Community health workers and Covid-19: Cross-country evidence on their roles, experiences, challenges and adaptive strategies

Abstract

Community health workers (CHWs) are a key part of the health workforce, with particular importance for reaching the most marginalised. CHWs’ contributions during pandemics have received growing attention, including for COVID-19. This paper contributes to learning about CHWs’ experiences during COVID-19, based on evidence from India, Bangladesh, Pakistan, Sierra Leone, Kenya and Ethiopia. The paper synthesises evidence from a set of research projects undertaken over 2020–2021. A thematic framework based on the research focus and related literature was used to code material from the reports. Following further analysis, interpretations were verified with the original research teams. CHWs made important contributions to the COVID-19 response, including in surveillance, community education, and support for people with COVID-19. There was some support for CHWs’ work, including training, personal protective equipment and financial incentives. However, support varied between countries, cadres and individual CHWs, and there were significant gaps, leaving CHWs vulnerable to infection and stress. CHWs also faced a range of other challenges, including health system issues such as disrupted medical supply chains, insufficient staff and high workloads, a particular difficulty for female CHWs who were balancing domestic responsibilities. Their work was also affected by COVID-19 public health measures, such as restrictions on gatherings and travel; and by supply-side constraints related to community access and attitudes, including distrust and stigmatization of CHWs as infectious or informers. CHWs demonstrated commitment in adapting their work, for example ensuring patients had adequate drugs in advance of lockdowns, and using their own money and time to address increased transport costs and higher workloads. Effectiveness of these adaptations varied, and some involved coping in a context of inadequate support. CHW are critical for effective response to disease outbreaks, including pandemics like COVID-19. To support CHWs’ contribution and protect their wellbeing, CHWs need adequate resources, managerial support, and motivation.

Leveraging Community Health Workers for COVID-19 Response in Democratic Republic of Congo, Nigeria, Senegal, and Uganda: Roles, Barriers, and Facilitators

“…In African countries where shortages, mal-distribution, absenteeism and poor motivation of health 23), Kenya and Ghana (24). Similarly, CHWs supported continuity of essential health services during the 2014 Ebola outbreak in West Africa (25).…”

A scoping review of the roles, challenges, and strategies for enhancing the performance of community health workers in the response against COVID-19 in low- and middle-income countries

“…For example, in India, Bangladesh, and Ethiopia, CHWs facilitated the willingness of family members exhibiting COVID-19 symptoms to agree to their admission to a treatment centre [15]. Moreover, through community collaboration, the CHWs achieved signi cant progress by educating individuals about quarantine protocols and effectively identi ed potential cases of COVID-19 [15]. In so doing, they signi cantly reduced stigma against those who had recovered by educating communities and demystifying COVID-19 infections [15].…”

“…In India for example, the CHWs were unaware of these additional incentives while incentives were not paid in other cases [15]. Further, there was variation between CHW cadres in India resulting into some CHWs being demotivated, and others going on strike due to lack of incentives for COVID-19 [15]. In Ethiopia, CHWs spent additional money out of their own pocket to provide services during COVID-19, without compensation [15].…”

“…A publication about CHWs' experiences during COVID-19 in India, Bangladesh, Pakistan, Sierra Leone, Kenya and Ethiopia showed that overall, support towards CHWs in responding to the COVID − 19 pandemic varied between countries and among different CHWs [15]. They were signi cant gaps including disruption of medical supply chains, high workloads, leaving CHWs vulnerable to infection and stress [15]. Some countries such as Brazil published contradictory recommendations on community engagement [16].…”

The Impact of the COVID-19 Pandemic on Neonatal Services: A Review Article

“…One of the main challenges neonatal healthcare professionals face during the pandemic is the increased workload (40). The pandemic has increased the number of critically ill patients requiring care in neonatal units (41).…”