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other·public health, epidemiology, family medicine, infectious disease, observational study·PMC10022071

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

PLOS Global Public Health · 8 authors, 7 centres

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TL;DR

The central finding is that CHWs made important contributions to the pandemic response but often faced significant gaps in support, leaving them vulnerable.

Full summary

706 CHARS

This study is a thematic synthesis of evidence from 25 reports based on 18 research projects conducted across India, Bangladesh, Pakistan, Sierra Leone, Kenya, and Ethiopia during 2020–2021. The central results show CHWs played key roles in COVID-19 surveillance, community education, and patient support. This left CHWs vulnerable to infection and stress, compounded by challenges like disrupted supply chains, high workloads, and stigmatization. CHWs demonstrated commitment by adapting their work, such as pre-stocking medicines, but these adaptations were often coping mechanisms for inadequate support. Limitations include the heterogeneity of CHW roles across countries, which was not fully examined.

STUDY TYPE

other

SPECIALTY

public health

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AI pipeline

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100% · A

ORIGINAL PAPER

PMC10022071

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

PLOS Global Public Health

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ABSTRACT

Community health workers (CHWs) are a key part of the health workforce, with particular importance for reaching the most marginalised. CHWs’ contributions during pandemics have received growing attention, including for COVID-19. This paper contributes to learning about CHWs’ experiences during COVID-19, based on evidence from India, Bangladesh, Pakistan, Sierra Leone, Kenya and Ethiopia. The paper synthesises evidence from a set of research projects undertaken over 2020–2021. A thematic framework based on the research focus and related literature was used to code material from the reports. Following further analysis, interpretations were verified with the original research teams. CHWs made important contributions to the COVID-19 response, including in surveillance, community education, and support for people with COVID-19. There was some support for CHWs’ work, including training, personal protective equipment and financial incentives. However, support varied between countries, cadres and individual CHWs, and there were significant gaps, leaving CHWs vulnerable to infection and stress. CHWs also faced a range of other challenges, including health system issues such as disrupted medical supply chains, insufficient staff and high workloads, a particular difficulty for female CHWs who were balancing domestic responsibilities. Their work was also affected by COVID-19 public health measures, such as restrictions on gatherings and travel; and by supply-side constraints related to community access and attitudes, including distrust and stigmatization of CHWs as infectious or informers. CHWs demonstrated commitment in adapting their work, for example ensuring patients had adequate drugs in advance of lockdowns, and using their own money and time to address increased transport costs and higher workloads. Effectiveness of these adaptations varied, and some involved coping in a context of inadequate support. CHW are critical for effective response to disease outbreaks, including pandemics like COVID-19. To support CHWs’ contribution and protect their wellbeing, CHWs need adequate resources, managerial support, and motivation.

CITATION EXPORT

Solomon Salve, Joanna Raven, Priya Das et al.. Community health workers and Covid-19: Cross-country evidence on their roles, experiences, challenges and adaptive strategies. PLOS Global Public Health. (2023). https://doi.org/10.1371/journal.pgph.0001447

AUTHORS

8 · 7 CENTRES

Solomon Salve, Joanna Raven, Priya Das, Shuchi Srinivasan, Adiba Khaled, Mahwish Hayee, Gloria Olisenekwu, Kate Gooding

1 Oxford Policy Management, Delhi, India
2 Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
3 Oxford Policy Management, Dhaka, Bangladesh
4 Oxford Policy Management, Islamabad, Pakistan
5 Oxford Policy Management, Abuja, Nigeria
6 Oxford Policy Management, Oxford, United Kingdom
York University, CANADA

EDITOR / REVIEWER

Amrita Daftary