Leveraging latent assets to strengthen the COVID-19 response and vaccine roll-out in Africa

Kaseje, Neema; Oruenjo, Kennedy; Kaseje, Dan; Evans, Timothy; Tanner, Marcel; Haines, Andy; Nyikal, James

doi:10.1136/bmjgh-2021-006289

Cited by 4 publications

(3 citation statements)

References 5 publications

(17 reference statements)

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“…In the case of COVID-19, adaptive trainings could hone CHWs educational role towards promoting vaccine uptake. Our findings align with global perspectives advocating for CHW as key assets and potential leaders within community-based health systems to educate about and in some countries (where permissible) administer vaccines [38]. Second, leveraging CHWs' intermediary role within community norms-shifting interventions can help destigmatize COVID-19 more broadly.…”

Section: Discussionsupporting

confidence: 75%

Confirming—and testing—bonds of trust: A mixed methods study exploring community health workers’ experiences during the COVID-19 pandemic in Bangladesh, Haiti and Kenya

Sripad

Gottert²,

Abuya³

et al. 2022

PLOS Glob Public Health

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Amidst the COVID-19 pandemic and national responses, trust (one’s belief that a system acts in one’s best interest) is important to consider. In community health systems, trust is embedded in relationships between clients, CHWs, and health system stakeholders. This mixed-methods study explores trust through the evolving COVID-19 crisis in Bangladesh, Haiti, and Kenya, where multi-country community health research was underway. We investigate the extent and ways trust between communities, community health workers (CHWs), and health system actors shift, including its relation to community fear and hostility, through self-reported positive and negative experiences of CHWs and policy/program stakeholders on a phone-based survey with 2,025 CHWs and 72 key informant interviews, including CHWs, in late 2020. On surveys, CHWs reported high levels of community trust (8/10 in Bangladesh and Kenya; 6/10 in Haiti) with over 60% reporting client relief in seeing their CHWs. About one-third of CHWs across countries reported experiencing instances of hostility from community members during the pandemic in the form of refused home-entry, ignored advice, or being shouted at. Multivariate analyses revealed that CHWs reporting more positive and fewer negative experiences is consistently associated with continuing routine work, doing COVID-19-related work, and greater community trust. Qualitative interviews showed that existing pre-pandemic trusting relationships withstood the early phase of COVID-19, mitigating negative community reactions toward CHWs and stigma towards COVID-positive individuals, maintaining routine health services, and sustaining appreciation for CHW-provided prevention information and emotional support. CHW-community and CHW-health system actor trust is strengthened when CHWs are well-resourced; CHW-community trust is strained by public frustration at the pandemic, associated restrictions, and sociopolitical stressors. Our study suggests that with adequate institutional support, bonds of trust can promote resilient community health systems during extended public health crises, through CHWs’ commitment to mitigating misinformation, reducing stigma, maintaining routine service provision, and promoting COVID-19 prevention.

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Section: Discussionsupporting

confidence: 75%

Confirming—and testing—bonds of trust: A mixed methods study exploring community health workers’ experiences during the COVID-19 pandemic in Bangladesh, Haiti and Kenya

Sripad

Gottert²,

Abuya³

et al. 2022

PLOS Glob Public Health

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“…Countries in SSA have faced challenges in COVID-19 vaccine administration. Some of these challenges include poor infrastructure for distributing the vaccine, limited cold chain facilities and growing vaccine hesitancy [ 16 ]. At the moment, only 26.8% of the population in SSA is fully vaccinated, compared with more than 50% of the population in the Global North [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Vaccine Hesitancy in Sub-Saharan Africa in the Context of COVID-19 Vaccination Exercise: A Systematic Review

Ochola

2023

Diseases

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Presently, the COVID-19 vaccine is seen as a means to an end in light of other challenges, such as vaccine inequity. Through COVID-19 Vaccines Global Access (COVAX), an initiative founded to guarantee fair and equitable distribution, vaccine hesitancy remains a critical component that needs to be addressed in sub-Saharan Africa. Utilizing a documentary search strategy and using the keywords and subject headings Utilitarianism and COVID-19 or Vaccine hesitancy and sub-Saharan Africa, this paper identified 67 publications from different databases (PubMed, Scopus and Web of Science), which were further screened by title and full text to achieve (n = 6) publications that were analyzed. The reviewed papers demonstrate that vaccine hesitancy occurs against a colonial backdrop of inequities in global health research, social–cultural complexities, poor community involvement and public distrust. All of these factors undermine the confidence that is crucial for sustaining collective immunity in vaccine programs. Even though mass vaccination programs are known to limit personal freedom, the exchange of information between healthcare professionals and citizens must be improved to encourage complete disclosure of vaccine information at the point of delivery. Moreover, addressing components of vaccine hesitancy should involve relying not on coercive public policies but on consistent ethical strategies that go beyond current healthcare ethics toward broader bioethics.

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“…Our study showed that training, equipping, and deploying CHWs can strengthen pandemic preparedness and response and lead to fewer COVID-19 infections and deaths compared to standard measures. In a global context of continued disparities in access to COVID-19 therapeutics and vaccines, a pattern repeated at all stages of the COVID-19 pandemic, defining interventions that would leverage assets already present in rural health PLOS GLOBAL PUBLIC HEALTH systems, including CHWs is crucial for robust current and future pandemic preparedness and response efforts [46]. The policy implications of our results from rural SSA are that building a community workforce is a critical component of pandemic preparedness and response especially in under-resourced health systems including rural health systems.…”

Section: Policy Implicationsmentioning

confidence: 99%

The effectiveness of community health worker training, equipping, and deployment in reducing COVID-19 infections and deaths in rural Western Kenya: A comparison of two counties

Kaseje,

Oruenjo,

Kaseje

et al. 2024

PLOS Glob Public Health

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COVID-19 and other pandemics remain significant threats to population health, particularly in rural settings where health systems are disproportionately weak. There is a lack of evidence on whether trained, equipped, and deployed community health workers (CHWs) can lead to significant reductions in COVID-19 infections and deaths. Our objective was to measure the effectiveness of deploying trained and equipped CHWs in reducing COVID-19 infections and deaths by comparing outcomes in two counties in rural Western Kenya, a setting with limited critical care capacity and limited access to COVID-19 vaccines and oral COVID-19 antivirals. In Siaya, trained CHWs equipped with thermometers, pulse oximeters, and KN95 masks, visited households to convey health information about COVID-19 prevention. They screened, isolated, and referred COVID-19 cases to facilities with oxygen capacity. They measured and digitally recorded vital signs at the household level. In Kisii county, the standard Kenya national COVID-19 protocol was implemented. We performed a comparative analysis of differences in CHW skills, activity, and COVID-19 infections and deaths using district health information system (DHIS2) data. Trained Siaya CHWs were more skilled in using pulse oximeters and digitally reporting vital signs at the household level. The mean number of oxygen saturation measurements conducted in Siaya was 24.19 per COVID-19 infection; and the mean number of temperature measurements per COVID-19 infection was 17.08. Siaya CHWs conducted significantly more household visits than Kisii CHWs (the mean monthly CHW household visits in Siaya was 146,648.5, standard deviation 11,066.5 versus 42,644.5 in Kisii, standard deviation 899.5, p value = 0.01). Deploying trained and equipped CHWs in rural Western Kenya was associated with lower risk ratios for COVID-19 infections and deaths: 0.54, 95% CI [0.48–0.61] and 0.29, CI [0.13–0.65], respectively, consistent with a beneficial effect.

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Leveraging latent assets to strengthen the COVID-19 response and vaccine roll-out in Africa

Cited by 4 publications

References 5 publications

Confirming—and testing—bonds of trust: A mixed methods study exploring community health workers’ experiences during the COVID-19 pandemic in Bangladesh, Haiti and Kenya

Confirming—and testing—bonds of trust: A mixed methods study exploring community health workers’ experiences during the COVID-19 pandemic in Bangladesh, Haiti and Kenya

Vaccine Hesitancy in Sub-Saharan Africa in the Context of COVID-19 Vaccination Exercise: A Systematic Review

The effectiveness of community health worker training, equipping, and deployment in reducing COVID-19 infections and deaths in rural Western Kenya: A comparison of two counties

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