A local response to a global problem: a programme to combat COVID-19 through empowerment of rural communities in Chiapas, Mexico

Abstract

Background: The Mexican State of Chiapas is the scene of serious social inequities, with more than 75% of the population living in poverty. The economic vulnerability of the population has been aggravated by the arrival of COVID-19. Since the national declaration of the pandemic on March 31, 2020, and until January 18, 2021, Chiapas, with a population of around 5·2 million, has registered 8745 positive COVID-19 cases and 1259 deaths from the virus. Since mid-April, 2020, Compañeros En Salud (CES) has been supporting nine rural communities in the Sierra Madre region of Chiapas to fight the pandemic through ten primary health-care centres and a team of over 40 community health workers. Here, we describe a programme to protect vulnerable communities from the health and economic burden associated with COVID-19 that joins efforts with the Mexican Ministry of Health to provide a timely and effective response to the challenges posed by the pandemic. Methods: We identify suspected COVID-19 cases through primary health centres and support their self-isolation through provision of essential groceries and hygiene supplies. These efforts are complemented by contact tracing and home follow-up of suspected cases. As a way to guarantee the sustainability of the programme, we engaged staff already working in the organisation for its implementation. Core nurses, nurse aides, and community health workers, who used to provide home follow-up for pregnant women and patients with chronic conditions and mental health disorders were trained to conduct home follow-up of COVID-19 suspected cases and contact tracing. Findings: Between April 20, 2020, and January 18, 2021, 287 suspected COVID-19 cases and 1111 contacts were identified in the rural communities supported by CES and 109 cases (38%) and 796 contacts (72%) have started follow-up with the CES team. In the case of contacts, median time between the last contact with the suspected case and the first visit by a member of the CES team is 4 days. We have supported 650 suspected cases and their families with essential groceries and hygiene supplies. Interpretation: As the pandemic progresses, further analysis of the effect of the implemented measures on the transmission rate of the virus as the pandemic progresses should be done, along with comparisons of the outcomes in our rural communities with other settings of similar characteristics where isolation and contact tracing measures have not been implemented. Funding: Partners In Health.