1
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Lotta G, et al.,
(2021)
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Document Review
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This paper analyses how the Brazilian government regulated the reorganization of Primary Health Care (PHC) and how FLW responded to these initiatives, comparing the roles played by nurses and community health workers.
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Documents
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▪ Given the multilevel health system, it was expected that the high level of ambiguity would stimulate innovations.
▪ However, data show that the ambiguity created different situations for each profession.
▪ While nurses were able to adapt their work and act with more autonomy, CHW lost their role in the policy.
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2
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Ballard et al., (2020)
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Prioritising the role of community health workers in the COVID-19 response.
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▪ Community health workers (CHWs) are poised to play a pivotal role in fighting the pandemic, especially in low-income countries with vulnerable health systems.
▪ The COVID-19 response must build on existing platforms, infrastructure, and relationships where are possible; the focus should be on supporting the Ministries of Health and regional authorities as they lead coordinated responses.
▪ achieving these goals will require targeted actions at different stages of the pandemic. These actions are delineated in the article.
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3
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Mayfield-Johnson et al.,
(2020)
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Qualitative study
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This study aimed at assessing the effect of the COVID-19-related lockdown on Tunisian women’s mental health and gender-based violence
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Female-exclusive social group on Facebook
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▪ A focus group with CHW leaders from 7 states revealed 8 major themes: CHW identity, CHW resiliency, self-care, unintended positives outcomes of COVID-19, technology, resources, stressors, and consequences of COVID-19.
▪ Understanding the pandemic's impact on CHWs has implications for workforce development, training, and health policies.
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4
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Ajisegiri, et al., (2020)
Nigeria
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m
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COVID-19 Outbreak Situation in Nigeria and the Need for Effective Engagement of Community Health Workers for Epidemic Response
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▪ We recommended that the government needs to promptly bring community health workers on board, deploy rapid epidemic intelligence and scale up the use of mobile Apps for contact tracing.
▪ This will result in an effective and coordinated response to the ongoing outbreak, sustain routine health services especially at the community level.
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5
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Bezbaruah et al.,
(2021)
South-East Asia
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Qualitative study
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Roles of community health workers in advancing health security and resilient health systems: emerging lessons from the COVID-19 response in the South-East Asia Region
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Review journal articles, policy documents, national guidelines, reports, and online publications
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▪ The regular role of a CHW in health education and promotion focused on awareness-raising and the promotion of “new normal” behaviours; CHWs also played critical roles in assisting in surveillance and contact tracing, and in ensuring that people followed isolation and quarantine guidelines.
▪ Development and implementation of long-term plans across the region to strengthen and support CHWs and recognize CHWs as an integral component of resilient health systems.
▪ Planning for CHWs as part of the primary health care system will enable local authorities to ensure that an adequate level of resources (including capacity-building, incentives, necessary equipment, and consumables) is allocated to CHWs.
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6
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Mistry et al. (2021)
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Qualitative study
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Community health workers can provide psychosocial support to the people during COVID-19 and beyond in low-and middle-income countries. Frontiers in Public Health
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Documents
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▪ The CHWs can be effectively engaged to provide psychosocial support at the community level. Engaging them can also be cost saving as they are already in place and may cost less compared to other health professionals. However, they need training and supervision and their safety and security need to be protected during this COVID-19.
▪ While many LMICs have mental health policies but their enactment is limited due to the fragility of health systems and limited health care resources.
▪ CHWs can contribute in this regard and help to address the psychosocial vulnerabilities of affected population in LMICs during COVID-19 and beyond.
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7
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Roy et al., (2020)
Bangladesh
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Mixed methods
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Examining Roles, Support, and Experiences of Community Health Workers During the COVID-19 Pandemic in Bangladesh.
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Policy makers, program managers, CHW supervisors, and CHWs.
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▪ During the first wave of the coronavirus disease (COVID-19) pandemic in Bangladesh, across all health areas, community health workers (CHWs) described a slight decrease in the routine services they were able to provide due to restrictions in movement posed by lockdowns and other challenges.
▪ The government and various nongovernmental organizations provided supportive mechanisms to CHWs through training, supplies, and supportive supervision; however, these supports were not always uniformly distributed across cadres, leading to some discontent among CHWs.
▪ CHWs were crucial actors in the government’s COVID-19 response, as they took on new pandemic-related responsibilities in their communities to prevent the spread of the disease while continuing their routine work.
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8
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Fernandez et al., (2020)
Brazil
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Quantitative
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How community health workers are facing COVID-19 pandemic in Brazil: personal feelings, access to resources and working process. Archive of Family Medicine and General Practice.
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Online Survey
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▪ HWs feel scared and unprepared in the face of the COVID-19 pandemic. The fear of COVID-19 is related to being prepared and to receiving support from federal government. The feeling of preparedness is associated with the lack of
▪ material working conditions, such as PPEs, guidance from managers and support from superiors and federal government.
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9
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Nepomnyashchiy et al.,
(2020)
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Qualitative study
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Africa needs unprecedented attention to strengthen community health systems.
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▪ CHWs matter because they are trusted members of the community who are often the most accessible point of care.
▪ Ongoing efforts to leverage CHWs for the COVID-19 response must not be one-offs in the face of an emergency. CHWs must be equipped, trained, and supported in the long term as a crucial human resource for health.
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10
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Fernanda et al.,
(2020)
South Africa
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Qualitative study
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Community health workers: reflections on the health work process in Covid-19 pandemic times.
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Literature review
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▪ CHW work, especially cultural competence, and community orientation, aiming to discuss the changes introduced in this work regarding the following aspects: 1) health teams support, 2) use of telehealth, and 3) health education.
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11
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Chitungo et al., (2021)
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A rapid review
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Utility of telemedicine in sub-Saharan Africa during the COVID‐19 pandemic. A rapid review. Human behavior and emerging technologies.
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A rapid review
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▪ Challenges to the implementation of telemedicine on the continent were lack of supporting telemedicine framework and policies, digital barriers, and patient and healthcare personnel biases.
▪ Telemedicine use by all stakeholders, including medical insurance organizations, the introduction of telemedicine training of medical workers, educational awareness programs for the public, and improvement of digital platforms access and affordability.
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12
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Kaseje et al., (2020)
Kenya
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Quantitative and qualitative methods
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Engaging community health workers, technology, and youth in the COVID-19 response with concurrent critical care capacity building: A protocol for an integrated community and health system intervention to reduce mortality related to COVID-19 infection in Western Kenya
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▪ the intervention will consist of training youth, community health assistants and community health workers in screening, case detection, prevention, management, and referral of COVID-19 cases with maintenance of essential health services.
▪ The community intervention will be enhanced by youth and use of digital tools.
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13
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Feroz et al,. (2021)
LMICs
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Equipping community health workers with digital tools for pandemic response in LMICs
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▪ CHWs are playing a huge role in providing essential health care services and Covid-19 related healthcare to the communities.
▪ CHWs are overburdened as they are expected to accomplish more although they are not getting the required support to perform their duties well, such as training, remuneration, protective gear, etc.
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14
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Bhaumik et al.,
(2020)
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Systematic review
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Community health workers for pandemic response: a rapid evidence synthesis.
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Articles
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▪ CHW roles and tasks change substantially during pandemics. Clear guidance, training for changed roles and definition of what constitutes essential activities (i.e., those that must be sustained) is required.
▪ Most common additional activities during pandemics were community awareness, engagement, and sensitisation (including for countering stigma) and contact tracing.
▪ CHWs were reported to be involved in all aspects of contact tracing - this was reported to affect routine service delivery. CHWs have often been stigmatised or been socially ostracised during pandemics.
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15
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Boyce et al.,
(2020)
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Community Health Workers and Pandemic Preparedness: Current and Prospective Roles
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.
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▪ CHWs promoted pandemic preparedness by acting as community-level educators and mobilizers, contributing to surveillance systems, and filling health service gaps. Acknowledging the success CHWs have had in these roles and in previous interventions, we propose that the cadre may be better engaged in pandemic preparedness in the future.
▪ Some practical strategies for achieving this include training and using CHWs to communicate One Health information to at-risk communities prior to outbreaks, pooling them into a reserve health corps to be used during public health emergencies, and formalizing agreements and strategies to promote the early engagement of CHWs in response actions.
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16
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Sudhipongpracha et al., (2020)
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Qualitative study
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Community health workers as street-level quasi-bureaucrats in the COVID-19 Pandemic: The cases of Kenya and Thailand. Journal of Comparative Policy Analysis: Research and Practice..
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Literature review
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▪ Findings show that how a public health system is organized (decentralization versus centralization) affects CHWs’ initial responses to the outbreak.
▪ While CHWs in Thailand’s centralized system conform to the “state agent” tradition by referring to the hierarchical chain of command, those in Kenya’s decentralized system follow the “citizen agent” tradition by prioritizing community safety.
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17
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Jalali, F., Fischer, H., & Nichols, C. (2022).
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Mixed methods
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Corona warriors”? Experiences of India's community health workers (ASHAs) in India's COVID-19 response. Political Geography, 99.
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CHWs
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▪ CHWs (ASHAs) were both proud ‘warriors’ and compelled to work due to the risk of letting down their community.
▪ While many CHWs felt deep fear and that they were ill-prepared-
▪ CHWs reported their sacrifices made both to their own personal health as well as their families, while expressing
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18
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Niyigena, A., Girukubonye, I., Barnhart, D. A., Cubaka, V. K., Niyigena, P. C., Nshunguyabahizi, M., ... & Bitalabeho, F. A. (2022).
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Mixed-method study
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Rwanda’s community health workers at the front line: a mixed-method study on perceived needs and challenges for community-based healthcare delivery during COVID-19 pandemic. BMJ open, 12(4), e055119.
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▪ supervision during the lockdown was low.
▪ CHWs additionally described increases in workload, lack of personal protective equipment and COVID-specific training, fear of COVID-19, and difficult working conditions.
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19
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Sripad, P., Gottert, A., Abuya, T., Casseus, A., Hossain, S., Agarwal, S., & Warren, C. E. (2022).
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This mixed methods
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Confirming—and testing—bonds of trust: A mixed methods study exploring community health workers’ experiences during the COVID-19 pandemic in Bangladesh, Haiti and Kenya. PLOS global public health, 2(10), e0000595.
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CHWs
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▪ CHWs reported high levels of community trust (8/10 in Bangladesh and Kenya; 6/10 in Haiti).
▪ with over 60% reporting client relief in seeing their CHWs.
▪ CHWs reporting more positive and fewer negative experiences is consistently associated with continuing routine work, doing COVID-19-related work, and greater community trust. Qualitative interviews showed that CHW-community and CHW-health system actor trust is strengthened when CHWs are well-resourced.
▪ CHW-community trust is strained by public frustration at the pandemic, associated restrictions, and socio-political stressors.
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20
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Dhaliwal, B. K., Singh, S., Sullivan, L., Banerjee, P., Seth, R., Sengupta, P., ... & Shet, A. (2021).
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Rapid qualitative evaluation
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Love, labor and loss on the frontlines: India’s community health workers straddle life and the COVID-19 pandemic. Journal of global health, 11.
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CHWs
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▪ CHWs faced increased workloads, decreased compensation, and stated that their work had shifted to focus on COVID-related work, as opposed to routine care.
▪ CHWs also shared that their needs included improved mental health services, financial payment that was not tied to incentives, and consistent access to PPE.
▪ CHW experiences through the context of the COVID-19 pandemic have not been well-explored.
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21
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Monreal, T. J., Falcão de Oliveira, E., Araujo Ajalla, M. E., Adania Zanoni, D., & Du Bocage Santos-Pinto, C. (2022).
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A descriptive cross-sectional study
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Community health workers and COVID-19 in a Brazilian state capital. Sociological Spectrum, 42(3), 217–230.
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CHWs
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▪ Around 40% of the sample reported at least one risk factor for COVID-19, 44% had experienced at least one COVID-19 symptom, and 76% had experienced symptoms of mental suffering during the first year of the pandemic. Mental suffering was associated with the onset of flu-like symptoms after the start of the pandemic and changes in work processes. Knowledge gaps were observed, mainly related to forms of transmission and disease prevention. In view of the uncertainty about how long this health emergency will last and the vital role CHWs play in the Brazilian Health System, health managers and society need to pay greater attention to these professionals to improve the effectiveness of the country’s COVID-19 response.
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22
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Gibson, E., Zameer, M., Alban, R., & Kouwanou, L. M. (2023).
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A Rapid Review
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Community health workers as vaccinators: a rapid review of the global landscape, 2000–2021. Global Health: Science and Practice, 11(1).
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Peer-reviewed literature
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▪ Community health worker (CHW) cadres administered vaccines in 20 of the 75 countries with documented CHW programs, improving access to immunization services for under-reached communities.
▪ The review identified several countries where CHWs with brief clinical training and experience were taught to vaccinate, suggesting the feasibility of task-shifting administering vaccines to CHWs with limited experience.
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23
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Olateju e al., (2022)..
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qualitative study
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Community health workers experiences and perceptions of working during the COVID-19 pandemic in Lagos, Nigeria—A qualitative study.
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CHWs
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▪ Trust and COVID-19 knowledge were found to aid Community Health Workers in their work. However, challenges included exhaustion due to an increased workload, public misconceptions about COVID-19, stigmatisation of COVID-19 patients, delayed access to care and lack of transportation.
▪ Influences on willingness to work in COVID-19 Role: Community Health Workers’ perceptions of COVID-19, attitudes towards responsibility for COVID-19 risk at work, commitment and faith appeared to increase willingness to work.
▪ Financial incentives, provision of adequate personal protective equipment, transportation, and increasing staff numbers were seen as potential strategies to address many of the challenges faced.
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24
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Salve, S., Raven, J., Das, P., Srinivasan, S., Khaled, A., Hayee, M., ... & Gooding, K. (2023).
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Synthesis of evidence
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Community health workers and Covid-19: Cross-country evidence on their roles, experiences, challenges and adaptive strategies.
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CHWs
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▪ CHWs made important contributions to the COVID-19 response, including in surveillance, community education, and support for people with COVID-19.
▪ There was some support for CHWs’ work, including training, personal protective equipment, and financial incentives.
▪ However, support varied between countries, cadres and individual CHWs, and there were significant gaps, leaving CHWs vulnerable to infection and stress.
▪ CHWs also faced a range of other challenges, including health system issues such as disrupted medical supply chains, insufficient staff and high workloads, a particular difficulty for female CHWs who were balancing domestic responsibilities.
▪ CHWs demonstrated commitment in adapting their work, for example ensuring patients had adequate drugs in advance of lockdowns and using their own money and time to address increased transport costs and higher workloads.
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25
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World Health Organization. (2021).
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Evidence synthesis
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The role of community health workers in COVID-19 vaccination.
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Reports and articles
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▪ This guide is intended to support national governments in developing their national deployment and vaccination plans (NDVP) for COVID-19 vaccines by outlining the roles, needs and opportunities for community health workers (CHWs) (International Labour Organization, 2007) 1 to contribute.
▪ Identifying CHW contributing roles at each stage of COVID-19 vaccines rollout.
▪ Counting and vaccinating CHWs within initial vaccine allocation as part of the essential health
▪ Workforce to optimally support the COVID-19 response and continuity of essential health services.
▪ Recognizing and remunerating CHWs commensurate to tasks undertaken and training.
▪ CHWs who are linked to health systems through regular compensation, dedicated supervision and accreditation are best placed to support an effective pandemic response and to prevent the next one.
▪ Considering community-based health worker representation on national coordinating committees.
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