Community Health Workers and Pandemic Preparedness: Current and Prospective Roles

Abstract

Despite the importance of community health workers (CHWs) to health systems in resource-constrained environments, relatively little has been written about their contributions to pandemic preparedness. In this perspective piece, we draw from the response to the 2014 Ebola and 2015 Zika epidemics to review examples whereby CHWs contributed to health security and pandemic preparedness. CHWs promoted pandemic preparedness prior to the epidemics by increasing the access to health services and products within communities, communicating health concepts in a culturally appropriate fashion, and reducing the burdens felt by formal healthcare systems. During the epidemics, CHWs promoted pandemic preparedness by acting as community-level educators and mobilizers, contributing to surveillance systems, and filling health service gaps. Acknowledging the success CHWs have had in these roles and in previous interventions, we propose that the cadre may be better engaged in pandemic preparedness in the future. Some practical strategies for achieving this include training and using CHWs to communicate One Health information to at-risk communities prior to outbreaks, pooling them into a reserve health corps to be used during public health emergencies, and formalizing agreements and strategies to promote the early engagement of CHWs in response actions. Recognizing that CHWs already play a role in pandemic preparedness, we feel that expanding the roles and responsibilities of CHWs represents a practical means of improving pandemic and community-level resilience.

COVID-19 Outbreak Situation in Nigeria and the Need for Effective Engagement of Community Health Workers for Epidemic Response

“…Infectious disease outbreaks of large magnitude, such as COVID-19, need special attention beyond the routine in terms of resources and procedures, as they have tendency to significantly impact the nation's economy and health system [34]. These impacts are usually more felt at the community level where the existing health resources are usually limited.…”

“…These impacts are usually more felt at the community level where the existing health resources are usually limited. CHWs are able to fill in these gaps in the health system by extending health services to these vulnerable populations [34].…”

“…In light of the aforementioned, it will be a good strategy for Nigeria to promptly and effectively bring the CHWs on board in the epidemic response against COVID-19 with two broad aims. The first is in the direct involvement in the various aspects of COVID-19 prevention and response activities, a contribution of adaptive resilience to the health system [34]. The second aim is to prevent a decline in health indices and sustain essential services, a contribution of inherent resilience to the health system [34].…”

“…The PHCs need to restructure and strategize, such that CHWs continue to deliver services such as routine immunization, maternal and child care services and community management of infectious diseases especially for children. These will reduce morbidity and mortality, improve populations' health and reduce their susceptibility to infection [34].…”

Who could be One Health Activist at the community level?: A case for India

“…According to various country reports, the role of CHWs generally includes health promotion, disease prevention, treatment of basic medical conditions, and collection of health data [7,11,12]. In addition, CHWs also have been considered as a valuable asset during outbreaks for social mobilization and the distribution of health information, thus improving health security and community-level resilience [13].…”