Prioritising the role of community health workers in the COVID-19 response

doi:10.1136/bmjgh-2020-002550

Review

. 2020 Jun;5(6):e002550.

doi: 10.1136/bmjgh-2020-002550.

Prioritising the role of community health workers in the COVID-19 response

Madeleine Ballard^{1

2}, Emily Bancroft³, Josh Nesbit⁴, Ari Johnson^{5

6}, Isaac Holeman^{4

7}, Jennifer Foth⁸, Debbie Rogers⁹, Jane Yang⁵, James Nardella¹⁰, Helen Olsen⁴, Mallika Raghavan¹⁰, Raj Panjabi^{10

11}, Rebecca Alban³, Serah Malaba⁸, Molly Christiansen⁸, Stephanie Rapp⁵, Jennifer Schechter¹², Patrick Aylward¹², Ash Rogers¹³, Jacques Sebisaho¹⁴, Clarise Ako¹⁴, Nandini Choudhury^{2

15}, Carey Westgate¹⁶, Julius Mbeya¹³, Ryan Schwarz^{11

15}, Matthew H Bonds^{17

18}, Rehan Adamjee¹⁹, Julia Bishop²⁰, Amanda Yembrick⁴, David Flood^{21

22}, Meg McLaughlin²³, Daniel Palazuelos^{11

24}

Affiliations

¹ Community Health Impact Coalition, New York, New York, USA madeleine.ballard@gmail.com.
² Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
³ VillageReach, Seattle, Washington, USA.
⁴ Medic Mobile, San Francisco, California, USA.
⁵ Muso, Bamako, Mali.
⁶ Global Health Sciences, University of California San Francisco, San Francisco, California, USA.
⁷ Department of Global Health, University of Washington, Seattle, Washington, USA.
⁸ Living Goods, Nairobi, Kenya.
⁹ Praekelt.org, Johannesburg, South Africa.
¹⁰ Last Mile Health, Monrovia, Liberia.
¹¹ Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹² Integrate Health, Lome, Togo.
¹³ Lwala Community Alliance, Rongo, Kenya.
¹⁴ Amani Global Works, Idjwi Island, Congo.
¹⁵ POSSIBLE, New York, New York, USA.
¹⁶ Community Health Impact Coalition, New York, New York, USA.
¹⁷ Harvard Medical School Department of Global Health and Social Medicine, Blavatnik Institute, Boston, Massachusetts, USA.
¹⁸ PIVOT, Ranomafana, Madagascar.
¹⁹ VITAL Pakistan, Karachi, Pakistan.
²⁰ One to One Africa, Cape Town, South Africa.
²¹ Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala.
²² Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
²³ THINKMD, Burlington, Vermont, USA.
²⁴ Partners In Health, Boston, Massachusetts, USA.

PMID: 32503889
PMCID: PMC7298684
DOI: 10.1136/bmjgh-2020-002550

Review

Prioritising the role of community health workers in the COVID-19 response

Madeleine Ballard et al. BMJ Glob Health. 2020 Jun.

. 2020 Jun;5(6):e002550.

doi: 10.1136/bmjgh-2020-002550.

Authors

Affiliations

¹ Community Health Impact Coalition, New York, New York, USA madeleine.ballard@gmail.com.
² Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
³ VillageReach, Seattle, Washington, USA.
⁴ Medic Mobile, San Francisco, California, USA.
⁵ Muso, Bamako, Mali.
⁶ Global Health Sciences, University of California San Francisco, San Francisco, California, USA.
⁷ Department of Global Health, University of Washington, Seattle, Washington, USA.
⁸ Living Goods, Nairobi, Kenya.
⁹ Praekelt.org, Johannesburg, South Africa.
¹⁰ Last Mile Health, Monrovia, Liberia.
¹¹ Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹² Integrate Health, Lome, Togo.
¹³ Lwala Community Alliance, Rongo, Kenya.
¹⁴ Amani Global Works, Idjwi Island, Congo.
¹⁵ POSSIBLE, New York, New York, USA.
¹⁶ Community Health Impact Coalition, New York, New York, USA.
¹⁷ Harvard Medical School Department of Global Health and Social Medicine, Blavatnik Institute, Boston, Massachusetts, USA.
¹⁸ PIVOT, Ranomafana, Madagascar.
¹⁹ VITAL Pakistan, Karachi, Pakistan.
²⁰ One to One Africa, Cape Town, South Africa.
²¹ Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala.
²² Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
²³ THINKMD, Burlington, Vermont, USA.
²⁴ Partners In Health, Boston, Massachusetts, USA.

PMID: 32503889
PMCID: PMC7298684
DOI: 10.1136/bmjgh-2020-002550

Abstract

COVID-19 disproportionately affects the poor and vulnerable. Community health workers are poised to play a pivotal role in fighting the pandemic, especially in countries with less resilient health systems. Drawing from practitioner expertise across four WHO regions, this article outlines the targeted actions needed at different stages of the pandemic to achieve the following goals: (1) PROTECT healthcare workers, (2) INTERRUPT the virus, (3) MAINTAIN existing healthcare services while surging their capacity, and (4) SHIELD the most vulnerable from socioeconomic shocks. While decisive action must be taken now to blunt the impact of the pandemic in countries likely to be hit the hardest, many of the investments in the supply chain, compensation, dedicated supervision, continuous training and performance management necessary for rapid community response in a pandemic are the same as those required to achieve universal healthcare and prevent the next epidemic.

Keywords: health policy; health systems; public health.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Epidemic phases and response interventions.

**Figure 2**
Timing of potential spread in vulnerable areas, from urban to rural.

See this image and copyright information in PMC

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References

1. World Health Organization Coronavirus disease (COVID-2019) situation reports. Available: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situatio... [Accessed 25 Mar 2020].
1. Walton D. Coronavirus will disproportionately affect the poor & vulnerable, 2020. Available: https://medium.com/build-health-international/coronavirus-will-dispropor...
1. Vermund S, Collins C. Remembering America’s global connections in the time of coronavirus, 2020. Available: https://www.thinkglobalhealth.org/article/remembering-americas-global-co...
1. Community Health Impact Coalition Available: www.chwimpact.org
1. Delbecq AL, Van de Ven AH. A group process model for problem identification and program planning. J Appl Behav Sci 1971;7:466–92. 10.1177/002188637100700404 - DOI

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[1] World Health Organization Coronavirus disease (COVID-2019) situation reports. Available: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situatio... [Accessed 25 Mar 2020].

[2] World Health Organization Coronavirus disease (COVID-2019) situation reports. Available: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situatio... [Accessed 25 Mar 2020].

[3] Walton D. Coronavirus will disproportionately affect the poor & vulnerable, 2020. Available: https://medium.com/build-health-international/coronavirus-will-dispropor...

[4] Walton D. Coronavirus will disproportionately affect the poor & vulnerable, 2020. Available: https://medium.com/build-health-international/coronavirus-will-dispropor...

[5] Vermund S, Collins C. Remembering America’s global connections in the time of coronavirus, 2020. Available: https://www.thinkglobalhealth.org/article/remembering-americas-global-co...

[6] Vermund S, Collins C. Remembering America’s global connections in the time of coronavirus, 2020. Available: https://www.thinkglobalhealth.org/article/remembering-americas-global-co...

[7] Community Health Impact Coalition Available: www.chwimpact.org

[8] Community Health Impact Coalition Available: www.chwimpact.org

[9] Delbecq AL, Van de Ven AH. A group process model for problem identification and program planning. J Appl Behav Sci 1971;7:466–92. 10.1177/002188637100700404 - DOI

[10] Delbecq AL, Van de Ven AH. A group process model for problem identification and program planning. J Appl Behav Sci 1971;7:466–92. 10.1177/002188637100700404 - DOI

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Prioritising the role of community health workers in the COVID-19 response

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Prioritising the role of community health workers in the COVID-19 response

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Conflict of interest statement

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