Since the beginning of the COVID-19 pandemic, Nigeria has been managing confirmed cases in government-designated hospital-based isolation/treatment centres to ensure recovery of cases as well as to prevent community transmission. As the pandemic has evolved, there is an increasing number of people who are asymptomatic or present with mild symptoms. To reduce the pressure on resources in treatment centres and ensure these resources are sufficient for people with severe symptoms, home-based care was introduced. However, people who are asymptomatic or have mild symptoms, but are unable to safely isolate themselves at home will be admitted to hospital-based isolation/treatment centres.
According to the Nigeria Centre for Disease Control (NCDC), eligibility for home-based care will be determined by a health care worker (HCW). The criteria include:
- Any patient below 60 years old who is clinically stable, no history of a noncommunicable disease AND
- Asymptomatic or mild symptoms
- Normal oxygen saturation (SpO2 ≥ 95% on room air)
- Has available space for optimal self isolation
- Any patient discharged from treatment centres for home care. This is to allow them to complete their isolation period.
The NCDC gave some of the following as guidelines to be considered when starting home-based care.
1. There should be an assessment of the patient’s home and the environment by a trained health care worker.
2. Educate the patient and household members about hygiene, infection prevention and control (IPC) measures and how to care for the patient.
3. Patients should remain isolated and should limit contact with other people including household members until all symptoms are gone and they have tested negative to COVID-19.
Home-based care was adopted by the Kano State Technical Response Committee on COVID-19 in August 2020. Initially, the state had five functional isolation centres, namely the Muhammad Buhari Specialist Hospital, the Daula Hospital, the Kwanar Dawaki Isolation Centre, the Karfi Sports Institute and the Abubakar Imam Urology Centre.
The State response team feared that the high number of confirmed cases would cause a shortage of bed spaces at treatments centres, especially for severe and critical cases. According to Mallam Nura Yahaya Ganduje, the coordinator of home-based care for COVID-19 patients in Kano State, ‘’This option entails the management of COVID-19 patients at home. It came about because the state did not have enough facilities to manage the rising number of cases at that time.’’
Most of the cases reported in the state were asymptomatic and mild cases which necessitated the need for home management. This created enough space at treatment centres to manage severe cases. Kano state was one of the first states in Nigeria that adopted a well-structured home-based care policy. It was adopted from the NCDC to the context of the state. The Kano State Home-Based Care Policy is designed to assess individuals using the existing structures at the local government level. There is a Local Government home based-care focal person in each of the 44 local government areas of the state and a Ward Technical Officer (WTO) who takes responsibility for the assessment of patients in his ward. The Ward Environmental Health Officers (WEHOs) follow up on contacts of all confirmed patients in isolation. To qualify for home-based care, a patient must meet up certain criteria. A checklist was designed by the state task force (Assessment criteria checklist) to decide the eligibility of cases. LGA assessors visit positive cases at home to administer the checklist which determines where they will be managed. A qualified patient for home-based care must follow all the Infection Prevention Control (IPC) measures, must have a well-ventilated single room with a toilet facility, must wear a face mask, and practice hand hygiene. The patient must not go out to places of worship, market, or any public place, and must go into isolation for two weeks. If these criteria are met, then the patient can be managed at home, if not, then he or she is evacuated to the isolation centre.
Due to an increase in the number of positive cases in the state, additional support was provided to the LGA teams to support home-based management of COVID-19, and an initiative called Home Base Care Riders or Assessors was established on the 19th of February 2021. Members of this group are mostly health care workers that have worked in isolation centres, equipped with motorcycles and all medications needed in managing COVID-19 cases at home. They can go to all parts of the state, especially the metropolitan areas to manage patients. According to Ganduje, the assessors administer drugs, monitor the patient, and go back for reassessment after seven and 14 days. If there are no symptoms, the patient is discharged. Due to their prompt intervention, cases are now reducing with a drastic reduction of the transmission rate.
This narrative was done in March 2021 as part of the #COVID19NigeriaStories documentation project on state-level responses to COVID-19, implemented by the Nigeria Centre for Disease Control and Nigeria Health Watch with support from the Ford Foundation.