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Understanding challenges and opportunities of Community Health Workers operating in times of COVID-19

8th September 2021

NTD delivery activities were interrupted with the emergence of the COVID-19 pandemic. In accordance with WHO recommended guidance on NTD programming during the pandemic, all countries temporarily suspended community-based health interventions, such as mass drug administration (MDA) campaigns, in March 2020. Many NTD programmes were facing potential negative impacts as a result of the COVID-19 pandemic, including delays or shortfalls on NTD elimination targets, impending expiry of drug stock, and missed treatment opportunities. Furthermore, interruption of NTD care and treatment may have resulted in loss of committed personnel, trained resources and hamper supply chains.

Community health workers (CHWs) are the frontline healthcare delivery cadre for many national NTD programmes. Their role, depending on the CHW system in each country, can include MDA, surveillance for morbidity management and disability prevention (MMDP), advice for healthy water, sanitation and hygiene (WASH) practices, and behaviour change communication (BCC). Fears of disturbances to routine healthcare delivery, as was experienced during the Ebola crisis, being repeated during COVID-19 were substantiated as more research emerged.

The first qualitative investigations into the effects of COVID19 on services provided by community-based and other healthcare workforce cadres in low- and middle-income countries (LMICs) have already reported increased staff shortages, reduced patient visits and inpatient admissions, refusal of service to low-risk patient groups, fears of personal risk or of transmitting COVID-19 due to occupational exposure, and the side-lining of other health services. The specific impacts on CHWs and their work in national NTD programmes, particularly MDA campaigns that rely on regimen adherence to achieve efficacy and herd immunity at the population level, are as yet undocumented.

This brief describes the methodologies of two studies designed to understand challenges and opportunities of CHWs operating in times of COVID-19. These studies were unfortunately cut short due to the premature termination of the Research and Innovation Fund, in line with ASCEND’s early exit. The first study (CHW1) was to be a rapid assessment of CHWs willingness and readiness to continue engagement in mass drug administrations (MDAs) and other NTD services during the pandemic. The second study (CHW2) was to run concurrently and provide a complementary, more in-depth qualitative investigation into the challenges and opportunities facing CHWs during the pandemic.

The study design and tools are now available as a public good, to facilitate further use of this work, they can be accessed below: Understanding challenges and opportunities of Community Health Workers operating in times of COVID-19 Methodology Paper