Community health workers for pandemic response: a rapid evidence synthesis

Abstract

IntroductionCoronavirus disease (COVID-19), affects 213 countries or territories globally. We received a request from National Health Systems Resource Centre, a public agency in India, to conduct rapid evidence synthesis (RES) on community health workers (CHWs) for COVID-19 prevention and control in 3 days.MethodsWe searched PubMed, websites of ministries (n=3), public agencies (n=6), multilateral institutions (n=3), COVID-19 resource aggregators (n=5) and preprints (n=1) (without language restrictions) for articles on CHWs in pandemics. Two reviewers screened the records independently with a third reviewer resolving disagreements. One reviewer extracted data with another reviewer cross-checking it. A framework on CHW performance in primary healthcare not specific to pandemic was used to guide data extraction and narrative analysis.ResultsWe retrieved 211 records and finally included 36 articles. Most of the evidence was from low-and middle-income countries with well-established CHW programmes. Evidence from CHW programmes initiated during pandemics and for CHW involvement in pandemic response in high-income countries was scant. CHW roles and tasks change substantially during pandemics. Clear guidance, training for changed roles and definition of what constitutes essential activities (ie, those that must to be sustained) is required. Most common additional activities during pandemics were community awareness, engagement and sensitisation (including for countering stigma) and contact tracing. CHWs were reported to be involved in all aspects of contact tracing - this was reported to affect routine service delivery. CHWs have often been stigmatised or been socially ostracised during pandemics. Providing PPE, housing allowance, equal training opportunities, transportation allowance, improving salaries (paid on time and for a broad range of services) and awards in high-profile public events contributed to better recruitment and retention. We also created inventories of resources with guiding notes on guidelines for health workers (n=24), self-isolation in the community (n=10) and information, education and counselling materials on COVID-19 (n=16).ConclusionsCHWs play a critical role in pandemics. It is important to ensure role clarity, training, supportive supervision, as well as their work satisfaction, health and well-being. More implementation research on CHWs in pandemics is required.

A Syndemic Perspective on the Management of Non-communicable Diseases Amid the COVID-19 Pandemic in Low- and Middle-Income Countries

“…CHWs can also carry out surveillance of risk factors and implement preventive and self-management strategies for PLWNCDs, who are at high risk of COVID-19. Potential CHW roles in COVID-19 management include community engagement, community sensitization, promoting isolation and quarantine, and performing contact tracing (44,45). Despite their huge potential in pandemic management, CHWs have been underutilized in the COVID-19 pandemic, especially in countries where CHWs are available, such as Bangladesh, India, and Nepal.…”

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

“…Although CHWs were trained for the selected zoonoses or participated in the zoonoses campaigning in the local setting, they urged for more intense OH training before being captivated as OHAs. Although the evidence already indicates the involvement of CHWs in pandemic control [51] and their multidisciplinary roles in infectious disease control [52] and surveillance [53], CHWs urged for more OH training on the multidisciplinary teamwork. Thus, the OH training should strengthen social and leadership skills, as well as training on coordinating roles in a multidisciplinary team along with the subject knowledge.…”

Agente comunitário de saúde: reflexões sobre o processo de trabalho em saúde em tempos de pandemia de Covid-19

“…The review of the evidence [23][24][25][26][27] on the CHW work in pandemic contexts, indicates that they represent a significant part of the workforce in the front line and can be valuable in pandemics control and prevention such as COVID-19. In countries with well-established programs, the CHW functions and tasks transform during pandemics because of the need to redefine normal procedures for conducting routine activities.…”