At the entrance of the Katima Mulilo State Hospital is a large tent. There, a 30-year-old Josephine Poniso gracefully interacts with an older male patient seeking medical attention. 

She encourages the patient to wear a mask and then explains that he would need to be screened for symptoms of Covid-19 before proceeding to the hospital. 

Poniso is a Senior Community Health Worker for the Community Based Response Initiative (CBRI), a project funded by the World Health Organization in collaboration with the Ministry of Health and Social Services.

Namibia is part of 15 countries in  the WHO African Region (AFRO) implementing the CBRI which aims to improve detection and response of COVID 19 as well as contribute to the reduction of COVID-19 cases and death in the selected member states. 

Mrs Klaudia Inghepa, the CBRI Coordinator in Namibia says the project was initiated in July 2022 in Namibia and will conclude August 2023. Katima Mulilo is one of 14 Health Districts in which the Namibia CBRI project is being implemented.  

 The tent where Poniso is stationed is divided into three compartments- a screening point, a testing point, and a post-testing point. 

The tent serves as a triage point to screen for Covid-19 cases before patients proceed to the hospital for their initial treatment.  

While stationed primarily at the tent, Poniso, who works with four other colleagues, also goes into the community where she traces contacts who might have been exposed to Covid-19. 

But, the starting point is the tent. 

Here, patients are first educated on ways to prevent Covid-19 and to recognize symptoms. Next, the patients are asked a few questions using a semi-structured questionnaire to determine their risk and exposure to the Covid-19 virus. 

“If the patient has more than three of the symptoms listed on the paper they are referred to the next tent for (Covid-19) testing,” explains Poniso. 

If a patient tests negative they are free to go to the outpatient department of the Katima Mulilo State hospital to seek medical attention. 

Those who test positive are required to provide information that would assist Poniso and her team to go to the patients’ homesteads to trace cases that might potentially be positive.  

Each time a patient tests positive for Covid-19, Poniso must go to the patients’ homesteads. 

When tracing contacts, Poniso is always accompanied by a nurse or two depending on the number of positive cases tested on that day. 

When she tests patients and their contacts in the field, the nurses are there to treat the people who test positive to Covid-19. 

“Before we test them, we explain why we are doing this. Most times they are understanding but we have patients who refuse to be tested and in that case, we cannot force them but if the person is symptomatic, especially in the field, we treat them because we go with nurses,” Poniso explains. 

The main reason patients refuse to get tested is their perception that it is painful to have their noses “poked”.  

“But we make sure that every person entering the hospital has a mask and is wearing it properly,” she adds. 

In the tent, the positive cases are referred to the hospital for further management. 
There are at least eight positive cases daily from the triage. A few other cases are detected at the casualty department of the hospital, Poniso explains. 

When doing outreach in the villages and locations around Katima Mulilo, Poniso and the team supply the communities with hand sanitizers, masks and emphasize on the importance of preventing Covid-19. 

This time, representatives from the WHO are accompanying Poniso as she goes in the field for outreach.

The first stop is Namalubi in Katima Mulilo where 63-year-old Edinah Sitali lives. 

She tested positive for Covid-19 in January this year after seeking medical attention at the Katima Mulilo State hospital. “I was weak and had difficulties breathing,” she recounts. At the hospital, her first point of contact was Poniso and the team. 

“When she tested positive, we had to come here at Namalubi to test her family who all tested negative,” explains Poniso. When doing contact tracing, Poniso and the team educate individuals how to protect themselves and their families from Covid-19. 

She encourages them to get vaccinated, to mask up when going to public places, and to wash their hands as frequently as needed. Sitali appreciates the gesture. 

“I am glad that they are moving from house to house sharing about Covid-19, testing people who might have been exposed to the virus and encouraging people to get vaccinated,” says Sitali. 

Even though her family tested negative for Covid-19, she is happy that the team reinforced the message of preventing Covid-19. “They have helped a lot of people by doing this,” says Sitali. 

She adds that some people will not necessarily seek medical attention if they are showing symptoms suggestive of Covid unless they are gravely ill because of the distance they must travel to seek medical attention. 

So far, the project has reached over 16,615 people in the Zambezi region with health education, testing, as well as supplies such as masks and sanitizers. 388 people have been vaccinated in the region since inception in 2022 through the project.  

“The vaccinations are picking up. People want to be vaccinated because they don’t want to get sick and die,” Poniso explains. 

Windhoek, Rehoboth, Okahandja, Gobabis, Karasburg, Lüderitz, Walvis Bay, Opuwo, Engela, Oshakati, Outapi, Rundu, and Onandjokwe Health Districts are the other 13 districts implementing the project. In total, 7773 people have been vaccinated, 3504 test were conducted, and 107,362 reached with health education since inception of the project in the 14 selected health districts.  

Inghepa is pleased with the outcome and commitment of the work being done in Katima Mulilo. “They have all the systems in place,” said Inghepa, highlighting the determination of the CBRI team in the Zambezi region. Nosiku Mundia, the Health Information System Officer in the Zambezi region can attest to the commitment of the CBRI team in the region. 

One team is stationed at the hospital while the other team is stationed at the Katima Mulilo clinic.

“The people the WHO has employed are very active. The numbers of those vaccinated and reached with masks and sanitizers has increased. They go out three days in a week for outreach services,” said Mundia.  

But, there are challenges such as the shortage of transportation and human resources that makes it difficult to reach all corners of the region. 

“Our region is very vast. People (nurses within the hospital) have relaxed on testing and following up on people. There is a big change because of the Community Health Workers. They are doing all of the Covid-19 outreach services,” said Mundia. 

Poniso is also proud of her contribution to the project. “I have gained a lot of valuable skills but I have also witnessed change. I have seen an uptake in vaccination numbers since we started on this project,” she says proudly.