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

Abstract

Background: With the spread of COVID-19 to most low-and middle- income countries (LMICs), global concerns arose on how to respond to the pandemic. While studies have documented the experience of community actors and in particular community health workers (CHWs) in responding to COVID-19 in LMICs, critical appraisal and synthesis of research data on the same is still lacking. We aimed to highlight, the roles and challenges of CHWs in the fight against COVID-19, and strategies to address these challenges. Methodology: Using a scoping review design, we systematically searched the following electronic databases: PubMed, HINARI, Cochrane Library (Reviews and Trials), Science Direct and Google Scholar. Three authors searched literature on CHWs and COVID-19 as well as CHWs and the COVID-19 vaccine. After critical appraisal of studies, informed by Arksey and O’Malley, twenty-five articles were included in the final analysis. Results: Community health workers assisted with and contributed to health promotion and education tasks, surveillance, contact tracing and quarantine, maintaining essential primary health services, linking people to services through referrals, advocating for clients and communities, supporting planning and coordination of vaccination, as well as participated in vaccine rollout tracking and follow-up. Challenges experienced by CHWs in the COVID-19 response included stigma and discrimination by community members, inadequate infection prevention and control preparedness, lack of supplies and commodities, limited supportive policies and inadequate remuneration and incentives. The performance of CHWs during COVID-19 pandemic response could be enhanced by harnessing digital technology (mHealth) to support CHWs, establishing collaborative groups via mobile-messaging platforms, prioritizing CHWs in receiving the COVID-19 vaccine, and periodically training CHWs in preventive measures of the COVID-19 response. It was also noted that implementing wellness programs for CHWs including the provision of adequate and quality protective equipment was vital. Conclusion: CHWs were found to be critical community actors and integral members of the health system during the COVID-19 pandemic. This calls for increased investments that will ensure greater support for the integration of CHWs into health systems as this could also ultimately contribute to maintaining the credibility and sustainment of CHW programs, as well as promoting more inclusive health systems.