What the COVID-19 Response Has Taught Us about the Critical Role of Community Health Workers

For decades, Community Health Workers (CHWs) have been delivering primary health services in hard-to-reach regions of the world.

While the terms CHW and Community Health Volunteers (CHVs) have been used interchangeably to mean the same thing, in Kenya, the use of the term ‘volunteer’ means that they are not required to be compensated. This is the case in many other African countries where CHWs or CHVs are not paid for the vital health services they provide to their communities. They should indeed be paid.

In 2018, the World Health Organisation (WHO) recommended that CHWs should be assigned a targeted population size that should impact their productivity, coverage, and health outcomes. Prominent among the many challenges that have continued to result in poor CHW performance is an excessive workload, often indirectly linked to an increased population size served by each CHW. In Kenya, CHWs operate within a structure of 500 people or 100 households. However, this has been surpassed to over 200 households due to the vastness of some parts of the country and high attrition due to the lack of support and motivation from the formal health system.

The emergence of COVID-19 globally has refocused attention to CHWs as the most easily accessible and available workforce to step in to turn off the tap of community transmission. Community transmission has increasingly been seen as aggravating the devastating effects of the disease on the economy and social fabric of the society world over.

CHWs are a Game-Changer

A global and local lack of adequate equipment and resources to empower and adequately equip health care workers for the COVID-19 response has caused fear among health care workers based on their risk of exposure to the disease. This has presented a challenge in tracing contacts of COVID-19 patients as well as surveillance provided at the community level. However, CHWs are playing a pivotal role in reducing the threat of transmission through the household-to-household search of case contacts and referring them for testing with the support of local administration and the national surveillance team. In South Africa, over 28,000 CHWs are involved in active case finding by going house-to-house in vulnerable communities screening and testing communities to find cases. In Kenya 63,350 CHWs have been sensitised on COVID-19. They have reached over 5.5million households with COVID-19 prevention messages, conducting contact tracing, and reporting new cases to the authorities for further health action.

Contact Tracing and Behaviour Change Champions

The Government of Kenya has developed clear protocols for CHWs in recognition of their role in contact tracing in aid of the COVID-19 response. They are expected to follow up anyone who has touched the patient’s body fluids (blood, vomit, saliva, urine, faeces); have had direct physical contact with the body of the patient (alive/dead); has touched or cleaned the linens or clothes of the patient; has slept or eaten in the same household as the patient; has been breastfed by the patient (i.e. babies); and health care workers who have suffered a needle-stick injury from a contaminated instrument while attending to a probable or confirmed COVID-19 patient. For them to perform these tasks, the CHWs are expected to have access to personal protective equipment (PPE), including face masks, gloves, gowns, face shields, and goggles; respiratory support supplies and equipment; 70% alcohol-based hand sanitisers; transport for on-spot response teams and a community-based ambulance for referrals. All these requirements are not supplied in proportionate quantities to their needs and use.

Amref Health Africa has long recognised the value of CHWs in creating lasting health change in Africa. That is why we are in support of Kenya’s Community Health Services Bill 2020 that is currently in Parliament. The CHS Bill seeks to entrench community health workers into the health system for ease of planning and resource allocation and investment by the state to mitigate the perpetual misuse of this group of frontline workforce that plays a critical role in regular community health service delivery and also in times of a pandemic such as the case of the COVID-19 emergency response.

The current debate as to whether CHWs should be remunerated and recognised not only does a great disservice to this group of frontline health workers who put their lives on the line every day, but it also has a huge bearing on the nation’s response to any other emerging pandemics. It is time to get our heads out of the sand and stand with CHWs as they are a game-changer in Kenya’s efforts to provide its citizens with the highest attainable standards of health.

By George Oele: Community Health Specialist, Amref Health Africa.