The Critical Role of Community Health Workers in Pandemic Preparedness and Response
Community health workers (CHWs) have long been an essential component of health care delivery, particularly in low- and middle-income countries. These frontline workers, trained to meet the health needs of their communities, have played a crucial role in preventing, detecting, and responding to pandemics across the globe. The COVID-19 pandemic has once again highlighted the indispensable value of CHWs in maintaining equitable access to essential health services and keeping communities safe during times of crisis.
CHWs as Pandemic Responders
When equipped with ongoing training, supervision, remuneration, medical supplies, and personal protective equipment (PPE), CHWs can undertake a wide range of vital tasks during pandemics:
- Leading community-based infection prevention and control measures
- Facilitating safe sample collection for testing
- Conducting contact tracing to identify and monitor exposed individuals
- Accelerating the rollout of vaccination campaigns
- Providing home-based care and support for those in quarantine
Evidence from recent studies suggests that CHWs supported in line with World Health Organization (WHO) guidelines were able to maintain the speed and coverage of essential community-based services, such as integrated community case management, household visits, and postnatal care, even during the COVID-19 pandemic. This is a testament to the resilience and adaptability of CHWs when they are properly equipped and integrated into the health system.
Maintaining Essential Health Services During Crises
Pandemics often lead to significant disruptions in the utilization of essential health services, which can ultimately result in more deaths than the disease outbreak itself. CHWs play a crucial role in maintaining equitable access to these vital services, even in the face of significant system-wide disruptions.
In many countries, CHWs provide a substantial portion of primary care services, including the management of common childhood illnesses, distribution of contraceptives, treatment of malnutrition, and administration of vaccines. For example, in Liberia, CHWs deliver 45% of malaria treatments, and in Rwanda, they provide 56% of such care.
Recent evidence from four sub-Saharan African countries (Kenya, Mali, Malawi, and Uganda) has demonstrated that CHWs supported with adequate training, supplies, and PPE were able to sustain the coverage and speed of community-based care delivery during the COVID-19 pandemic. This includes maintaining the frequency of household visits, the timeliness of integrated community case management, and the registration of pregnancies and provision of postnatal care.
Professionalizing Community Health Workers for Pandemic Preparedness
Despite the critical role of CHWs and their proven ability to maintain essential services during crises, the majority of CHWs globally remain unpaid, lacking essential medications, inadequately supervised, and largely unsupported. This systemic underinvestment in CHWs represents a significant missed opportunity, particularly in light of the inevitability of future pandemics.
To ensure that CHWs can effectively prevent, detect, and respond to pandemics while also maintaining the delivery of essential health services, they must be treated as true professionals, fully integrated into the national health system. This requires a comprehensive approach that includes:
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Inclusion in National Health Registries: Governments must know who and where their CHWs are to support and deploy them effectively during emergencies.
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Institutionalized Minimum Practice Standards: Establishing clear competency requirements and standards of care will help formally acknowledge the crucial role of CHWs and ensure they can deliver high-quality services.
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Equitable Access to Care: Eliminating point-of-care user fees for CHW-delivered services is essential for improving access and promoting equity.
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Comprehensive Training and Supervision: Ongoing training in clinical and non-clinical skills, as well as dedicated supervisors, are necessary to equip CHWs with the knowledge and support they need.
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Fair Compensation and Benefits: CHWs should be paid at competitive rates, consistently, and on time, with the benefits they deserve, including hazard pay, family leave, and sick leave.
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Meaningful Inclusion in Decision-Making: CHWs must be represented in bodies that plan their work and working conditions, ensuring their perspectives inform policy decisions.
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Integrated Digital Data Systems: Comprehensive, non-vertical data systems and data literacy training will empower CHWs to document their work, report to the health system, and use data to improve performance.
By implementing these evidence-based recommendations, governments can design and invest in high-performing CHW programs that are prepared to respond effectively to pandemics and maintain essential health services, even in the face of significant disruptions.
Rethinking Donor Practices to Support Resilient Health Systems
Achieving resilient health systems with well-supported CHW programs requires a fundamental shift in the approach to bi/multilateral aid and private philanthropic investments in low- and middle-income countries. Too often, these funding sources have hindered the institutionalization and professionalization of CHWs through practices that cause harm, such as high transaction costs, earmarking, short-termism, and appropriation of sovereignty.
To address this, global health actors must accelerate the transition from harmful practices to those that accelerate impact and enable sovereign, resilient health systems to flourish. This includes:
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Aligning Investments with Government Strategies: New philanthropic investments should support the priorities and changing needs of national governments, as identified through meaningful engagement with civil society.
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Providing Flexible, Transparent Funding: Immediately available, flexible, and transparent funding with robust accountability mechanisms can sustain the long-term execution of government-led strategies.
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Valuing CHW Labor and Contributions: Funders must understand and address the degree to which their grantmaking relies on the unremunerated efforts of predominantly poor women of color.
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Replacing Harmful Practices: Intentionally replacing funding models that hinder CHW professionalization (e.g., short-term project funding, earmarking) with those that enable resilient health systems (e.g., pooled funding, longer-term commitments).
The COVID-19 pandemic has presented a unique opportunity for landmark policy changes that can strengthen community health systems and better prepare them for future crises. Global health actors must seize this moment and partner with governments to invest in high-performing CHW programs that can prevent epidemics from becoming pandemics and maintain essential health services, even in the face of significant disruptions.
Leveraging Government-Led Funding Mechanisms
One example of a government-led funding mechanism that supports community health system strengthening is the Community Health Roadmap Catalytic Fund. This unique fund is designed to meet the flexible, small-scale funding needs prioritized by community health coordinating mechanisms within Ministries of Health. During the COVID-19 response, this fund was able to quickly channel resources to the government-led efforts in Malawi and Zambia, helping both countries kickstart their community-level pandemic response.
Another example is the COVID-19 Action Fund for Africa (CAF-Africa), a collaboration that integrated with national COVID-19 responses to provide PPE to CHWs while also contributing to their recognition, equality, and pay across the continent. In Uganda, the government announced plans to compensate CHWs, known locally as village health teams, for their role in combating COVID-19 shortly after receiving a PPE shipment through this initiative.
These examples demonstrate how crises can present opportunities for landmark policy changes and investments that professionalize the CHW workforce and build resilient community health systems. By working in partnership with Ministries of Health and leveraging government-led funding mechanisms, global health actors can ensure that their investments have a sustainable, long-term impact on pandemic preparedness and response.
Conclusion: Seizing the Moment for Transformative Change
The COVID-19 pandemic has exposed and exacerbated long-standing inequities in health systems, diminishing tolerance for inequality and catalyzing demands to dismantle inequitable systems. This crisis presents a pivotal opportunity to make transformative changes that strengthen community health systems and better prepare them for future pandemics.
By professionalizing the community health workforce and rethinking donor practices to support resilient health systems, we can ensure that CHWs are equipped, trained, and empowered to prevent, detect, and respond to pandemics while also maintaining the delivery of essential health services, even in the face of significant disruptions. The time is now to seize this moment and invest in a future where community health systems are the backbone of pandemic preparedness and response.
As the world grapples with the ongoing COVID-19 crisis and braces for future health emergencies, the importance of community health workers has never been clearer. By embracing evidence-based strategies and forging new, transformative partnerships, we can build resilient health systems that serve everyone, no matter the circumstances.
