Integrated Framework, Part 2: Integration of Multi-Sectoral Services and Cross-Cutting Themes

The integration entry points described in the Integrated Framework, Part 1 can be considered as good practices or principles of integrated programming. The integration entry points explain how an organization or coordinating agencies can provide the foundation for effective response integration in the field and help efficiently meet the holistic needs of affected populations. Humanitarian NGOs are currently programming for COVID-19. This Integrated Response Framework shows how these entry points can be used within each sector to promote holistic programming for affected communities through the lens of two specific NPIs: household quarantine or household isolation na quarantine facilities or community isolation centers (CICs). It is worth considering that not all sectors or activities may realistically be integrated. However, agencies can prioritize the broader goal of integration with affected individuals at the center of the response activities. In that case, each sector integrates where relevant, then siloed programming is avoided, thereby accomplishing the objective of integrated, holistic multi-sector programming. As the COVID-19 response is ongoing and dynamic, the activities and adapted programming are constantly changing. They will have to be implemented with the context and severity of the COVID-19 outbreak in mind.

The sections below present illustrative activities (this is not a comprehensive list of activities) per sector to (1) promote adherence to physical distancing NPIs, namely during household quarantine or household isolation and in quarantine facilities or CICs; (2) highlight cross-cutting themes across the sectors; and (3) provide examples of how overall sector or technical area programming has been adapted for COVID-19. For further reference, existing resources, guidelines, and frameworks that have been produced by the humanitarian community to support COVID-19 programming are listed at the end of every section for the specific sector or technical area.

Afya Maji, Usafi wa Mazingira na Usafi (WASH)Ulinzi Lishe Food Security

Household Quarantine and Household Isolation

Programu ya Afya ya Jamii

Community leaders or community-appointed focal points can assess the residential setting in preparation for household quarantine and/or isolation.

Maintain physical distancing (no touch, safe distance of 2 meters) and use of appropriate personal protective equipment (PPE)/face coverings while conducting assessments. Assessments will include checking for access to WASH facilities, environmental health concerns including the type of cooking stoves, space limitations, household composition, housing quality (animal/vector exposure risk), noting high-risk persons, chronic conditions requiring medication, and potential protection risks.

As much as possible, the assessor should conduct the assessment outside the household, relying on household members’ responses to complete the assessment.

CHWs should conduct daily visits to quarantined households while equipped with appropriate PPE/face coverings and maintaining physical distancing. Where CHW visits are not possible; alternatively engage well-oriented family members. During these visits, they will:

record temperature (the quarantined/isolated individual could do this with CHW inspection);
monitor symptoms;
assess for co-morbidities or other health-related concerns that need medical attention;
distribute and dispense medical treatment to households for individuals with chronic health conditions as prescribed by a medical provider; distribute contraception; distribute kits (such as dignity kits) as needed;
inform and ensure household level infection, prevention, and control (IPC) measures are in place;
provide referral information as needed.

Community health surveillance teams should gather information on contacts from quarantined and/or isolated household members. They should then provide information to community-based surveillance teams and child protection teams (where relevant). RCCE interpersonal communication principles should be incorporated into any community-based surveillance standard operating procedures and trainings to ensure community-level trust and compliance.

Social workers or community-appointed protection advocates or volunteers should conduct household visits to share basic psychosocial support activities that the household can do while quarantining. The advocates can raise awareness on protection issues such as gender-based violence and child protection. Ensure that all outreach workers are familiar with the referral system.

Develop a strategy for RCCE to support a contact tracing initiative. Contact tracing can only succeed if people accept tracing as an effective measure.

Identify people that communities trust and enlist these people as message validators. These people may include faith and ethnic group leaders, community leaders, business leaders, leaders within vulnerable populations, teachers, or public officials. Use existing community platforms to ensure non-stigmatizing, gender-, age-, and disability-appropriate RCCE materials are accepted.

Understand risk communication principles and apply them – express empathy often, gain and maintain trust, respect confidentiality, and evaluate and improve communication efforts. Provide accurate information and reduce fear and stigma of what household quarantine is and why it is important to families and communities. Determine messages and channels for relaying messages to cases, contacts, and health care providers.

Ensure staff, CHWs, social workers, and other community outreach workers are supported in all decision-making, including guidelines for what to do if families have to separate. Provide detailed criteria for home-based care and/or end of life care if the family cannot obtain a referral.

Ensure staff, CHWs, social workers, and other community outreach workers are never in a position to solely decide who is and who is not to be referred to treatment facilities.

Reproductive, Maternal, Newborn, Child, and
Adolescent Health (RMNCAH)

Depending on the context, community-based sexual and reproductive health (SRH) extension workers, such as Community Health Assistants (CHAs), Lady Health Workers (LHWs), or Traditional Birth Attendants (TBAs), who under normal circumstances deliver RMNCAH messaging in communities, should continue to engage adolescent girls and women in household quarantine and/or isolation conditions to determine their needs and provide contextualized SRH messaging. If these cadres conduct outreach visits, equip them with appropriate PPE/face coverings per their risk level. Contextualize messaging based on community-level data. Messages should include information about COVID-19 danger signs, as well as information about where people can find routine services such as contraceptives, STI treatment, and ART. The messaging should also include links to other referral services, such as mental health and psychosocial support, gender-based violence services, or social support, when appropriate.

When appropriate, train CHAs, LHWs, and TBAs to counsel and gain consent for referrals. They should distribute and provide clients with PEP and emergency contraception, condoms, STI treatment; chlorhexidine for cord care (as per national recommendation); clean delivery kits, misoprostol for PPH prevention, and short-acting contraception methods.

CHAs, LHWs, and TBAs should provide health messaging following physical distancing precautions to support basic antenatal and postnatal care at clients’ homes, which should include information about maternal and newborn danger signs. Use text messaging to send pregnant girls and women information on danger signs and other pregnancy information during COVID-19.

CHAs, LHWs, and TBAs should provide clear, locally contextualized messaging on the importance of attending the health facility if a woman or adolescent girl is in labor or if any danger signs are present for the woman or newborn.

When appropriate, use chlorhexidine for cord care (as per national recommendation). Distribute clean delivery kits and misoprostol for PPH prevention.

If appropriate, CHAs, LHWs, and TBAs should provide family planning (FP) counseling and/or provide contraceptive commodities (including emergency contraception). These practices ensure the continuation of preventative methods and protection from unwanted pregnancies. Otherwise, CHWs can provide information about where routine services, such as contraceptive provision, are available to women, men, adolescent girls, and adolescent boys.

Establish community feedback mechanisms (including child-friendly feedback mechanisms). Collect the feedback and address concerns with a multi-sectoral response, where needed, link to other response areas to share feedback data for a more holistic response.

Community leaders can help identify “community ambulances” and drivers to transport women and girls in quarantine to BEMONC/CEMONC facilities for delivery, post-partum complications, newborn complications, etc. This ambulance should also be reserved for gender-based violence survivors to access health facilities and other related referral services. Use text messaging, community radio, existing hotlines, or other communication channels to ensure women and girls and their families receive contact information for these community ambulances.

Afya ya Akili na Msaada wa Kisaikolojia
(MHPSS)

Train social workers or community-appointed MHPSS focal points on stigma and psychological first-aid and para-professional counseling (lay model) to provide psychosocial support to quarantined or isolated household members, focusing on stress management and positive coping strategies. Use text messaging to share coping tips and information for Hotline numbers.

Train community leaders and trusted community spokespersons and advocates to engage positive deviance techniques to reduce community stigma associated with COVID-19.

Equip social workers with relevant referral information for MHPSS referrals, including Hotline/Helpline numbers and community-based MHPSS focal points.

Ensure everyone, including children, are receiving Psychosocial Support (PSS) Kits and MHPSS messages. These kits and messages are context-specific and can include “Stress Busters” and similar relaxation activities appropriate for children and parents/caregivers, basic art supplies (pencils, crayons, modeling clay), paper or notebooks for drawing and writing, children’s books and toys.

Quarantine Facilities and Community Isolation Centers

Programu ya Afya ya Jamii

Determine number, composition (i.e., gender, age), and functions of the team appointed to quarantine facility/CIC. Prioritize training cross-sectoral positions to minimize the number of people, times, and contact points between the service provider and those quarantined.

Determine SOPs for:

movement of staff within the facility
WASH protocol, including IPC management within the facility
security protocols within the facility (ensuring both male and female staff are present at all times)
protection protocol within the facility for childcare arrangements, including protocols for unaccompanied minors
clear reporting lines, key actions in protection scenarios, and draft scripts for responding to disclosure
dietary and kitchen protocols
housekeeping protocol
daily monitoring of symptoms of admitted persons
isolation of positive, asymptomatic cases (in the case of quarantine facilities) and referral for household quarantine or isolation where possible if isolation at a facility is not feasible
referral to treatment facilities for case management of positive patients meeting case definition for treatment
referral to other programs (nutrition, protection, etc.)
principles of RCCE/interpersonal communication to build trust and ensure compliance

Train quarantine facility/CIC staff on PPE conservation strategies and ensure appropriate PPE use within the facility, along with physical distancing measures (when possible).

Determine triage protocol and safe patient flow to:

isolate those exhibiting symptoms to receive priority testing if in a quarantine facility and,
refer the patient to a treatment unit for advanced care if they can no longer be treated in a CIC.

Communities, including children, should be involved in all stages of the process, such as conducting risk assessments, setting up quarantine facilities/CICs, including planning, implementation, maintenance, and operation.

Ensure consent materials are developed and translated into the respective dialects. Train staff to provide support for consenting patients before admission. In CICs, the staff is also trained to obtain informed consent from symptomatic caregivers who wish to bring an asymptomatic child into the facility or an asymptomatic caregiver who wishes to accompany a symptomatic child.

Ensure that all staff is trained in information sharing data protection protocols and that an appropriate focal point for data protection is identified.

Staff should receive the opportunity to decline to support the response or negotiate different responsibilities at the start or at any point during a response should they deem their involvement too risky either to themselves or others. Consider recruiting and training additional staff should existing staff fall ill or decline to work on the response.

Ensure that all staff is trained in, and aware of, the expectation that they provide kind, caring, respectful, safe, effective, and inclusive services.

Reproductive, Maternal, Newborn, Child, and
Adolescent Health (RMNCAH)

Ensure that referral services are in place for emergency cases and that facilities are linked with Basic Emergency Obstetric and Newborn Care (BEMONC) and Comprehensive Emergency Obstetric and Newborn Care (CEMONC) centers.

Ensure that basic supplies are available as required (dependent on the level of staffing and health services available at the facility). At a minimum (when appropriate to the context), this should include PEP and emergency contraception, condoms, STI treatment, chlorhexidine for cord care (as per national recommendation), clean delivery kits, misoprostol for PPH prevention, and short-acting contraception methods.

Develop and disseminate clear SOPs for referrals between BEMONC/CEMONC facilities and COVID-19 quarantine facilities, including up-to-date mapping of facilities.

Ensure the quarantine facility is equipped with an appropriate area (and available skilled staff, drugs, and equipment) to manage common obstetric complications for women and newborns who cannot be transferred to maternal health facilities.

At a minimum (when appropriate), facilities should have available emergency contraception, condoms, and short-acting contraceptive methods.

At a minimum (when appropriate), facilities should have available emergency contraception, condoms, and short-acting methods of contraception.

Develop and disseminate clear SOPs for referrals between BEMONC/CEMONC facilities and COVID-19 quarantine facilities. This activity includes transportation options for pregnant women to BEMONC/CEMONC for facility-based deliveries.

Afya ya Akili na Msaada wa Kisaikolojia
(MHPSS)

Recruit new staff members for a well-being role. Alternatively, identify and build the capacity of a staff well-being focal point to ensure psychosocial support to staff (preferably using remote options but in-person if needed).

Consider playing messages on radios in quarantine centers to dispel myths and stigmas around COVID-19. Promote positive messages on quarantine facilities, share coping and stress management strategies, and provide referral numbers for protection issues or special needs.

Prioritize access to specialized mental health services for persons with pre-existing mental health conditions or those with new acute presentations (in coordination with health teams).

Additional COVID-19 Programming Adaptation Considerations

Programu ya Afya ya Jamii

Consider immediately identifying equal numbers of male and female community leaders, community focal points, and community health workers (CHWs). Train them on COVID-19, including the local case definition, no-touch protocols, PPE, relevant risk communication messaging, and where to refer for various sectors’ (health, nutrition, MHPSS, protection) services.

Provide technical guidance if needed to MOH to develop specific reference terms for CHWs on their role within the COVID-19 response.

Acknowledge the inherent risk related to isolation measures and strengthen or establish safety measures to identify context-specific risks. Ensure that adequate measures are taken to establish, run, and monitor the centers.

Take proper precautions (and in some cases, pause or alter non-essential plans) for field work related to non-COVID-19 research on people and animals to protect all species’ health and safety.¹¹

Note on PPE

PPE is routinely used every day by health care personnel as a form of infection prevention and control to protect themselves and patients. In the context of COVID-19, PPE includes gloves, medical masks, respirators, goggles, face shields, and gowns. Given the general shortage of PPE, WHO recommends that PPE be reserved for health care workers and medical mask use for those who are confirmed with COVID-19 to reduce transmission.¹² Non-medical masks or face coverings are recommended for the general public.¹³ Governments and NGOs determine PPE distribution to staff, health workers, outreach workers, etc. based on PPE availability in their local markets. This guidance refers to the use of PPE/face coverings, acknowledging that PPE use will be practiced differently based on national directives, organizational policies, and PPE availability.

Consider advocating with national and local governments to ensure the continuation of community health services and the rapid adaptation of national protocols to ensure safe service delivery of basic primary health services.

Community health workers will continue to serve as the pivotal link to primary health care facilities, quarantine facilities, or CICs and treatment units. To support the integrated approach from the perspective of an affected person, CHWs, community leaders and liaisons, social/caseworkers, etc. serve as important messengers and referral agents for various services and care that affected individuals and households may need.

Provision of appropriate PPE and buffer stocks of medications, supplies, tools

Identify and agree on alternative approaches for providing clinical care and referrals, including consideration for enhanced telecommunications for all community-based focal points and staff.

Prepare with community leaders for physical distancing scenarios. Select available radio, mobile, social media, or other channels for remote engagement (e.g., collect phone numbers, set up WhatsApp groups, inform community members how to connect digitally with physical community displays).

READY offers guidance on a six-step process for engagement during COVID-19 that can be combined with the following guidance on Resolve to Save Lives’ Contact Tracing Playbook.

CHWs, social workers, and other community outreach workers should receive the opportunity to decline to support the response or to negotiate different responsibilities at the start or during any point of the response should they deem their involvement too risky, either to themselves or others.

¹¹ Guidelines for Working with Free-Ranging Wild Mammals in the ERA of the COVID-19 Pandemic. 2020. World Organization for Animal Health; 2020. (https://www.oie.int/fileadmin/Home/eng/Our_scientific_expertise/docs/pdf/COV-19/WHSG_and_OIE_COVID-19_Guidelines_Aug2020.pdf accessed September 9, 2020)

¹² Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages. 2020. Geneva: World Health Organization; 2020. (https://www.who.int/publications/i/item/rational-use-of-personal-protective-equipment-for-coronavirus-disease-(covid-19)-and-considerations-during-severe-shortages accessed August 26 2020)

¹³ Advice on the use of masks in the context of COVID-19. 2020. Geneva: World Health Organization; 2020.(https://www.who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak accessed August 26 2020)

Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH)

The availability of all critical services and supplies, as defined by the Minimum Initial Services Package (MISP)^[5] for SRH, must continue.

Pre-position RH kits and newborn kits (where available) for health facilities to ensure that basic supplies and equipment are available to provide services outlined in the MISP.

Consider reducing face-to-face ANC clinic visits to the minimum required four visits. Consider the COVID-19 context and national guidance and prioritize routine visits for women in the third trimester and with high-risk pregnancies. Consider remote counseling and screening where possible.

Ensure pregnant women/adolescent girls and new mothers have access to women-centered, respectful, skilled care. Ensure that they have a designated space that enables privacy and access to essential maternal and newborn services.

Redesign triage protocols and patient flow to separate ANC and PNC clients from general patients present for emergency/other outpatient care.

Access to contraceptives is part of the MISP. A range of long-acting reversible and short-acting contraceptive methods, including emergency contraception and post-partum contraception, should be made available. Where feasible, consider remote approaches (phone, text messaging, digital applications) for consultations, screening, and follow-up. If restrictions on commodities need to be made, focus on providing contraceptive coverage continuity and a few months’ supply.

⁵ This includes intrapartum care for all births, emergency obstetric and newborn care, post-abortion care, safe abortion care to the full extent of the law, contraception, clinical care for rape survivors, and prevention and treatment for HIV and other sexually-transmitted infections. A lead SRH organization should be identified to coordinate implementation of the MISP for SRH and to plan for comprehensive sexual and reproductive health services if not already in place.

Mental Health and Psychosocial Support (MHPSS)

Define which activities need to be continued or stopped. Downscale face-to-face activities and prioritize urgent vs. non-urgent service users based on individual risks and needs assessments. Create new services feasible within the context, such as Helplines, outreach, and community-based mental health screening tools.

Engage community members to develop materials with COVID-19 related MHPSS messages on strategies to maintain well-being, manage anxiety, parenting, and caring for the elderly, disabled persons, and children.

Maintain social contact with people who might be isolated using phone/text/radio.

For all activities, review the appropriateness and cease if needed to ensure alignment with physical distancing and infection control.

Works Cited and Additional Resources

Works Cited and Additional Resources: Health Sector

Household Quarantine and Household Isolation

Household Quarantine and
Household Isolation: WASH

Provide a household IPC kit adapted for the local context and delivered through in-kind distribution. Kits will enable hand-washing with soap (including buckets with taps for areas with no running water), cleaning commonly touched surfaces, and separate cleaning and hygiene products for any isolated individuals within the households.

Ideally, this kit should be sufficient for 14 days. Upon completing the household quarantine or isolation, provide a top-up supply of IPC materials to continue household hygiene practices.

Ensure menstrual hygiene products are available as part of the kit distribution. Take into account the number of adolescent girls and women per household and provide for their potentially restricted access to WASH facilities during quarantine/isolation. For example, provide an extra pair of underwear as the girls and women may not be able to do laundry daily.

CHWs and volunteers should educate household members to use dedicated linen and eating utensils for the suspected or confirmed household member, to clean and disinfect surfaces that are frequently touched (e.g., toilet and bathroom surfaces), to place contaminated linen into a laundry bag separate from other household members, and to manage waste at the household level.

CHWs should engage household members on household IPC practices. Women may be more at risk, considering the gender norms of their role as caregivers. Actively listen to community perceptions, misinformation, and concerns about COVID-19 from data collected (via house-to-house visits, hotlines, surveys, etc.), and adapt programming based on results.

Establish a community feedback mechanism and collect feedback. Address the feedback with a multi-sectoral response, where needed. Link to other response areas to share feedback data for a more holistic response.

Quarantine Facilities and Community Isolation Centers

Quarantine Facilities and
Community Isolation Centers: WASH

Provide sufficient hand-washing stations (preferably pedal-operated taps) and separate toilets and shower facilities for men and women that are also accessible to children. Provide separate toilets and shower facilities for isolated cases and designated toilet and shower facilities for persons with disabilities.

Ensure adequate access to water supply (increased sufficiently to cater for additional hand-washing needs).

Make menstrual hygiene management resources and hygiene kits available per the Toolkit for Integrating Menstrual Hygiene Management into Humanitarian Response.^[1]

Train cleaning staff to clean and disinfect touched surfaces regularly – bed frames, bedside tables – clean and disinfect bathroom and toilet surfaces at least once daily. Clean clothes; bed linen, and towels using regular laundry soap and water (ideally at 60-90 degrees Celsius where possible). Waste management includes clearly defined areas to dispose of waste. Waste should not be disposed of in an unmonitored open area.

Engage affected individuals and quarantine facility/CIC staff on IPC measures. Use standard precautions with all quarantined persons on arrival, including child-friendly and pictorial messaging, with posters around the quarantine facility visibly reinforcing these messages.

Monitor IPC protocols regularly to ensure standards are met as per protocol.

Distribute face masks to all individuals in quarantine facilities or CICs. Educate people on correctly using and disposing of masks. If disposable masks are not available, cloth masks may be distributed.

^[1]A TOOLKIT FOR INTEGRATING MENSTRUAL HYGIENE MANAGEMENT (MHM) INTO HUMANITARIAN RESPONSE (https://www.rescue.org/sites/default/files/document/2113/themhminemergenciestoolkitfullguide.pdf), accessed on October 27, 2020.

Additional COVID-19 Programming Adaptation Considerations

Program Adaptation Considerations: WASH

Engage and work with communities to develop solutions to WASH/IPC in the community.

Assess secondary impacts of COVID-19 on WASH infrastructure and services at community and institution levels (schools, health care facilities, etc.).

Ensure continuity of operations for water and sanitation services in highly vulnerable settings, e.g., refugee camps, collective shelters, and other ongoing programs.

Pre-position emergency water supply storage, water treatment plants (equipment and chemical consumable) for supporting community and health services during water supply disruptions or shortages.

In sites with ongoing programming, strive to meet adapted standards for access to water and sanitation services (e.g., the quantity of water, the physical location of infrastructure, the number of users per infrastructure, etc.).

In coordination with the local authority, assess the capacity of environmental sanitation/disinfection, solid waste, and medical waste management at the community and institutional level.

Based on the assessment and in line with WHO guidance, address distancing and environmental cleaning/disinfection activities in the community and at the institutional level. It is important for camps with densely populated settings to ensure safe solid waste management, given the possibility of a high volume of infectious waste.

Engage community members, including women, children, and people with disabilities, in developing messaging on hand-washing and personal hygiene practices. Engage household members on what a virus is and how COVID-19 transmission occurs to help make sense of the recommended WASH/IPC practices.

Monitor IPC protocols regularly to ensure standards are met as per protocol.

Works Cited and Additional Resources

Works Cited and Additional Resources: WASH

World Health Organization (WHO). Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19). Geneva: WHO; 2020 (https://www.who.int/publications/i/item/considerations-for-quarantine-of-individuals-in-the-context-of-containment-for-coronavirus-disease-(covid-19), accessed on July 6, 2020)
United Nations Children Fund (UNICEF). COVID-19 Preparedness and Emergency Response. WASH and Infection Prevention and Control (IPC) Measures in Households and Public spaces. UNICEF; 2020. (https://www.unicef.org/media/66371/file/WASH-COVID-19-infection-prevention-and-control-in-households-and-communities-2020.pdf, accessed on July 6, 2020)
United Nations High Commissioner for Refugees (UNHCR). Technical WASH Guidance for COVID-19 Preparedness and Response. UNHCR; 2020 (https://wash.unhcr.org/download/technical-wash-guidance-for-covid-19-preparedness-and-response-unhcr/, accessed on July 6, 2020)

Household Quarantine and Household Isolation

Ulinzi wa Mtoto

Train social workers or community-appointed protection advocates or volunteers to detect and screen for child protection risks within the household, including the potential risk of family separation (i.e., the child is in an unstable care arrangement, or the caregivers are in the high-risk category). Train social workers or community-appointed protection advocates or volunteers to detect and screen for distress, substance abuse by caregivers or the child/adolescent, domestic violence, lack of appropriate care for children with disabilities, lack of education and recreational activities, unequal distribution of food and hygiene supplies, and risk of exploitation due to loss of family income.

Social workers or community-appointed protection advocates or volunteers can refer families in quarantine for phone screenings to assess the child’s situation as well as the necessity and suitability of care placement. Phone screenings can also increase positive parenting support and connect at-risk parents/caregivers with WhatsApp groups that can reduce stressors.

Social workers or community-appointed protection advocates or volunteers should provide close follow-up of households with children at risk of protection concerns as well as children with disabilities and without appropriate support. Offer support and resources to caretakers so that they can practice IPC measures and physical distancing within the household while caring for children with disabilities.

Actively listen to the perceptions, misinformation, and concerns around COVID-19 of children and their caregiver(s) from data collected (via house-to-house visits, hotlines, surveys, etc.). Adapt programming based on results.

Establish a child-friendly community feedback mechanism. Collect the feedback and address results with a multi-sectoral response, where needed.

Gender-Based Violence

Social workers/community-based women’s groups should receive refresher training on gender-based violence messaging, including IPV, and be familiar with the referral system. They should provide clear information on the importance of attending the health facility if a woman/adolescent girl has experienced sexual assault.

Given the heightened vulnerability of female frontline workers and women as social workers, CHWs, CHAs, LHWs, and TBAs, set up measures to prevent and mitigate harassment, abuse, or other forms of GBV towards them. These measures include equipping them with mobile phones with saved emergency contacts, phone credit, flashlights, and whistles. Policies should restrict working after dark, promote working in pairs, require consistent check-ins with the supervisor, and so on.

Encourage social workers, CHWs, CHAs, LHWs, and TBAs to use counseling for services such as SRH and nutrition as an entry-point to disseminate information about GBV services. Collect feedback from women and girls about their safety concerns.

Actively engage and listen to community perceptions, misinformation, and concerns during COVID-19 from data collected (via house-to-house visits, hotlines, surveys, etc.), and adapt programming based on results.

Establish a community feedback mechanism. Collect the feedback, and address the feedback with a multi-sectoral response, where needed. Share the feedback with other response areas for a more holistic response.

Quarantine Facilities and Community Isolation Centers

Ulinzi wa Mtoto

Determine SOPs for Child Protection in quarantine facilities. In particular, address the ethical considerations and alternative options to isolating and/or quarantining unaccompanied minors. Consider appropriate care for children separated from their family, family tracing and reunification, psychosocial support activities, and corresponding measures to mitigate protection risks and provide adequate responses.

Work alongside child protection case management actors to prepare for the following child protection scenarios^[1]

an unaccompanied child arrives at the quarantine facility/CICs and requires family tracing and reunification as well as alternative care within and outside of the facilities;
a child enters quarantine facilities/CICs with a caregiver who is then transferred to health facilities because they need treatment and leaves the child behind;
caregiver dies;
the child needs to be referred to a treatment center/health facility with or without a caregiver;
caregiver wishes to accompany the child to a treatment center/health facility but does not have adequate care arrangements for the remaining children under his/her care;
child and/or caregiver is in distress and requires psychosocial support

Provide child-friendly spaces and activities if a child is quarantined with their caretaker. Create and/or designate areas such a children’s wards for unaccompanied children. Provide support and resources for parents/caregivers to support their children’s well-being, including opportunities to continue learning and developing.

Ensure additional protective measures for children at risk, such as adolescent girls and children with disabilities who have mobility issues. These measures include difficulty with self-care, which increases their exposure due to dependence and the physical proximity of non-caretakers.

Ensure that there are safe spaces for child/adolescent caregivers who accompany dependent children to a health facility.

^[1] Guidance for Alternative Care Provision During COVID-19 (https://resourcecentre.savethechildren.net/node/18217/pdf/guidance_for_alternative_care_covid_19.pdf), accessed on October 27, 2020.

Gender-Based Violence

Adhere to and provide the MISP (which includes clinical management for GBV survivors). At a minimum, PEP kits should be made available at the quarantine facility with a referral pathway to a facility that can provide the full CMR to the survivor.

All PSEA protocols must be in place, including training and Code of Conduct for responders and complaint mechanisms and services for survivors. Clearly communicate these services during quarantine facility admission and reinforce the messaging during their stay with posters, radio messaging, and text messaging.

Factor in gender-based differences in literacy levels and access to information tools such as mobile phones and the Internet to ensure inclusive communication. Transmit the information in the quarantine facilities through multiple media options, including radio and visual guides.

Additional COVID-19 Programming Adaptation Considerations

Ulinzi wa Mtoto

Adapt or develop (where it does not exist) a vulnerability and prioritization criteria for child protection cases. Identify cases where children are at risk of violence, abuse, exploitation, or neglect without supervision to prioritize preparedness planning. Place child protection caseworkers at health clinics and community centers.

Save the Children has developed guidance on:

COVID-19 Guidance for Interim Care Centers^[2] Interim care is defined as care arranged for a child temporarily for up to 12 weeks. The placement may be formal or informal with relatives, foster carers, or residential care, such as an Interim Care Centre (ICC).
Child Safe Programming and Safeguarding in Interim Care Centers^[3]

Better Care Network, Save the Children, The Alliance for Child Protection in Humanitarian Action, and UNICEF have developed Guidance for Alternative Care Provision During COVID-19.^[4] Further, the Alliance for Child Protection in Humanitarian Action provides a Guidance Note: Protection of Children During Infectious Disease Outbreaks.^[5]

Learn how communities are connecting remotely or in-person and identify the trusted sources of information. Establish remote communication platforms, such as Hotlines and WhatsApp support groups. Train staff on virtual screening, identifying violence against children, counseling, and awareness-raising. It is important to make considerations for vulnerable populations without access to phones or the Internet.

Ensure children with and without disabilities, including child/adolescent caregivers, receive child-friendly awareness-raising messages on COVID-19, how to protect and care for themselves, and positive coping mechanisms.

At a minimum, ensure social workers, CHWs, and staff working in quarantine facilities and CICs have a clear understanding of how their role relates to safeguarding (e.g., reporting lines and mechanisms to respond to allegations/concerns).

All staff should be trained on the centrality of protection and understand their role in promoting protection principles. Ensure that all staff members know how to identify and refer protection cases.

^[2]  COVID-19 Guidance for Interim Care Centres (https://resourcecentre.savethechildren.net/library/covid-19-guidance-interim-care-centres), accessed on October 27, 2020.
^[3]  Child Safe Programming and Safeguarding in Interim Care Centres (https://resourcecentre.savethechildren.net/library/child-safe-programming-and-safeguarding-interim-care-centres), accessed on October 27, 2020
^[4]  Guidance for Alternative Care Provision During COVID-19 (https://resourcecentre.savethechildren.net/node/18217/pdf/guidance_for_alternative_care_covid_19.pdf), accessed on October 27, 2020.
^[5]  The Alliance for Child Protection in Humanitarian Action (https://alliancecpha.org/en/system/tdf/library/attachments/cp_during_ido_guide_0.pdf?file=1&type=node&id=30184), accessed on October 27, 2020.

Gender-Based Violence

The protection response must prepare for an increased need for GBV response and support, identify gaps in GBV survivor-service provision, and prepare to provide essential stop-gap measures where feasible.

Conduct a regularly updated, multi-sectoral gender analysis to identify inequalities, gaps, and capacities. Identify the specific gaps of the crisis on women, girls, men, boys, and LGBTIQ individuals.

Involve women and girls in developing IEC materials on COVID-19. Counsel them on the preferred alternatives to in-person complaints (phone, online, other).

Works Cited and Additional Resources

Works Cited and Additional Resources: Protection Sector

Cited in this section:

Guidance for Alternative Care Provision During COVID-19 (https://resourcecentre.savethechildren.net/node/18217/pdf/guidance_for_alternative_care_covid_19.pdf), accessed on October 27, 2020.
COVID-19 Guidance for Interim Care Centres (https://resourcecentre.savethechildren.net/library/covid-19-guidance-interim-care-centres), accessed on October 27, 2020.
Child Safe Programming and Safeguarding in Interim Care Centres (https://resourcecentre.savethechildren.net/library/child-safe-programming-and-safeguarding-interim-care-centres), accessed on October 27, 2020.
Guidance for Alternative Care Provision During COVID-19 (https://resourcecentre.savethechildren.net/node/18217/pdf/guidance_for_alternative_care_covid_19.pdf), accessed on October 27, 2020.
The Alliance for Child Protection in Humanitarian Action (https://alliancecpha.org/en/system/tdf/library/attachments/cp_during_ido_guide_0.pdf?file=1&type=node&id=30184), accessed on October 27, 2020.

Additional Resources:

Household Quarantine and Household Isolation

Household Quarantine and
Household Isolation: Nutrition

Prioritize direct food distribution of locally-acceptable nutritious food during the quarantine. Limit the number of distributions by making a one-time distribution or a once a week for two weeks distribution.

Ensure grains and other food supplies are adequately stored to avoid attracting pests or contamination by animals.

Train CHWs, CHAs, LHWs, and TBAs on maternal, infant, and young child nutrition and counseling. Train CHWs, CHAs, LHWs, and TBAs to provide age-specific education and counseling to pregnant and breastfeeding women and parents/caregivers of children < 2 years on the following:

a healthy diet during pregnancy;
the importance of early and exclusive breastfeeding (including mothers who are diagnosed with COVID-19);
proper latch and positioning for breastfeeding;
timely introduction of solid foods and complementary feeding.

Training and counseling should dispel myths around and stress the importance of breastfeeding during COVID-19 and feeding during the mother’s illness. Additionally, counsel mothers on the need to wear a mask when breastfeeding if the mother has respiratory symptoms or is diagnosed with COVID-19, as well as proper hand-washing practices, including before and after feeding her child. Counsel mothers feeding with breast-milk substitutes to wash any feeding cups, bottles, or teats with soap and water before and after use.

CHWs, CHAs, LHWs, and TBAs should distribute mid-upper arm circumference (MUAC) tapes in the community. They should train the caregivers of children aged 6-59 months to undertake MUAC measurements and seek a yellow/red measurement referral (per local guidance). Additionally, train caregivers to use soap after taking MUAC measurements.

Quarantine Facilities and Community Isolation Centers

Quarantine Facilities and Community
Isolation Centers: Nutrition

Train kitchen staff to adhere to IPC measures and food preparation standards. Prepare and serve three meals a day of locally-acceptable nutritious food.

Screen for severely malnourished children.
Provide information to lactating women.
Implement partial suspension of non-emergency services such as routine or follow-up visits and preventive services such as vaccination, antenatal care, etc.

Promote Parent-led MUAC – Awareness raising for parents to screen their children and know what to do when children get sick.

Include nutrition as part of an integrated package of maternal and newborn health services.

Include nutrition information in radio messages in quarantine centers to dispel myths and stigmas around COVID-19. Promote positive messages on quarantine facilities, share coping and stress management tips. Share referral numbers for protection issues or special needs (links to Health section).

Identify and/or establish breastfeeding corners within female wards of the quarantine facilities to ensure privacy and comfort during breastfeeding. Create consistent messaging on breastfeeding and IEC materials.

Monitor acute malnutrition among quarantined children and alert nutrition programs to receive RUTF to feed children with moderate and severe acute malnutrition.

Additional COVID-19 Programming Adaptation Considerations

Additional Programming Considerations: Nutrition

Identify and map critical and non-critical distributions. Identify beneficiaries that will require modified distribution of items and methods for item distribution

In alignment with the International Code of Marketing of Breast-Milk Substitutes (the Code), educate health workers and volunteers on not accepting any donated breast-milk substitutes (including follow-on formulas or “toddler formulas”) and the importance of monitoring for and reporting Code violations.

Develop and implement simplified treatment protocols to minimize the risk of spreading COVID-19 through nutrition services. Provide RUTF for both moderate and severe acute malnutrition and delivery of CMAM through integrated community case management services.

Additional Resources

Additional Resources: Nutrition

Save the Children, United Nations Children Fund (UNICEF), United States Agency for International Development (USAID). Infant and young child feeding recommendations when COVID-19 is suspected or confirmed: Recommended practices booklet. Save the Children, UNICEF, USAID; 2020 (https://reliefweb.int/report/world/infant-and-young-child-feeding-recommendations-when-covid-19-suspected-or-confirmed, accessed on July 6, 2020)
Save the Children. Integrated Nutrition COVID Response Framework. UK: Save the Children; 2020. (Not yet available to the public.)
World Health Organization (WHO). Frequently Asked Questions: Breastfeeding and COVID-19 for health care workers. WHO; 2020. (https://www.who.int/docs/default-source/maternal-health/faqs-breastfeeding-and-covid-19.pdf?sfvrsn=d839e6c0_5, accessed on July 6, 2020)
World Food Programme (WFP). WFP’s additional recommendations for the management of maternal and child malnutrition prevention and treatment in the context of COVID-19. WFP; 2020. (https://reliefweb.int/report/world/wfp-s-additional-recommendations-management-maternal-and-child-malnutrition-prevention, accessed on July 6, 2020)

Household Quarantine and Household Isolation

Household Quarantine and
Household Isolation: Food Security

Train NGO staff, civil society organizations (CSO) staff, appointed community members, and community-based food cooperatives on food distribution standard operating procedures.

Engage local authorities, community leaders, community groups, and nutrition programs to identify the existing local food pipeline and the 14-day food rations’ composition for direct distribution to quarantined households. Engage communities in the planning, implementation, and evaluation of the activity.

Create linkages with national RCCE working groups to collect existing data on perceptions, concerns, rumors, etc., related to shifts in the household or community food security and distributions.

Alternatively, collect rapid assessment data on these perceptions and concerns, including food acquisition practices. Assess whether the food acquisition practices increase zoonotic disease risk (e.g., via hunting, slaughter, or food preparation processes).

Review market price and food production monitoring information to determine whether in-kind food distribution, food vouchers, or cash is the most appropriate modality for post-quarantine assistance.

Provide cash or food voucher transfers to households completing the quarantine period. This action minimizes perceived or real risks of household-level food shortages due to loss of income or inability to stock-pile because of their movement restriction during the household quarantine.

Distribute cash or voucher transfers where possible to female household members as the cash/voucher recipient. Select contactless transfer mechanisms.

Quarantine Facilities and Community Isolation Centers

Quarantine Facilities and Community
Isolation Centers: Food Security

Contract with local retailers for monthly procurement of staples and dry goods.

Contract smallholder farmers to provide weekly drop-off of fresh produce while maintaining physical distance measures. Pay them through contactless funds transfer (mobile money, online payments, etc.).

Review market price and food production monitoring information to determine whether in-kind food distribution, food vouchers, or cash is the most appropriate modality for post-quarantine assistance.

Provide cash or food voucher transfers to individuals being discharged from the quarantine facility. This action provides a buffer period to procure food and other basic necessities, relieves anxiety, and promotes positive coping mechanisms.

Engage community leaders and community members, particularly representatives of vulnerable and marginalized groups, to distribute cash or voucher transfers, preferably through contactless transfer, to individuals being discharged from the quarantine facility. This process promotes transparency on the type and number of cash/vouchers being distributed. The process enables community leaders to reassure their communities of this service and help calm fears about food insecurity.

Additional COVID-19 Programming Adaptation Considerations

Additional Programming Considerations: Food Security

Monitor food production, supply/intervention market prices, transportation restrictions, and services using primary (remotely gathered) or secondary (WFP/FAO/FEWSNET, etc.) data.

Source food supplies from smallholder farmers. When physically and economically viable, have the farmers make home/community deliveries of fresh foods. Design, deliver and monitor food assistance, emergency agricultural support, and agricultural livelihood-saving interventions with women’s engagement. It should not put women and girls at additional risks.

Develop contingency plans to change modalities between in-kind food and vouchers/cash if one form is no longer appropriate.

Improve local storage and preservation of staples and perishable foods at household and community levels to mitigate future shortages.

Pre-position materials like seeds and fertilizers and utilize electronic cash transfer and voucher mechanisms when appropriate and available.

Additional Resources

Additional Resources: Food Security

United Nations (UN). Policy Brief: The Impact of COVID-19 on Food Security and Nutrition. Geneva: UN; 2020. (https://reliefweb.int/sites/reliefweb.int/files/resources/sg_policy_brief_on_covid_impact_on_food_security.pdf, accessed on July 6, 2020)
Inter-Agency Standing Committee (IASC), developed by the World Food Programme (WFP). Interim Recommendations for Adjusting Food Distribution Standard Operating Procedures in the Context of the COVID-19 Outbreak. Version 2. IASC, WFP; 2020. (https://interagencystandingcommittee.org/system/files/2020-03/Final%20Interim%20IASC%20Guidance%20on%20COVID-19%20Outbreak%20Readiness%20and%20Response%20-%20Food%20Distribution.pdf, accessed on July 6, 2020)
World Food Programme (WFP). General Guidelines for Food and Nutrition Assistance in the Context of the COVID-19 Outbreak. WFP; 2020. (https://reliefweb.int/sites/reliefweb.int/files/resources/general_guidelines_for_food_and_nutrition_assistance_in_teh_context_of_t.pdf, accessed on July 6, 2020)
World Food Programme (WFP), Food and Agriculture Organization of the United Nations (FAO), United Nations Children Fund (UNICEF). Interim Guidance Note. Mitigating the effects of food and nutrition of schoolchildren. WFP, FAO, UNICEF; 2020. (https://docs.wfp.org/api/documents/WFP-0000114175/download/?_ga=2.197767343.1613059591.1586615089-349477419.1586373676, accessed on July 6, 2020)
United States Agency for International Development (USAID). Modality Decision Tool for Humanitarian Assistance. USAID; 2018. (https://www.usaid.gov/documents/1866/modality-decision-tool-humanitarian-assistance, accessed on August 3, 2020)

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Tovuti hii imewezeshwa na usaidizi mkubwa wa watu wa Marekani kupitia Shirika la Maendeleo ya Kimataifa la Marekani (USAID). Yaliyomo ni wajibu wa READY na si lazima yaakisi maoni ya USAID au Serikali ya Marekani. Ikiongozwa na Save the Children, mpango wa READY unatekelezwa kwa ushirikiano na Kituo cha Johns Hopkins cha Afya ya Kibinadamu, Kituo cha Johns Hopkins cha Mipango ya Mawasiliano, UK-Med, na Chuo cha Uongozi wa Kibinadamu. READY inaongeza uwezo wa kimataifa kwa mashirika yasiyo ya kiserikali kukabiliana na milipuko mikubwa ya magonjwa ya kuambukiza.