Federated States of Micronesia: Empowering local communities & preparing for COVID-19

The Federated States of Micronesia (FSM) is one of the few countries where there isn’t any reported COVID-19 cases. Since early January, WHO has been working with the government and partners to support FSM to prepare for COVID-19 with a special focus on empowering local communities.

In April, chiefs from the U municipality on Pohnpei main island (photo 1) came together to discuss how they can protect their communities from COVID-19. They considered issues ranging from the lack of running water in some households to the difficulties of protecting family members with mental health illness, who may refuse to follow advice on physical distancing. They agreed on unique and practical solutions, such as using colour coding to distinguish houses with members under home quarantine, while preventing stigma by providing additional education through appointed community volunteers. Each community then developed their own action plans and assigned focal points to implement the activities.

“Microplanning in our community is crucial, as this is the ground level. We would need to have a plan in place if people get sick here. Every individual would know what they would be doing when it happens. This is so much better than waiting in fear for the disease to arrive.” Says JP, one of the traditional leaders from the U Municipality.

Community based planning of public health interventions has been ongoing since 2017. Now this unique platform is being leveraged to discuss community-based approaches to preventing COVID-19. Recognizing the key role of traditional community leaders in FSM, WHO, together with UNICEF, Micronesian Red Cross and local NGOs, is supporting FSM in implementing a comprehensive COVID-19 Community Outreach Package, which aims to empower the communities to protect themselves from COVID-19.

“It is great to see the engagement we have with the communities,” says Dr Eunyoung Ko, country liaison officer for FSM, “during the micro-plan meetings, we can see that the communities were engaging with the community outreach plan we drew up and really addressing the issues from their own angle. They also provided us a lot of feedback so that we made revisions that are realistic so that they can use.”

The package is organized into two phases. Phase one consists of a series of microplanning workshops with the community leaders (known as chiefs). During the workshop, the chiefs work together to identify risks specific to their communities, such as social gatherings and cultural practices. Through a facilitated discussion, the group identifies additional measures which could be implemented in their respective communities. By actively involving the leaders in developing the action plan, the solutions are tailored to the local context and more likely to be adopted by the community.

Additionally, the workshops provide an opportunity for the leaders to ask questions and address any misinformation circulating in the communities. Since they are highly respected by their communities, they are able to support risk communication efforts more effectively than other common approaches. The chiefs can also share what has already been implemented in their communities.

Many communities organized COVID-19 volunteer groups and issued recommendations on culturally sensitive practices, such as funerals and traditional feasts. Incorporating existing community initiatives in government strategies facilitates coordination and helps to prevent duplication of efforts.

Since the traditional community leaders are men, it is important to include female voices in the discussion. The leaders' spouses play a very important role in the communities, and female teachers and leaders of local women's groups are also actively invited to join.

Following microplanning workshops with the leaders, the outreach teams begin Phase two. This phase involves a house-to-house outreach, where the teams provide education on COVID-19, handwashing and social distancing, as well as distribute soaps and information materials. It is a labour intensive activity, enabled by a cross-sectoral collaboration between the departments of health, education, and local and international partners. With technical support from WHO, the teams are trained to deliver consistently high quality of education to all communities.

Pohnpei State has already completed microplanning workshops in all main island municipalities and is currently finalizing community action plans. The activity was so positively received by the communities, that local business owners have requested to undertake a similar activity to help them prepare risk mitigation strategies and protect their customers. The experience gained in Pohnpei has been shared with the other FSM States as well as the Republic of the Marshall Islands, where a similar community engagement has taken place.