COVID-19- WHO boosts Plateau state's home-based care strategy

Jos - In Plateau state, north-central Nigeria, the number of COVID-19 positive patients was on the rise between August and September, following a major push in sample collection and testing. The state, a picturesque region and a major mining hub in the West African country, reinforced efforts to systematically and widely test (10,000 tests per week) its 4.615,698 million population based on available resources, resulting in the significant numbers recorded. However, health workers in the state faced a challenge: Case numbers were rising faster than the available bed spaces, thus there was a need to innovate. States across the country also face similar scenarios and are trying to implement innovations to adapt. One solution Plateau State has adopted, with support from the World Health Organisation (WHO), is the Home-Based Care method of treatment, which sees asymptomatic and mild cases of COVID-19 treated in their homes with regular visits from health workers. In some cases, patients are treated as ‘outpatients’, that is, they come to the hospitals at scheduled times while maintaining prevention measures including physical distancing of at least one meters, hand washing and mask wearing. Health workers in the state say the strategy has relieved hospitals and has also worked for patients who prefer to receive treatment in the comfort of their own homes. So far, 99.5% of  COVID-19 patients are being treated under the Home-Based Care (HBC) strategy than as in-patients in treatment centres, just as rising infections have slowed down.


Technical Contacts:

Dr Rex Mpazanje; Email: mpazanjer [at] who.int; Tel: +234 803 960 0874

Dr Williams Wadzingi; Email: wadzingiwil [at] who.int; Tel: +234 703 490 3060

Visiting patients at home
A health officer visits a COVID-19 patient at her home in Agwan Rogo area of Jos. Photo: WHO/Bridget Jangfa
A health officer visits a COVID-19 patient at her home in Agwan Rogo area of Jos, Plateau State capital, where she has been receiving treatment. The aim of treating patients at home is to ease the pressure on the state’s healthcare infrastructure. Plateau State, which is seeing a rise in infections, has recorded 3,869 cases of the disease by November 30, 2020. About 90 per cent of those patients are being treated in their homes under the HBC strategy which started in July, four months after the COVID-19 outbreak in Nigeria. WHO defines home-based care (HBC) as any form of care given to ill people in their homes. Such care may be physical, psychosocial or palliative. In the context of the limited resources available, HBC has become a critical component of the COVID-19 response in Plateau state. Patients are often visited at least three times throughout their quarantine or treatment and called frequently on the phone in between visits.
Asymptomatic COVID-19 cases treated as out-patients
A nurse checks on a toddler patient at the Agwan Rogo Primary healthcare Center in Jos, the Plateau state capital Photo: WHO/Bridget Jangfa
Asymptomatic COVID-19 cases are being treated as ‘outpatients' here, that is, they visit COVID-19 treatment centres for regular checks. This strategy is part of the Plateau State government’s modified HBC system which is designed for efficiency. The COVID-19 isolation capacity in the state comprises five isolation centres with a total of 217 bed spaces. Presently, there are less than 50 patients on admission.
Home-based care remains safe and effective
Nurse Theresa Jugu Stephen OIC administering medication to asymptomatic patient on HBC Photo: WHO/Bridget Jangfa
Patients under HBC are given treatments provided freely by the state regularly to manage their symptoms. The strategy is prescribed by WHO in resource-limited settings and is a good fit for Plateau state. “Home-Based-Care has proven to be a safe and effective alternative for providing health services. The state provides medication and preventive materials such as face masks and hand sanitisers via its emergency operations center (EOC) to support all patients on HBC so they don’t spread the disease to family members. This is in addition to the deployment of 100 Red Cross Volunteers supported by WHO to monitor and trace persons of interest in hotspots,” says Wadzingi Williams, WHO state coordinator for Plateau state. The number of confirmed cases within the state is 17 times more than the available intensive care beds. By the end November, there were 485 patients on HBC. Of the 3,869 cases treated overall by the same month, 2,962 were HBC patients: more than 97% of the total cases discharged and no household members have been infected during the same period, according to Mr Williams.
COVID-19 mild symptoms were enrolled under HBC
Nurse guiding COVID-19 patient on recommended drug dosage . Photo: WHO/Bridget Jangfa
Home-Based Care in Plateau State commenced in mid-2020 with a few patients who met the relevant criteria for this option: that is as cases increased, asymptomatic COVID-19 patients or those with mild symptoms were enrolled under HBC. The strategy was necessary: Less than 60 days into the outbreak of the novel coronavirus in Plateau State, the isolation centres became full with positive patients. Resources were inadequate, and capacity was insufficient to meet the demand for health care services. To avoid a situation where a backlog of positive cases would be allowed to roam the streets and potentially infect others, the state had to fully embrace the HBC approach.
Capacity building ongoing to increase effectiveness
Health workers in Plateau state attend a training centred around managing COVID-19 patients in their homes Photo: WHO/Bridget Jangfa
WHO in collaboration with the state government and other partners like the International Red Cross Society continue to train caregivers on how to keep themselves and their patients safe while delivering care at home. Health workers are also being trained for community case detection and contact tracing to improve case detection. More than 120 field volunteers responsible for monitoring persons of interest (POIs) within the period of their 14-day isolation have been trained. These field volunteers monitor patients and visit them at least thrice during the quarantine period. A separate 150 health workers across the state have been trained on disease diagnosis, case management and Infection Prevention and Control (IPC) as relating to HBC. Surveillance officers are also being taught how to monitor the clinical evaluation of COVID-19 patients while in their homes and how to monitor that patients’ homes are set up properly to avoid further spread.
Testing COVID-19 samples
Medical laboratory officer tests COVID-19 samples at a testing centre in the Plateau State Hospital, Jos Photo: WHO/Bridget Jangfa
A medical laboratory officer tests COVID-19 samples at a testing centre in the Plateau State Hospital, Jos. Around the state, community informants such as Patent Medicine Vendors have been sensitized and trained to identify suspected cases and enhance sample collection in all 17 local government areas. Persons with Influenza-like illnesses, severe acute respiratory infection (SARI) or a history of fever or measured fever of 38℃ or more with onset within the last 10 days, are all eligible for COVID-19 testing. The state conducts an average of 1000 tests per week.
Ramping up sample collection
sample collection for COVID-19 testing Photo: WHO/Bridget Jangfa
The Plateau State health ministry, supported by WHO and the Nigeria Center for Disease Control (NCDC) continues to ramp up sample collection for COVID-19 testing. The state now has 23 mobile testing centres across its 17 local government areas. To get more people to testing centres, civil servants at workplaces are being mobilised for advocacy. Health teams have also conducted advocacy and sensitisation visits to community and religious leaders to encourage community compliance to testing. However, COVID-19 stigma is keeping some people from testing. By November, 32,271 people had been tested in the state. Since the intervention by WHO and its partners, test positivity in the state has been declining and was below 5% by November 25, down from over 30% some weeks before.
Recording timely information
Health worker taking patient’s relevant information Photo: WHO/Bridget Jangfa
HBC, while proving successful in Plateau, faces a few obstacles. The stigma attached to COVID-19 disease in the state and across Nigeria continues to pose a challenge, leading some positive patients treated as outpatients to shun treatment centres at their scheduled times. Poor records have also frustrated health workers: at the start of the program, it was difficult to trace some patients because of wrong addresses or wrong phone numbers provided due to fear. Now, officials take down relevant information at the point of testing, whether the individual is positive or not, to reduce the chances of recording wrong contact information.
Health talks on COVID-19
Volunteer student nurse, Hassana Hussaini taking patient’s relevant demographic information. Photo: WHO/Bridget Jangfa
Despite the challenges, health workers at health care centres say they continue to give health talks on COVID-19 to patients, even those who have come for other purposes. The talks are important especially as WHO experts warn of a second wave hitting African countries as COVID-19 restrictions are rolled back across the continent.
“I advise them on personal hygiene in this trying period and on washing their hands, wearing facemasks and social distancing,” says Nurse Zaharau Aminu Baba, 29. But many patients do not follow the guidelines, Nurse Baba says. “It’s a real problem for us health workers.”
With rising cases of COVID-19, Plateau to continue home based care
WHO personnel speaks to community members during a recent HBC visit to the Agwan Rogo community in Plateau state. Photo: WHO/Bridget Jangfa
Despite the challenges faced, Plateau State continues to battle Covid-19 with the HBC strategy. In several communities, WHO and state health officials are sensitising primary health care providers and patent medicine vendors on Community Case Definition for COVID-19 to enable quick detection. For the wider public, the state and WHO are supporting the use of radio jingles, TV commercials, as well as health care shows, to continue to educate people on COVID-19 prevention and symptoms as well as on the HBC method of treatment. Dr Nimkong Lar Ndam, the Commissioner for Health in Plateau in a recent statement pledged to keep the pressure on the COVID-19 fight. He also appreciates WHO’s support. “Thanks to WHO for continued support and capacity building of health workers on infection prevention and control as well as case management,” Commissioner Ndam said. “The support that is very important to us in Plateau State."
For Additional Information or to Request Interviews, Please contact:
Ms Charity Warigon

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Email: warigonc [at] who.int