Boost community health worker capacity to fight Covid-19

About a century ago, in 1920s China, a cadre of health workers emerged.

Unlike trained doctors and nurses, these health workers operated outside of health facilities, visiting people in their homes and interacting with them within their communities.

Here, they would share basic health knowledge on everything from simple hygiene to how to care for minor ailments.

By the 1960s, similar units had cropped up in countries such as India and Tanzania, and the following decade, they were formally recognised in the Alma Ata Declaration of 1978.

This declaration articulated the urgent need for governments, communities, and health and development workers everywhere to protect and promote the health and well-being of all people.

It set the stage for modern-day Universal Health Coverage (UHC) ambitions and outlined the role of Community Health Volunteers (CHVs) in delivering Primary Health Care (PHC), the foundation of UHC.

CRUCIAL LESSONS

Now, just a decade away from the global target of achieving UHC by 2030, the world is facing an unprecedented calamity: the coronavirus pandemic that causes Covid-19 disease.

With over 24,000 deaths and more than 530,000 cases worldwide as of March 27, Covid-19 is crippling what were previously thought to be robust public health systems in countries across the globe.

This is happening at a time when there is a global shortage of 17.4 million health workers, according to the World Health Organisation (WHO), hampering countries’ efforts to deliver healthcare to the more than 400 million people worldwide that still lack access to essential healthcare.

In the midst of this misfortune, however, are important lessons to be learned on the journey towards achieving UHC by strengthening health systems, and the role that community-based health programmes can play in addressing the health needs of underserved populations around the world – especially during times of crisis.

PREVENTION

One of the greatest lessons we are learning from the coronavirus pandemic is that prevention is better than cure.

If done effectively, prevention could be one of the biggest weapons against the coronavirus outbreak.

That is why health professionals and leaders all over the world are advocating for preventive measures such as proper handwashing, social-distancing and self-quarantine.

But how often do these messages filter down to grassroots level? This is where CHVs play a vital role.

As trusted members of their communities, CHVs can complement mainstream sources of information such as mass media in a more personal way, having an intimate understanding of the contexts they operate in.

If we strengthened our health systems at all levels, from the community level to the big referral hospitals, we would be better equipped to share information on simple preventive measures such as hygiene maintenance and handwashing: these messages would be disseminated to communities by CHVs.

HEALTH AGENTS

CHVs offer the first line of defence during disease outbreaks: they are often the first point of contact between communities – especially rural ones and urban informal settlements – and health systems.

These health workers and volunteers are key in ensuring that families stay healthy, and are an important resource that can be deployed to monitor the health of communities and relay consequential information to the formal healthcare system.

But for them to carry out these duties, they need to be empowered.

Training CHVs in Covid-19 prevention and control would enable them deliver quality services and accurate messages, including how to prevent infection, what to do when you come into contact with an infected person, how to manage symptoms and when to seek further treatment.

Moreover, CHVs are well-placed to deliver this information in the languages best understood by their communities.

Recently, Amref Health Africa and the Ministry of Health in Kenya partnered to launch a campaign to educate health workers on Covid-19.

TRAINING

Using Leap, a mobile health platform developed by Amref Enterprises Limited, health workers are being trained to identify, isolate and refer suspected Covid-19 cases as well as maintain safety standards at points of entry or high-risk areas to prevent possible transmission.

By leveraging the ubiquity of the mobile phone to deliver customised content to health workers through their mobile devices – both feature phones and smart phones – these CHVs can reach tens of thousands of households that are far removed from the formal health system, helping to prevent the spread of the disease to localities with fragile or non-existent health systems.

Amref already has 50,000 health workers on the platform and is enrolling more in order to reach rural and remote areas, where close to 70 per cent of Kenya’s population lives, according to the Kenya National Bureau of Statistics.

It is a relatively simple approach to a complex problem, but investing in CHVs is not only key to expanding health coverage from the bottom up in the long term – it is critical to saving lives during the coronavirus pandemic in the near term.

Mr Kinoti is Group Programmes Director, Amref Health Africa