CommunityFirst solutions for COVID-19: decolonising health crises responses
Authors: Rachel Kiddell-Monroe, Jessica Farber, Carol Devine, James Orbinski
Journal: The Lancet Planetary Health (2021)

History has shown vulnerabilised communities that they cannot afford to wait for external actors to save them in an emergency. If aid does arrive, it is often too late and imposed on the community without regard for their priorities, needs, or assets. The COVID-19 pandemic has been no different. Since the pandemic hit, we at SeeChange Initiative (a Canadian organisation), have been asking communities across the Americas and east Africa how we can help. The communities said they needed technical support in emergency response planning, verified health information, resources to implement culturally, contextually, and socially relevant responses, and space to address their historical trauma. They asked for solidarity and connection. From this appreciative inquiry, CommunityFirst Solutions for COVID-19 emerged. This cocreated adaptive approach puts communities at the heart of their own health crisis response and is informed by their historical and present-day trauma. The CommunityFirst COVID-19 Roadmap is a step-by-step emergency planning tool complemented with curated health information and infographics. It was first developed in Clyde River, Nunavut, Canada, when an Inuit community asked our team at SeeChange Initiative, in April, 2020, to support them in developing their COVID-19 preparedness plan. Indigenous communities in Mexico, Honduras, Guatemala, Colombia, Peru, Bolivia, Canada, and Kenya are using CommunityFirst Solutions for COVID-19 to create and activate response plans adapted to their realities. In Tana River County, Kenya, Salim and his youth-led theatre troupe are planning outdoor performances explaining how to prevent COVID-19 at schools across the county. In Guatemala, Alma and Elsy at the community organisation, Tz'unun use community radio stations to disseminate COVID-19 messages in local languages and host mask-making workshops with Indigenous women in remote communities. The Indigenous Lenca community of Reitoca, Honduras, adapted the Roadmap to focus on mobilising the strengths of women's groups and identified the external resources they needed. With these communities, we created an Accompaniment Programme and offered orientations on the Roadmap as well as training, workshops, and one-on-one technical support on its adaptation and implementation. The Roadmap and database of curated community-relevant resources have expanded to six languages. Women from across the Mesoamerican region began to share their stories and hardships with the SeeChange Initiative team and each other. They identified a desire for a safe space where they could connect with others in similar positions. A solidarity network was born. By late 2020, communities were actively adapting the COVID-19 Roadmap to respond to intersecting crises. In the days between Hurricanes Eta and Iota in Honduras, communities adapted the Roadmap to provide guidance on setting up dignified shelters for displaced people, to ensure COVID-19 safety within the shelters, to create protocols to foster a safe environment for individuals most at risk, and to coordinate with humanitarian actors (appendix). As the UN predicted in April, 2020, marginalised communities are experiencing the worst of the socioeconomic impacts of COVID-19. Yet they "hold the key to flatten the curve, respond to the pandemic and ensure longer-term recovery. They will need investment."1UNA UN framework for the immediate socioeconomic response to COVID-19.https://www.un.org/sites/un2.un.org/files/un_framework_report_on_covid-19.pdfDate: 2020Date accessed: February 2, 2021Google Scholar This investment has yet to happen. 1 year later, the abandonment of communities in the throes of multiple global pandemics is unacceptable. The refrain "we are all in this together" rings hollow as do the expressions "community-led" or "community-based". To truly centre communities, a decolonised approach to health crisis response needs to be adopted and understood. Communities know that "solutions are within ourselves, within our communities".2Wagner D Grantham-Phillips W 'Still killing us': the federal government underfunded health care for Indigenous people for centuries. Now they're dying of COVID-19.https://www.usatoday.com/in-depth/news/nation/2020/10/20/native-american-navajo-nation-coronavirus-deaths-underfunded-health-care/5883514002/Date: 2020Date accessed: January 10, 2021Google Scholar Yet too often, global and public health interventions continue to reinforce colonial power dynamics, failing to recognise and support traditional knowledge and unique ways of problem solving.3Büyüm AM Kenney C Koris A Makumba L Raveendran Y Decolonising global health: if not now, when?.BMJ Glob Health. 2020; 5e003394Crossref PubMed Scopus (152) Google Scholar A paradigm shift is imperative. The pandemic is layered on top of a climate crisis that was impacting the health and livelihoods of vulnerabilised communities before COVID-19 hit.4Watts N Adger W Agnolucci P et al.Health and climate change: policy responses to protect public health.Lancet. 2015; 386: 1861-1914Summary Full Text Full Text PDF PubMed Scopus (1167) Google Scholar, 5Least developed countries expert groupUNConsiderations regarding vulnerable groups,communities and ecosystems in the context of the national adaptation plans.https://unfccc.int/sites/default/files/resource/Considerations%20regarding%20vulnerable.pdfDate: 2018Date accessed: April 12, 2021Google Scholar, 6Islam SN Winkel J Climate change and social inequality.https://www.un.org/esa/desa/papers/2017/wp152_2017.pdfDate: 2017Date accessed: April 12, 2021Google Scholar Increasingly severe droughts and more intense and frequent extreme weather events have been contributing to food and water insecurity, emerging and re-emerging infectious diseases, and driving displacement of communities for decades.7Watts N Amann M Arnell N et al.The 2020 report on the Lancet Countdown on health and climate change: responding to converging crises.Lancet. 2021; 37: 129-170Summary Full Text Full Text PDF Scopus (820) Google Scholar, 8Confalonieri U Menne B Akhtar R et al.Human health.in: Parry ML Canziani OF Palutikof JP van der Linden PJ Hanson CE Climate change 2007: impacts, adaptation and vulnerability. Cambridge University Press, Cambridge2007: 391-431Google Scholar These same communities are now at the forefront of both the climate crisis and the COVID-19 pandemic. And they are mostly alone. CommunityFirst reflects demands by vulnerabilised communities worldwide for a new approach to health crisis response that is culturally sensitive and trauma-informed, responsive to the vulnerabilities of these communities and cognisant of their unique assets, respectful of their knowledge and identification of solutions, and honouring their right to self-determination. It also incorporates a planetary health lens in identifying responses and solutions to the intertwined COVID-19 pandemic and climate crisis. The CommunityFirst approach offers practical ways to decolonise health crisis response. Communities are and will be the key actors in preventing, preparing for, and responding to a pandemic such as that of COVID-19 and sustaining that response for these crises and the ones to come. We declare no competing interests. Download .pdf (.19 MB) Help with pdf files Supplementary appendix