A Situation Assessment of Community Health Workers’ Preparedness in Supporting Health System Response to COVID-19 in Kenya, Senegal, and Uganda

Abstract

Background: Coronavirus disease (COVID-19) caused socio-economic disruptions across the globe. The pandemic disrupted the health system (HS) calling for reengineering in response to high infection rates, deaths, and resultant containment measures. To deal with COVID-19 and promote resilience, community health workers (CHWs) were engaged across countries. Objective: Assess the preparedness of CHWs in supporting health system response in prevention and management of COVID-19 in Kenya, Senegal, and Uganda. Methods: A mixed methods design study involving national and subnational jurisdictions in the 3 countries. Key informant interviews were conducted with policy actors (16) and health care workers (24) while in-depth interviews involved CHWs (14) and community members (312) subjected to survey interviews. Results: Most (>50%) households survived on <USD 100/month during COVID-19 announced in March 2020 through national TV (57%), FM (42%), and radio station (27%). Community members interactions with CHWs increased during the pandemic through home visits as health educators, basic counseling providers and distributors of pandemic information tools, personal protective equipments, and social support commodities. The CHWs faced challenges during pandemic prevention and management including lack of: protective gear, salary, refresher courses, and identification tools; limited supervision and training; hostile reception during home visits; misconception and politicking about the pandemic. To effectively support prevention and manage of COVID-19, priority needs for CHWs were identified namely: provision of resources, protective gear, transport reimbursement, stipends, identification cards, and tools for recording and reporting; empowerment with adequate skills, trainings on provision of psychosocial support, first aid, and sensitization on policies. Conclusion: COVID-19 linked disruptions to optimal functioning of HS necessitated engagement of CHWs in the pandemic prevention and management. Findings underscore the important role CHWs play in supporting HS during crisis like COVID-19 to mitigate disruptions and stabilize the system for effective response. The CHWs can improve resilience of social and HS during unplanned disruptions for optimal functioning and attainment of universal health care. Policy makers should develop structured mechanisms for engaging CHWs while committing resources to address challenges that affect seamless synergy between health and CHWs Systems.

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

“…Our synthesis showed that apart from routine service delivery CHWs were actively involved in COVID-19 activities such as contact tracing, community education and awareness on COVID-19, screening people with potential COVID-19 symptoms, counselling migrants. Similar roles in both the COVID-19 response and continued delivery of routine services during COVID-19 have been identified by other research, both in some countries included in our research, such as India, Sierra Leone and Kenya and in other contexts, as well as in global syntheses [8,16,18,22,[83][84][85].…”

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

“…In this context, CHWs had little access to external support and training [ 36 ]. Similarly, in a mixed methods study Chengo et al document CHW household visits in Kenya, Uganda, and Senegal during the COVID-19 pandemic [ 8 ]. Chengo et al also highlight key challenges experienced by CHWs including the lack of protective gear, training, and reporting tools that were addressed by the intervention in Siaya County [ 8 ].…”

“…Qualitative data from India, Bangladesh, Pakistan, Sierra Leone, Kenya and Ethiopia, document the important role CHWs played in surveillance, community education and support of community members with COVID-19 [ 7 ]. An assessment of CHW preparedness in Kenya, Senegal, and Uganda by Chengo et al found, however, that CHWs faced significant challenges because of the lack of training and personal protective equipment (PPE) [ 8 ]. Other studies demonstrated that training, especially of rural CHWs, led to improved COVID-19 surveillance efforts and reduced COVID-19 infections.…”

Psychosocial work aspects, work ability, mental health and infection rates of on-site and remote Brazilian workers during the COVID-19 pandemic – a longitudinal study

“…Numerous studies investigated the mental health of healthcare providers, demonstrating considerable levels of mental exhaustion during the COVID-19 pandemic [8][9][10][11]. However, few studies addressed the effects of the pandemic on the mental health of remote and on-site general workers over time [12,13].…”