key: cord-0824373-96zrmjup authors: Bhaumik, S.; Moola, S.; Tyagi, J.; Nambiar, D.; Kakoti, M. title: Community health workers for pandemic response: a rapid evidence synthesis date: 2020-05-02 journal: nan DOI: 10.1101/2020.04.28.20082586 sha: fda3644f0983ba52968a9ed7ef9cbde5302d81e1 doc_id: 824373 cord_uid: 96zrmjup Introduction: Coronavirus disease (COVID-19), a respiratory illness, first discovered in China in December 2019 has now spread to 213 countries or territories affecting millions across the globe. We received a request from National Health Systems Resource Centre, a public agency in India, for a Rapid Evidence Synthesis (RES) on community health workers (CHWs) for COVID-19 prevention and control. Methods: We searched PubMed, websites of ministries, public agencies, multilateral institutions, COVID-19 resource aggregators and pre-prints (without language restrictions) for articles on the role, challenges and enablers for CHWs in pandemics. Two reviewers screened the records independently with a third reviewer resolving disagreements. One reviewer extracted data in a consensus data extraction form with another reviewer cross-checking it. A framework on CHW performance in primary healthcare not specific to pandemic was used to guide data extraction and narrative analysis. Results: We retrieved 211 records and finally included 36 articles on the role, challenges and enablers for CHWs in pandemics. We found that CHWs play an important role in building awareness, countering stigma and maintaining essential primary healthcare service delivery. It is essential that CHWs are provided adequate Personal Protective Equipment (PPE) and appropriately trained in its usage in the early stages of the pandemic. Wide range of policies and guidance is required to ensure health systems functioning. A clear guidance for prioritizing essential activities, postponing non-essential ones and additional pandemic related activities is crucial. CHWs experience stigmatization, isolation and social exclusion. Psychosocial support, non-performance-based incentives, additional transport allowance, accommodation, child-support, awards and recognition programs have been used in previous pandemics. We also created inventories of resources with guiding notes for quick utility by decision makers on guidelines for health workers (n=24), self-isolation in the community (n=10) and information, education and counselling materials on COVID-19 (n=16). Conclusions: CHWs play a critical role in pandemics like COVID-19. It is important to ensure role clarity, training, supportive supervision, as well as their work satisfaction, health and well-being. There is a need for more implementation research on CHWs in pandemics like COVID-19. . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 2, 2020. W h a t i s a l r e a d y k n o w n ? • C O V I D -1 9 i s a p a n d e m i c w h i c h h a s n o w s t r a i n e d h e a l t h s y s t e m s a c r o s s t h e w o r l d . C o m m u n i t y h e a l t h w o r k e r s ( C H W s ) a r e b e i n g d e p l o y e d i n m a n y c o u n t r i e s f o r C O V I D -1 9 p r e v e n t i o n a n d c o n t r o l . H o w e v e r , t h e r e i s n o e v i d e n c e s y n t h e s i s o n t h e i s s u a p a n d e m i c c o n t e x t m u s t b e c l e a r . A p a r t f r o m c l e a r g u i d a n c e a d e q u a t e t r a i n i n g a n d s u p p o r t s h o u l d b e p r o v i d e d . r e q u i r i n g a d e q u a t e t r a i n i n g a n d g u i d a n c e i s u s e f u l . C o n t a c t l i s t i n g a n d i d e n t i f i c a t i o n s h o u l d b e d o n e b y s e p a r a t e t r a i n e d c a d r e . • C o u n t r i e s w i t h o u t p r e -e x i s t i n g C H W s p r o g r a m m u s t c o n s i d e r a p p l i c a b i l i t y o f a v a i l a b l e e v i d e n c e b e f o r e i n v e s t i n g i n a m b i t i o u s n e w C H W p r o g r a m s . • T h e r e i s a n e e d f o r m o r e i m p l e m e n t a t i o n r e s e a r c h o n C H W s i n p a n d e m i c s l i k e C O V I D -1 9 . T h e C O V I D -1 9 o u t b r e a k t h a t o r i g i n a t e d i n W u h a n C i t y , C h i n a i n D e c e m b e r 2 0 1 9 h a s e m e r g e d a s a p a n d e m i c t r i g g e r i n g a p u b l i c h e a l t h e m e r g e n c y w o r l d w i d e . T h e d i s e a s e n o w a f f e c t s 2 1 3 c o u n t r i e s o r t e r r i t o r i e s a f f e c t i n g m i l l i o n s a c r o s s t h e g l o b e . S e v e r a l m e a s u r e s a r e b e i n g i m p l e m e n t e d b y g o v e r n m e n t s a c r o s s t h e w o r l d t o p r e v e n t a n d c o n t r o l C O V I D -1 9 . B e t t e r h e a l t h w o r k f o r c e u t i l i s a t i o n a n d w e l l -b e i n g i s o n e o f t h e k e y p i l l a r s g o v e r n m e n t T h e N H S R C i s a p u b l i c a g e n c y w i t h t h e m a n d a t e t o p r o v i d e t e c h n i c a l a s s i s t a n c e t o t h e N a t i o n a l H e a l t h M i s s i o n . A n i n v e n t o r y o f r e s o u r c e s w h i c h g o v e r n m e n t d e c i s i o n m a k e r s a n d t e c h n i c a l a g e n c i e s c o u l d r a p i d l y s c a n t o h e l p d e v e l o p g u i d e l i n e s , s t a n d a r d s o f p r o c e d u r e s , a d v i s o r y n o t e s a n d c o m m u n i c a t i o n m a t e r i a l s w a s a l s o d e e m e d t o b e a u s e f u l a d d e n d u m b y t h e r e q u e s t e r s . W e t h u s a i m e d t o : • u n d e r s t a n d k e y r o l e s , i s s u e s , b a r r i e r s a n d e n a b l e r s f o r C H W s f o r p a n d e m i c r e s p o n s . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 2, 2020. T . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 2, 2020. . https://doi.org/10.1101/2020.04.28.20082586 doi: medRxiv preprint e r a t u r e r e v i e w s ( n = 3 ) ( 3 3 -3 5 ) , m i x e d -m e t h o d s s t u d i e s ( n = 2 ) ( 3 6 , 3 7 ) , g u i d e l i n e s ( n = 2 ) ( 3 8 , 3 9 ) , o n e s y s t e m a t i c r e v i e w ( 4 0 ) , o n e r a n d o m i s e d c o n t r o l l e d t r i a l ( 4 1 ) , a n d o n e c a s e r e p o r t ( 4 2 ) . K e y c h a r a c t e r i s t i c s o f t h e i n c l u d e d s t u d i e s a r e p r e s e n t e d i n T a b l e . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. T h e i n c l u d e d s t u d i e s e x a m i n e d t h e r o l e o f C H W s i n d i s e a s e o u t b r e a k s i t u a t i o n s , i n a d d i t i o n t o e x p l o r i n g t h e b a r r i e r s a n d e n a b l e r s o f w o r k i n g i n p a n d e m i c s i t u a t i o n s . O v e r a l l , t h e s t u d i e s r e p o r t e d t h a t C H W s h a d a r o l e t o p l a y i n t e r m s o f c o m m u n i t y et i n g u i s h t a s k s a s e s s e n t i a l ( r o u t i n e a c t i v i t i e s t h a t n e e d t o b e c o n t i n u e d b u t w i t h m o d i f i c a t i o n s f o r d e c r e a s e d t r a n s m i s s i o n r i s k ) , n o n - e s s e n t i a l ( n o n - e s s e n t i a l a c t i v i t i e s t h a t c o u l d b e p o s t p o n e d ) a n d a d d i t i o n a l ( a c t i v i t i e s t h a t n e e d t o b e c a r r i e d o u t a d d i t i o n a l l y o w i n g t o t h e p a n d e m i c ) t o b r i n g a c c o u n t a b i l i t The copyright holder for this preprint this version posted May 2, 2020. a n d l i s t i n g t o b e c o n d u c t e d b y a t r a i n e d e p i d e m i o l o g i s t o r s u r v e i l l a n c e o f f i c e r , w h i l e c o n t a c t f o l l o w -u p m i g h t b e d o n e t h r o u g h C H W s . ( 3 8 ) H o w e v e r , p o l i c e s t o i n v o l v e C H W s i n s o m e a s p e c t s o f c o n t r a c t t r a c i n g h a d b e e n d e v e l o p e d a n d i m p l e m e n t e d d u r i n g E V D . . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 2, 2020. w a s r e p o r t e d t h a t t h e r e w a s a c h a n g e i n p e r c e p t i o n s o f C H W s , l e a d i n g t o m o r e p r o a c t i v e i n v o l v e m e n t i n d i s e a s e p r e v e n t i o n a n d c o n t r o l . A p p r o p r i a t e t r a i n i n g h e l p e d C H W s o v e r c o m e f e a r a n d b e c o m e m o r e c o n f i d e n t a b o u t p r o v i d i n g a n d d e l i v e r i n g c a r e a n d h e l p e d t h e m d e a l w i t h a b r o a d r a n g e o f c h a l l e n g e s . T r a n s p a r e n c y . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 2, 2020. e n g a g e m e n t o f c o m m u n i t y l e a d e r s w e r e r e p o r t e d t o h e l p b u i l d t r u s t i n C H W s , l e a d i n g t o b e t t e r a c c e s s a s w e l l a s s a t i s f a c t o r y e x p e r i e n c e i n c a r e r e c e i v e d . ( 8 , 2 8 , 3 3 , 3 5 , 3 7 ) C o m m u n i t y e l d e r s a n d v i l l a g e h e a d s s h o u l d b e e n g a g e d a n d i n v o l v e d t o r e b u i l d t r u . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 2, 2020. . 1 1 W e c r e a t e d t h r e e i n v e n t o r i e s t o g u i d e a n d e x p e d i t e r e s o u r c e d e v e l o p m e n t . T h e f i r s t i n v e n t o r y ( A p p e n d i x 5 ) c o m p i l e d 2 4 d o c u m e n t s . A p a r t f r o m g u i d a n c e d o c u m e n t s u s e f u l f o . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 2, 2020. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 2, 2020. . https://doi.org/10.1101/2020.04.28.20082586 doi: medRxiv preprint ( d o m e s t i c w o r k ) a s w e l l a s o t h e r g e n d e r e d v u l n e r a b i l i t i e s a n d r i s k s ( l i k e d o m e s t i c v i o l e n c e ) ( 4 6 ) . S u s t a i n e d i n v e s t m e n t t o g e t h e r w i t h g o v e r n a n c e a n d i n f o r m a t i o n s y s t e m s s u p p o r t i s i m p o r t a n t . F u r t h e r , a s a r g u e d e l s e w h e r e , C H W s a r e p a r t o f a l a r g e r e c o s y s t e m o . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 2, 2020. . 1 4 Conclusion I n c o n c l u s i o n a n d b a s e d o n o u r f i n d i n g s , C H W s p l a y a n i m p o r t a n t r o l e i n t h e p r e v e n t i o n a n d c o n t r o l o f p a n d e m i c s l i k e C O V I D -1 9 . T h i s i s r e l e v a n t a n d f e a s i b l e i n c o u n t r i e s w h i c h a l r e a d . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 2, 2020. . It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 2, 2020. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 2, 2020. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 2, 2020. Augmenting the Disaster Healthcare Workforce Supporting the Health Care Workforce During the COVID-19 Global Epidemic Roles and Functions of Community Health Workers in Primary Care Rapid reviews to strengthen health policy and systems: a practical guide: World Health Organization Geneva PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation A conceptual framework for measuring community health workforce performance within primary health care systems Control of highly pathogenic avian influenza in Quang Tri province, Vietnam: voices from the human-animal interface When Ebola enters a home, a family, a community': A qualitative study of population perspectives on Ebola control measures in rural and urban areas of Sierra Leone Pinkowski Tersbol B. 'Tiny Iceland' preparing for Ebola in a globalized world Healthcare providers on the frontlines: a qualitative investigation of the social and emotional impact of delivering health services during Sierra Leone's Ebola epidemic Fighting a battle': Ebola, health workers and the health system in Sierra Leone. UK: ReBUILD Research Programme Consortium The first mile: community experience of outbreak control during an Ebola outbreak in Luwero District Community health worker perspectives on past Ebola and Marburg outbreaks in Uganda Healthcare workers' attitudes to working during pandemic influenza: a qualitative study What adaptation to research is needed following crises: a comparative, qualitative study of the health workforce in Sierra Leone and Nepal Retention of health workers in rural Sierra Leone: findings from life histories How do health workers experience and cope with shocks? Learning from four fragile and conflict-affected health systems in Uganda Knowledge and attitudes of community volunteers on Lassa and Ebola viral haemorrhagic fevers in the Donga Department Knowledge, attitudes and practices of healthcare providers on suspected Ebola cases in Guinea The impact of active surveillance and health education on an Ebola virus disease cluster -Kono District Global Health Security Agenda Implementation: A Case for Community Engagement Community Health Workers and Pandemic Preparedness: Current and Prospective Roles. Front Public Health Community health worker programmes after the 2013-2016 Ebola outbreak Impact of the Ebola outbreak on health systems and population health in Sierra Leone Community health workers during the Ebola outbreak in Guinea, Liberia, and Sierra Leone Contact Tracing During an Outbreak of Ebola Virus Disease Brazzaville: World Health Organization African Region Office Infection prevention and control during health care when novel COVID-19 is suspected 2020 Infection Rates and Risk Factors for Infection Among Health Workers During Ebola and Marburg Virus Outbreaks: A Systematic Review Automated monitoring to detect H1N1 symptoms among urban, Medicaideligible, pregnant women: a community-partnered randomized controlled trial Delivery of an Ebola Virus-Positive Stillborn Infant in a Rural Community Health Center The health impact of the 2014-15 Ebola outbreak Community health workers and accountability: reflections from an international "think-in" Impact of Ebola outbreak on reproductive health services in a rural district of Sierra Leone: a prospective observational study COVID-19 and violence against women : What the health sector/system can do: World Health Organisation National UK programme of community health workers for COVID-19 response Taking stock of 10 years of published research on the ASHA programme: examining India's national community health worker programme from a health systems perspective Increasing community health worker productivity and effectiveness: a review of the influence of the work environment Trust and teamwork matter': community health workers' experiences in integrated service delivery in India Community health workers in Brazil's Unified Health System: a framework of their praxis and contributions to patient health behaviors COVID-19 Preparedness Checklist for Rural Primary Health Care and Community Settings New Delhi The George Insitute for Global Health , India COVID-19 Preparedness Checklist for Urban Primary Health Centres in India Bengaluru: Insitute of Public Health