organisational structure of the COMVID COVID-19 movement followed three main steps. First, the member organisations of the DES-ICI platform established a 12-member secretariat. This secretariat coordinated the activities of the movement, advocated for the inclusion of the movement in the national COVID-19 response plan and for resource mobilisation, ensured transparent management of the mobilised resources and established strategic partnerships with other actors involved in the COVID-19 response. Second, the mobilisation of community organisations was carried out online via Facebook and Google Forms, with more than 300 community organisations enrolling within 24 hours. Among these community organisations, 54 were chosen as focal points, one for each sector of the city of Ouagadougou, which has 55—a focal point could not be set up. The focal points were selected based on their intervention domain and had to meet the following criteria: (1) be focused on health, (2) have their site or headquarters in the sector they cover, (3) have solid experience in community mobilisation and (4) have a good reputation. Finally, a citizen health watch unit (CCVS) was created in each sector of the city of Ouagadougou under the leadership of the respective focal points. These CCVS were responsible for implementing the activities of the COMVID COVID-19 movement at the community level. Each CCVS was composed of at least 14 members, including 10 community organisations based in the intervention zone, a representative of the locally elected officials, two opinion leaders and a representative of vulnerable people such as people with disabilities. Prior to the launch of the CCVS, the focal points received training to strengthen their knowledge on COVID-19 (its clinical signs, transmission routes and prevention), a communication plan on the disease and its manifestations and a guide on how to set up the CCVS. The CCVS were expected to work as volunteers—they were not specifically remunerated for joining the COMVID COVID-19 movement.

Achievements and challenges of the ’Communities are committed to Eradicate COVID-19’ movement

The activities of the CCVS at the community level were diverse and consisted particularly of: (1) raising awareness about disease prevention and control measures; (2) mobilising resources, including endogenous resources, and providing vulnerable households with protective equipment; (3) tracing contact; (4) monitoring the movement’s activities and (5) monitoring the management of donations received at the local level for the COVID-19 response.

The COMVID COVID-19 movement was able to start its activities with seed money provided by the non-governmental organisation called Results for Development through the African Collaborative for Health Financing Solutions project (ACS). This money was used to purchase sensitisation and protection equipment, including posters, tape recorders and alcohol-based hand sanitiser for use by the CCVS to conduct their field activities, including door-to-door outreach. The CCVS worked as volunteers and their members were trained in sensitisation techniques, hand washing and various protective measures by Red Cross staff and health workers. The innovative and promising nature of the COMVID COVID-19 movement in its approach and operations assisted it to be included in the national COVID-19 response plan. This gave credibility to the movement in the eyes of the national and international donors, allowing them to mobilise some financial and material resources.

While these resources were insufficient to meet the needs on the ground, they did help to strengthen awareness activities. As a result, the CCVS conducted multiple sensitisation activities reaching approximately 30 000 households, and 1000 awareness-raising activities in public places (markets, places of worship, entry points to the city of Ouagadougou, bus stations, water fountains, informal living settlements, hair salons, stores, tea bars, kiosks and restaurants). The COMVID COVID-19 movement also produced a music video and short sensitisation videos that were broadcast on TV, radio and social networks, and hosted conferences and radio programmes in both French and the main local languages. Also, the resources enabled the CCVS to produce liquid soap, alcohol-based hand sanitiser, face masks and hand washing devices that were distributed to 21 000 vulnerable households and placed in markets, schools and places of worship. Lastly, the CCVS participated in the identification and follow-up of COVID-19 contact cases, with the collaboration and technical support of the Health Emergency Response Operations Centre (CORUS) of the Ministry of Health. Any individual presenting with COVID-19 symptoms was sensitised and taken to a health facility for further investigation, or the case was notified to CORUS. If a case was confirmed, the CCVS would trace the contacts and follow-up with them at home. At least three home visits were conducted to ensure that these contacts would not subsequently develop any signs of the disease and would respect the quarantine instructions. This activity lasted for 3 months, from August to October 2020, and resulted in the visit and sensitisation of nearly 1000 households and the identification of 40 suspected cases.

The COMVID COVID-19 secretariat faced challenges in monitoring and evaluating the activities of the CCVS. Even though a WhatsApp group and an online form had been created to help the CCVS report their daily achievements and challenges, complaints about the time and internet connection availability were recurrent. Many of the challenges encountered related to the lack of a performance framework accepted by the stakeholders to objectively measure the achievement of the different objectives of the movement.

To fund the implementation of activities, the COMVID COVID-19 movement secretariat and the CCVS mobilised material and financial resources at the national, international and local levels, but this was mostly done in a fragmented and uncoordinated manner. Moreover, the lack of formal and systematic accountability tools made it difficult for the CCVS to capitalise on the resources collected and constituted a shortcoming in transparency and accountability, which sometimes led to mistrust among the actors. A consultation workshop that brought together the different stakeholders of the movement was organised to find solutions to these issues, and it was decided that henceforth, each actor would communicate to the other stakeholders the cash and in-kind donations they received.

Enabling factors and constraints faced by the ’Communities are committed to Eradicate COVID-19’ movement

One of the assets that facilitated the implementation of the COMVID COVID-19 movement’s activities was the profile of the actors who ensured its coordination and constituted the CCVS. Most of the stakeholders involved in the movement had a solid community base, were members of several networks at national and/or international level and had good reputation and legitimacy at the local level. Therefore, the proximity of the members of the CCVS to the local populations strengthened mutual trust and facilitated the implementation of the activities, especially at the beginning of the pandemic when there was great panic since the disease was unknown and the predictions for Africa were very bleak.17 The COMVID COVID-19 movement, thanks to its community-based approach, filled a gap that the government had not yet been able to address, as most of its efforts had long been focused on addressing the clinical and biomedical aspects of the disease. Another factor that facilitated the implementation of COMVID COVID-19 activities was the eventual inclusion of the DES-ICI platform in the national COVID-19 response plan, which gave them legitimacy with their partners.

However, the voluntary nature of participation in the COMVID COVID-19 movement ended up demotivating some CCVS, making it difficult to mobilise their members in the long run. In fact, most community-based organisations did not have a solid funding base, so the continuation of the activities of the CCVS under these conditions constituted an enormous opportunity cost for them. As a result, these actors, in their constant search for new opportunities, were more and more inclined to devote their time to other more lucrative activities or projects. Keeping these actors motivated and engaged in the COMVID COVID-19 movement required the creation of other incentive mechanisms, particularly extrinsic ones, such as being financially compensated for efforts to carry out activities, receiving training in resource mobilisation or being on the Ministry of Health’s short list for funding to implement community activities. Furthermore, as COVID-19 evolved, its relatively low lethality, the numerous conspiracy theories as well as the polemics around vaccination spread through social networks and the media led to a certain distrust of the disease among the population, some of whom no longer even believed in its existence.14 This situation caused awareness-raising activities to become less and less effective and curbed the adherence of most of the population to the protective measures, as illustrated during the presidential election campaign in November 2020, when thousands of people attended large meetings every day, without any precautions. All these factors made it difficult for the movement to scale up to other cities, despite the increasing number of COVID-19 cases that were still being reported regularly by CORUS.

The main lessons we can learn from the above are that effective and early involvement of community and civil society actors in activity planning and joint decision-making is important to tackle health emergencies. This is especially true if they are firmly anchored in local settings as this proximity to communities is a major asset for carrying outreach activities to ensure response effectiveness and public acceptance of protective and prevention measures. Besides, to secure an effective and sustainable contribution of community actors to activities, capacity building and provision of financial and material resources are essential, as is the ability to maintain constant public attention and trust, especially when the situation becomes volatile.