The COVID-19 pandemic has highlighted the world’s reliance on community health workers for basic medical treatment and education. But despite the critical functions they perform, these caregivers lack recognition and support from the governments and NGOs that depend on their services.
NEW YORK/CHICAGO – In every phase of the COVID-19 pandemic, community health workers have been indispensable. They made diagnoses, carried out contact tracing, cared for the sick and administered vaccines. And they accomplished all of these tasks with minimal funding, oversight, and assistance.
The use of community health workers in rural health care has a long history of success. In the 1960s, thebarefoot doctors” helped the country eradicate smallpox and double life expectancy. A decade later, Bangladesh partly emulated the Chinese initiative when it spear its community health worker program, which has helped the country to reach a majority of the health-related Millennium Development Goals, such as increasing immunization rates against diphtheria, tetanus and whooping cough among rural children from near zero in the 1980s to more than 90% today.
Community health workers are neither doctors nor nurses. They are local residents with basic medical training who help bridge the gap between health care facilities and underserved populations. Usually they are trained by NGOs and receive little or no compensation from their governments. In fact, few governments around the world keep registries of community health workers or have a way to communicate with them.
These committed people can form the backbone of the resilient health systems needed to manage the next pandemic. But for that, they need more support.
The challenges faced by community health workers around the world are considerable. Many, like Nepal’s 50,000 female community health volunteersare unpaid, even though the value of the free wages and labor these workers provide around the world is estimated at $1.5 trillion.
But money is only a problem. In Brazil, some community health workers receive only one or two weeks of training before starting unsupervised work. Community health workers in Ethiopia spend more time traveling than treating patients due to the rural and remote nature of the communities they serve. A survey in Liberia in 2018 and 2019 found that less than half of community health workers had life-saving supplies of zinc or amoxicillin. And just over half had oral rehydration solution and malaria medication – crucial tools in a country where thousands of people die of diarrhea and malaria each year.
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It is no wonder that many community health worker programs experience high levels of attrition and vacancies. In Bangladesh, 15% of positions are vacant whenever. Staff turnover increases costs as replacements must be recruited, trained and deployed. It also reduces the quality of care, as new workers generally have less hands-on experience in providing health services.
The pandemic has revealed the need for strong and adaptable health systems, especially in underserved communities. To build these systems, we must find a way to properly recruit, train, equip, supervise and compensate frontline workers.
To begin with, groups running community health worker programs should review and strive to follow World Health Organization guidelines. recommendations on supporting community health workers. In addition, governments should develop and maintain geo-referenced information national registries of community health workers, which can be used to disseminate public health messages, improve links between rural communities and health clinics, and manage crises. Monitoring community health workers can also help ensure that they are properly trained and equipped.
Finally, governments and funding partners should explore other ways to support community health workers. An unrecognized and inexpensive tool is a sturdy bicycle. World Bicycle Reliefin collaboration with civil society organizations such as the Catholic Medical Mission Board and the Ministries of Health of seven countries, has distributed nearly 175,000 of its purpose-built Buffalo bikes, enabling community health workers to spend less time commuting and more time with patients.
Bicycles have improved health outcomes in several African countries. In Kenya, community health workers on bicycles saw 88% more patients and referred 50% more patients for TB screening at a local clinic. Community health workers equipped with bicycles in Zambia quadrupled the frequency of visits to their patients. And in Malawithey doubled the number of patients they could visit. Surveys show that community health workers who have bicycles are less likely to quit. Similarly, if program supervisors have bicycles, they can provide more guidance to community health workers, leading to better care for patients and more job satisfaction for caregivers.
When the acute phase of the COVID-19 pandemic ends, it will be largely thanks to the tireless work of community health workers. The best thing the world can do to maximize their effectiveness in future crises is to ensure they are properly trained, equipped, empowered and even compensated.