GCRF_NF407 - Emergency strategies for mitigating the effects of COVID-19 in care homes in low and middle income countries

Lead Research Organisation: University of East Anglia
Department Name: International Development


In many developing countries there are large numbers of care homes for older people. Until the onset of the COVID-19 pandemic, they received little attention from policymakers or academics. There is now understandable concern that the pandemic will affect care home residents, as well as staff. Responsibility for care homes is mainly devolved to local governments, and many are looking to develop emergency plans. These need to take account of specific contexts, including scarce resources and very limited regulation of care homes prior to the pandemic. We will partner local government agencies in three countries (Brazil, South Africa and Mexico) to support the development and implementation of emergency plans, and to assess their effects on care homes. Based on consultations with a wider network of policy-makers and experts, we have developed a set of guiding principles (The CIAT Framework). We will work with local governments to put this framework into practice, refine it and assess its potential value for developing countries more generally. At the same time, we will develop an interactive online network with policy-makers and researchers interested in care homes and COVID-19, linked to an existing online policy network we have developed during the pandemic.


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Description We developed a simple policy tool for developing countries, the CIAT framework, to inform emergency support for long-term care facilities. We have demonstrated the validity of this approach, working with government agencies in 3 countries. We have extended the framework to include elements related to COVID-19 vaccination in these facilities, and this has been shown to be effective.
Exploitation Route we are applying for additional funding to build this framework into a more long-term strategy for developing country governments to improve long-term care services for their populations.
Sectors Healthcare

Description MARCH 2022 ENTRY: We developed a 3rd edition of the CIAT framework and this has been used to support COVID-19 vaccination uptake in long-term care facilities in our three study settings. MARCH 2021 ENTRY: The project entails close partnership with local government agencies responsible for care homes in 3 different countries, including the co-production of an emergency framework for supporting these care homes during the COVID-19 pandemic. Elements of this framework are already being applied and the framework itself is being developed to take account of feedback from these experiences.
First Year Of Impact 2021
Sector Healthcare
Impact Types Societal,Policy & public services

Description Develop national network of care homes in Brazil to address COVID-19 pandemic
Geographic Reach South America 
Policy Influence Type Influenced training of practitioners or researchers
Impact The National Front for Long-Term Care Facilities. One key focus of this project is that many care homes are unregistered with government agencies, impeding quality assurance and meaning that reliable information on facilities was often unavailable to the general public. This limited the capacity of many government agencies to respond to the crisis. The joint coordinator of this project, Karla Giacomin, led the development of a new, grassroots initiative to support long-term care facilities in Brazil in the context of the pandemic: The National Front for Long-Term Care Facilities (NF-LTCF) (https://frente-ilpi.com.br/). This GCRF project cannot claim full responsibility for this achievement, but did make significant contributions. In terms of funding, part of Giacomin's work, along with part of Lloyd-Sherlock's support of NF-LTC was paid through this grant (in keeping with national dissemination and engagement practices). These activities have also been supported by the Bahia State project team. Indicators of impact of NF-LTCF include: Producing the first national data base on long-term care facilities (with 8,000 providers), and now accessible tor the public. Reaching more than 600,000 different people and organisations through the NF-LTC website and other social media platforms. Becoming the main source of information about COVID-19 in care homes, providing support and emergency training manuals, videos, etc., etc. The recent launch of the NF-LTC's remodelled online platform was widely reported by major national media. Advocacy at all levels, including bringing about eight special meetings of the National Congress's Committee on Human Rights, focussing on the needs of care homes in the pandemic. This has led to numerous new pieces of emergency national legislation, including the provision of US$37 million of emergency funding to support the most vulnerable care homes. All the above has contributed to a much lower rate of COVID-19 mortality in old age care homes than that reported in high-income countries and in middle-income countries. It has been estimated that for 2020, there were around 883 deaths attribtable to COVID-19 among a national survey of 60,000 care home residents (in other words, 1.5% of residents died from COVID-19) (http://www.ggaging.com/details/1660/en-US/estimates-of-infection-and-mortality-from-covid-19-in-care-homes-for-older-people-in-brazil). In the UK and other high income countries, around 10 per cent of older people in residential care had died of COVID-19 by April 2021. The difference between Brazil and these countries was not because Brazil was less affected by COVID-19 in 2020: it had one of the highest per capita COVID-19 death rates in the world. Studies demonstrating the significance of NF-LTC in limiting deaths (and not authored by members of this project team) include: https://www.sescsp.org.br/files/artigo/02028d4c/ca1c/455c/b778/d8e30e24e538.pdf https://www.arca.fiocruz.br/bitstream/icict/43526/2/nota_idoso_equipe_gise_14.09.2020.pdf
URL https://frente-ilpi.com.br/
Description Emergenct responses to COVID-19 in care homes: Mexico
Geographic Reach South America 
Policy Influence Type Contribution to new or Improved professional practice
Impact Aspects of this research have influenced national and local levels. According to the Director of Mexico City government's lead agency for care homes: "my department has found the CIAT Framework developed by this expert group to be highly useful, since it highly relevant to the challenging context of Mexico City. For example, many long-term care facilities were not registered with official agencies and so we took specific measures to update our registers and to include new service providers. This has enhanced our capacity to engage with different care homes, including those which operate more informally and which may be more vulnerable to the pandemic. The CIAT framework has also informed our strategy of monitoring the situation in these facilities, developing a more robust information base and in identifying different types of targeted based on the experiences of other cities in developing countries. We are still developing our collaboration with the CIAT team as the pandemic unfolds, with a growing focus on effective vaccination coverage."
Description Informing global COVID-19 policies in care homes
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a advisory committee
Impact Aspects of this research have influenced WHO's Technical Guidance for Managing Covid in care homes. This has been the main COVID-19 reference document for all residential care facilities and health ministries, including those in LMICs. Lloyd-Sherlock was on the expert committee responsible for ensuring that the guidance was scientifically robust and that it drew on this research in several ways, including acknowledging the importance of LMIC settings and contexts (such as a lack of space for case isolation), more realistic regulatory engagement between state agencies and care homes, and a need to balance the requirements of infection control with the rights, dignity and wellbeing of residents.
URL https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance-publications
Description A Frente Nacional de Fortalecimento a`s ILPIs (The National Movement for Supporting Care Homes in Brazil) 
Organisation A Frente Nacional de Fortalecimento a`s ILPIs
Country Brazil 
Sector Charity/Non Profit 
PI Contribution Joint dissemination events. Joint production of dissemination materials. All related to the impact of COVID-19 on care homes in Brazil.
Collaborator Contribution Joint dissemination events. Joint production of dissemination materials. All related to the impact of COVID-19 on care homes in Brazil.
Impact Joint webinar: https://us02web.zoom.us/webinar/register/WN_fA_sqZ1wRL--zB5kQxxZkg
Start Year 2020