OPINION - Fighting COVID-19 where it matters most: Rural communities

by Willy Foote and Raj Panjabi | Root Capital and Last Mile Health
Tuesday, 25 August 2020 18:37 GMT

Farmer Japheth Kibaari tends to his sorghum in Meru, Kenya, November 2015. Photo courtesy of Stuart Freedman/Root Capital

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Infections are spiking where you might least expect: in remote rural communities, from the Peruvian Amazon to the dry zone of Kenya

COVID-19 once seemed like a problem primarily for dense urban areas. But now, infections are spiking where you might least expect: in remote rural communities, from the Peruvian Amazon to the dry zone of Kenya. And it’s in these areas where our biggest fight against the pandemic will unfold.

Here in the United States, we’ve seen that communities of color are dying of COVID-19 at disproportionate rates due to systemic racism. In Africa and Latin America, centuries of colonialism and exploitation have similarly resulted in higher pandemic-related risk today. That risk is compounded in remote rural areas, where it can be extremely difficult for service providers—including governments—to reach people in need.

Difficult, but not impossible. We lead organizations dedicated to meeting, respectively, the economic and health needs of last mile communities. What we’ve learned over decades of experience is that these communities have resources and infrastructure ready to be mobilized in times of crisis. By leveraging these resources, we can preserve both lives and livelihoods in vulnerable rural areas.

The first step is to invest in community health workers. A billion people living in remote communities have no access to essential health services. Well-trained community health workers—equipped with basic medicines and supplies, and supervised by nurses—can bridge this gap. These workers serve as the eyes and ears of the health system and are often the first to flag potential outbreaks. What’s more, they are recruited directly from impacted communities and paid for their work—giving people a crucial economic lifeline as other sectors shut down. In the age of remote learning, we can leverage digital tools to quickly up-skill this essential workforce. For example, Last Mile Health is providing education and training resources—on COVID-19 and beyond—to local health leaders through its Community Health Academy.

Second, we must bolster pre-existing platforms that can effectively deliver critical goods and services to remote communities. Rural families primarily depend on small-scale farming, and many sell their harvests to local agricultural businesses, such as farmer cooperatives. In normal times, these businesses are skilled at delivering training, fertilizer, seeds, and other inputs to their farmer-members. Now, they can act as cost-effective, dispersed platforms through which to distribute soap, personal protective equipment, and information on disease prevention. Root Capital has reached hundreds of thousands of farming families in the last few months by working with local agricultural businesses to purchase and distribute badly needed health and hygiene supplies. While agriculture is one platform, similar opportunities may exist in other sectors that are already embedded in rural communities.

Finally, we’ve learned from past epidemics—such as the Ebola outbreak in West Africa—that the public health response must give equal attention to economic impacts. Governments around the world have provided various forms of economic relief to their citizens, and the global community should deploy these same models to support hard-hit rural areas. A global response could include direct cash transfers to rural families, particularly those that work in hard-hit industries. It could also subsidize small businesses that provide income and employment to millions in rural areas through interest rate relief, debt forgiveness, grants to maintain workforces, and liquidity management measures. According to the International Labour Organization, 70% of employment worldwide is in small businesses (comprised of less than 50 employees). A concerted effort to ensure small business survival globally would pay dividends in both health and economic terms.

These three steps are just one part of what must be a comprehensive response to preserve lives and livelihoods in remote rural areas. Crucially, these efforts must proactively include women, youth, indigenous populations, and others that are disproportionately impacted by this pandemic.

Of course, mobilizing billions of dollars in public and private capital to address the impacts of COVID-19 in far-flung communities around the world is a tall order when so many of our own neighborhoods are still reeling. But it’s not just the right thing to do; it’s also vital to our own health and economic security. The virus doesn’t respect borders, and everything we do to contain its impacts now—especially in the most at-risk communities—will secure our own future.

This moment calls for unprecedented, cross-sector, and multilateral collaboration. But by leveraging the ingenuity and entrepreneurship of rural communities, we can rebuild better in the wake of COVID-19.

Willy Foote is Founder and CEO of Root Capital. Dr. Raj Panjabi is CEO of Last Mile Health and Assistant Professor at Harvard Medical School and the Division of Global Health Equity at Brigham & Women’s Hospital.

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