Using telehealth to support community health workers in Uganda during COVID-19: a mixed-method study

Abstract

Background At the onset of the COVID-19 pandemic, a local consortium in Uganda set up a telehealth approach that aimed to educate 3,500 Community Health Workers (CHW) in rural areas about COVID-19, help them identify, refer and care for potential COVID-19 cases, and support them in continuing their regular community health work. The aim of this study was to assess the functioning of the telehealth approach that was set up to support CHWs during the COVID-19 pandemic. Methods For this mixed-method study, we combined analysis of routine consultation data from the call-center, 24 interviews with key-informants and two surveys of 150 CHWs. Data were analyzed using constant comparative method of analysis. Results Between March 2020 and June 2021, a total of 35,553 consultations took place via the call center. While the CHWs made extensive use of the call center, they rarely asked for support for potential Covid-19 cases. According to the CHWs, there were no signs that people in their communities were suffering from severe health problems due to COVID-19. People compared the lack of visible symptoms to diseases such as Ebola and were skeptical about the danger of COVID-19. At the same time, people in rural areas were afraid to report relevant symptoms and get tested for fear of being quarantined and stigmatized. The telehealth approach did prove useful for other purposes, such as supporting CHWs with their regular tasks and coordinating the supply of essential products. The health professionals at the call center supported CHWs in diagnosing, referring and treating patients and adhering to infection prevention and control practices. The CHWs felt more informed and less isolated, saying the support from the call center helped them to provide better care and improved the supply of medicine and other essential health products. Conclusions The telehealth approach, launched at the start of the COVID-19 pandemic, provided useful support to thousands of CHWs in rural communities in Uganda. The telehealth approach could be quickly set up and scaled up and offers a low cost strategy for providing useful and flexible support to CHWs in rural communities.

Covid-19 hotlines, helplines and call centers: a systematic review of characteristics, challenges and lessons learned

“…As Table 1 shows 18 Studies were undertaken in the Asia (India [ 36 – 43 ], China [ 30 , 44 – 47 ], Qatar [ 48 , 49 ], Bangladesh [ 50 ], Indonesia [ 51 ], Nepal [ 52 ]), 11 in the North America (United States [ 17 , 20 , 29 , 31 , 53 – 58 ], Dominican Republic [ 59 ]), 10 in the Europe (Austria [ 60 ], France [ 61 ], United Kingdom (UK) [ 62 , 63 ], Slovenia [ 64 ], German [ 65 ], Ireland [ 66 ], Poland [ 16 ], Serbia [ 67 ], Spain [ 68 ]), 3 in Africa (Tunisia [ 69 ], Egypt [ 70 ], Uganda [ 71 ]), and 1 in South America (Bolivia [ 22 ]). Among them, 11 studies were published in 2020, 11 in 2021, 9 in 2022, and 12 in 2023, and a summary of them is presented in Table 1 .…”

“…The concerns of the callers should be characterized into five groups including exacerbation of preexisting mental and physical illness (30.9%), known case of mental or physical illness (19%), Covid-19 related mental health concerns (22.2%), administrative or logistic issues (7.1%), newonset mental health‑related concerns or illnesses (15.9%). 38 Kok et al, 2023 [ 71 ] Uganda Assessing the functioning of the telehealth approach that was set up to support community health workers during the Covid-19 pandemic Mixed-method Toll-free line/ Community health workers March 2020/ seven days a week, from 7:00 to 23:00 from Monday to Friday, and from 9:00 to 18:00 on Saturday and Sunday Educating Community Health Workers in rural areas about Covid-19, refering and caring for potential Covid-19 cases, and supporting them in continuing their regular community health work Covid-19 queries, Psychological issues The telehealth approach did prove useful for supporting community health workers regular health services in rural communities. The community health workers felt better informed, less isolated and indicated that the support helped them to provide better care.…”

“…According to the finding, most of the studies aimed to describe a Covid-19 hotline/helpline/call center [ 17 , 20 , 29 , 31 , 40 , 44 , 49 , 52 , 56 , 58 – 65 , 69 ], analyze the calls [ 16 , 20 , 22 , 29 , 30 , 37 – 43 , 45 – 47 , 49 – 52 , 54 , 55 , 57 – 68 , 71 ] and the demographic characteristics of the callers [ 16 , 22 , 29 , 30 , 37 , 38 , 40 , 41 , 43 , 45 , 46 , 48 – 50 , 54 , 58 – 60 , 65 , 68 , 70 ], examine the callers’ feedback on the hotline/helpline/call center [ 30 , 31 , 36 – 38 , 52 , 59 , 60 , 62 , 69 , 70 ], and assess hotline/helpline/call center volunteers’ experiences [ 53 , 66 , 71 ].…”

“…About half of the hotlines/helplines/call centers ( n = 22) [ 29 – 31 , 37 , 41 – 45 , 47 , 49 , 51 , 54 – 56 , 60 – 62 , 64 , 65 , 70 , 71 ] were active seven days a week. The access time for other hotlines/helplines/call centers were different and included six days a week [ 48 ], five days a week [ 16 , 58 , 63 , 66 , 68 ], working days and Saturday [ 67 ], Monday to Wednesday [ 59 ], (seven days a week, then Monday to Saturday, then Monday to Friday) [ 20 ] and the access time was not reported in 12 articles [ 17 , 22 , 36 , 38 – 40 , 46 , 50 , 52 , 53 , 57 , 69 ].…”

“…About one third of the hotlines/helplines/call centers were active 24 h a day [ 29 , 30 , 37 , 41 – 45 , 47 , 51 , 54 – 56 , 61 , 70 ]. The rest of them were available 16 h a day from Monday to Friday, and 9 h a day on Saturday and Sunday [ 71 ],15.5 h a day [ 52 ], 14 h on working days and 7 h on Saturdays [ 67 ], 12 h a day [ 16 , 20 , 31 , 38 , 40 , 49 , 50 , 64 , 68 ], 9 h a day [ 62 , 63 , 65 ], 8 h a day [ 58 , 63 ], 6 h a day [ 55 , 60 ], 4 h a day [ 39 , 59 ], 3 h a day [ 66 ], and the number of hours were not reported in 8 studies [ 17 , 22 , 36 , 46 , 48 , 53 , 57 , 69 ].…”