Community health workers for pandemic response: a rapid evidence synthesis

Abstract

Introduction: Coronavirus disease (COVID-19), a respiratory illness, first discovered in China in December 2019 has now spread to 213 countries or territories affecting millions across the globe. We received a request from National Health Systems Resource Centre, a public agency in India, for a Rapid Evidence Synthesis (RES) on community health workers (CHWs) for COVID-19 prevention and control. Methods: We searched PubMed, websites of ministries, public agencies, multilateral institutions, COVID-19 resource aggregators and pre-prints (without language restrictions) for articles on the role, challenges and enablers for CHWs in pandemics. Two reviewers screened the records independently with a third reviewer resolving disagreements. One reviewer extracted data in a consensus data extraction form with another reviewer cross-checking it. A framework on CHW performance in primary healthcare not specific to pandemic was used to guide data extraction and narrative analysis. Results: We retrieved 211 records and finally included 36 articles on the role, challenges and enablers for CHWs in pandemics. We found that CHWs play an important role in building awareness, countering stigma and maintaining essential primary healthcare service delivery. It is essential that CHWs are provided adequate Personal Protective Equipment (PPE) and appropriately trained in its usage in the early stages of the pandemic. Wide range of policies and guidance is required to ensure health systems functioning. A clear guidance for prioritizing essential activities, postponing non-essential ones and additional pandemic related activities is crucial. CHWs experience stigmatization, isolation and social exclusion. Psychosocial support, non-performance-based incentives, additional transport allowance, accommodation, child-support, awards and recognition programs have been used in previous pandemics. We also created inventories of resources with guiding notes for quick utility by decision makers on guidelines for health workers (n=24), self-isolation in the community (n=10) and information, education and counselling materials on COVID-19 (n=16). Conclusions: CHWs play a critical role in pandemics like COVID-19. It is important to ensure role clarity, training, supportive supervision, as well as their work satisfaction, health and well-being. There is a need for more implementation research on CHWs in pandemics like COVID-19.

Community engagement for COVID-19 prevention and control: a rapid evidence synthesis

“…In line with community agency and taking into account a framework developed by UNICEF and revised by Community Health–Community of Practice, the definition of community engagement adopted in this study covers the range of collaborative processes with community actors that transcend beyond CHWs and includes community groups, informal providers, faith organisations or social networks. 34 We excluded CHW approaches and interventions as reviews of this nature have already been conducted, 31 though we included articles if they described community engagement approaches alongside CHW programmes and narrowed the scope to include five recent infectious disease outbreaks: Ebola, SARS, MERS, Zika and H1N1.…”

“…Recent reviews on global evidence for COVID-19 have focused on community health workers (CHWs) 31 providing important evidence and insights to guide response. However, there is no evidence synthesis that addresses how community engagement can be used for COVID-19 prevention and control.…”

Equipping community health workers with digital tools for pandemic response in LMICs

“…In Vietnam, the Ministry of Health has piloted a telemedicine platform to reduce direct contact of CHWs with community patients, decreasing the risk of infection for community-based health workers, in the context of the Covid-19 pandemic. In Mozambique [ 7 ], upSCALE digital platform has been adapted to support CHWs to respond to COVID-19. The CHWs in Mozambique utilize upSCALE digital platform to provide basic healthcare and conduct health promotion activities [ 8 ].…”

“…Therefore, user-friendly digital health solutions should be developed and integrated into the routine workflow of CHWs for pandemic preparedness and response [ 1 ]. Training of CHWs on basic technological skills such as the use of digital megaphones and robocalls for health education, SMS for data collection, and voice call for a consultation, will help accelerate the response to the Covid-19 pandemic [ 7 ]. Engaging governments on the approach for training existing CHWs to prevent, detect, and manage Covid-19 cases, would be useful in ensuring better community health [ 13 ].…”

Community Health Workers: Challenges and Vulnerabilities of Accredited Social Health Activists Working in Conflict-affected Settings in the State of Assam, India

“…We suggest health systems to consider incentivising the ASHAs when they provide services during con ict. We also suggest psychological support and job security for ASHAs working in fragile and con ict settings, which has already been raised as an important need in outbreak contexts (17).…”