Community health workers for pandemic response: a rapid evidence synthesis
Abstract
Introduction
Coronavirus disease (COVID-19), a respiratory illness, first discovered in China in December 2019 has now spread to 213 countries or territories affecting millions across the globe. We received a request from National Health Systems Resource Centre, a public agency in India, for a Rapid Evidence Synthesis (RES) on community health workers (CHWs) for COVID-19 prevention and control.
Methods
We searched PubMed, websites of ministries, public agencies, multilateral institutions, COVID-19 resource aggregators and pre-prints (without language restrictions) for articles on the role, challenges and enablers for CHWs in pandemics. Two reviewers screened the records independently with a third reviewer resolving disagreements. One reviewer extracted data in a consensus data extraction form 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.
Results
We retrieved 211 records and finally included 36 articles on the role, challenges and enablers for CHWs in pandemics. We found that CHWs play an important role in building awareness, countering stigma and maintaining essential primary healthcare service delivery. It is essential that CHWs are provided adequate Personal Protective Equipment (PPE) and appropriately trained in its usage in the early stages of the pandemic. Wide range of policies and guidance is required to ensure health systems functioning. A clear guidance for prioritizing essential activities, postponing non-essential ones and additional pandemic related activities is crucial. CHWs experience stigmatization, isolation and social exclusion. Psychosocial support, non-performance-based incentives, additional transport allowance, accommodation, child-support, awards and recognition programs have been used in previous pandemics.
We also created inventories of resources with guiding notes for quick utility by decision makers 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).
Conclusions
CHWs play a critical role in pandemics like COVID-19. It is important to ensure role clarity, training, supportive supervision, as well as their work satisfaction, health and well-being. There is a need for more implementation research on CHWs in pandemics like COVID-19.
Summary Box
What is already known?
COVID-19 is a pandemic which has now strained health systems across the world. Community health workers (CHWs) are being deployed in many countries for COVID-19 prevention and control. However, there is no evidence synthesis on the issue.
What are the new findings?
CHWs can play an important role in creating awareness, countering stigma, and maintaining essential primary healthcare delivery.
Adequate provisions for personal protective equipment are essential for CHWs
Governments should provide a clear guidance to CHWs for prioritizing essential activities, postponing non-essential ones and for additional pandemic related activities, while also ensuring their health and safety
CHWs experienced stigmatization, isolation and were socially ostracized in previous pandemics. Psychosocial support, non-performance-based incentives, additional transport allowance, accommodation, child-support, awards and recognition programs have been used as enablers.
What do the new findings imply?
Roles of CHWs in a pandemic context must be clear. Apart from clear guidance adequate training and support should be provided. requiring adequate training and guidance is useful. Contact listing and identification should be done by separate trained cadre.
Countries without pre-existing CHWs program must consider applicability of available evidence before investing in ambitious new CHW programs.
There is a need for more implementation research on CHWs in pandemics like COVID-19.
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