Community Health Toolkit

Community Health Research Round-Up, Issue 028

Hey all,

Breaking with our usual approach of summarizing the latest community health academic papers every two weeks, we just released a special COVID-19 research-round up.

This edition focuses on evidence on the roles of community health workers in pandemics & epidemics and is below

As an additional resource, Community Health Impact Coalition members are sharing COVID-19 explainers, internal policies, clinical protocols, & more live on this doc: Please do use, contribute, and share.

Community Health Research Round-Up, Issue 028

Special COVID-19 Edition

  1. Community Health Workers and Pandemic Preparedness: Current and Prospective Roles
  • Comments: Perspective piece drawing from the response to the 2014 Ebola and 2015 Zika epidemics
  • Methods: Perspective
  • Takeaway: CHWs promoted pandemic preparedness prior to the epidemics by increasing the access to health services and products within communities, communicating health concepts in a culturally appropriate fashion, and reducing the burdens felt by formal healthcare systems. During the epidemics, CHWs promoted pandemic preparedness by acting as community-level educators and mobilizers, contributing to surveillance systems, and filling health service gaps.
  1. Lessons Learned from Reinforcing Epidemiologic Surveillance During the 2017 Ebola Outbreak in the Likati District, Democratic Republic of the Congo
  • Comments: Comprehensive lessons from ebola in DRC - I have highlighted the community health recommendations below
  • Methods: Case study
  • Takeaway: Community health workers supported case finding and contact monitoring activities. At the community level, provide participatory training and supportive supervision to community health workers by reinforcing: (i) Knowledge of EVD signs and symptoms; (ii) Comprehension and application of outbreak definitions relevant to community health worker roles/responsibilities (community case definition, alert, contact), (ii) Procedures for reporting alerts, suspected cases, and other unexplained illness or deaths in the community; (iv) Procedures for tracing and monitoring contacts; and (v) Best practices for infection prevention and control to protect against disease exposure during direct interactions with suspected cases and contacts.
  1. Protecting Home Health Care Workers: A Challenge to Pandemic Influenza Preparedness Planning
  • Comments: A great summary of healthcare safety, security and wellness considerations
  • Methods: Summarized findings from a national stakeholder meeting
  • Takeaway: Federal, state, and local pandemic preparedness planners should consider approaches to help home health care workers protect their income; obtain access to health care, especially in light of their low rate of insurance coverage; obtain structural support for child care and transportation; and receive the necessary training for caring for clients
  1. The first mile: community experience of outbreak control during an Ebola outbreak in Luwero District, Uganda
  • Comments: Interesting piece on the cultural dimensions of public health messaging (adaptation!)
  • Methods: First-hand ethnographic data from the center of an Ebola outbreak in Luwero Country, Uganda
  • Takeaway: Explanations of the disease were undermined by an insensitivity to local culture, a mismatch between information circulated and the local interpretative framework, and the inability of the emergency response team to take the time needed to listen and empathize with community needs. Stigmatization of the local community – in particular its belief in amayembe spirits – fuelled historical distrust of the external health system and engendered community-level resistance to early detection.
  1. Piloting a participatory, community-based health information system for strengthening community-based health services: findings of a cluster-randomized controlled trial in the slums of Freetown, Sierra Leone
  • Comments: Helpful trial of a CHIS during three separate epidemic shocks.
  • Methods: C-RCT
  • Takeaway: Implemented under challenging conditions of cholera and Ebola epidemics, the study provides evidence of moderate effectiveness of the PCBHIS intervention in: improving CHW functionality, improving healthy household behaviors and healthcare-seeking behaviors, as well as strengthening the capacity of Ward Development Committees to fulfil their roles.

6 & 7. Effect of the Ebola-virus-disease epidemic on malaria case management in Guinea, 2014: a cross-sectional survey of health facilities & Implementation research on community health workers’ provision of maternal and child health services in rural Liberia

  • Comments: A pair of complementary studies: the first demonstrating the interruption of PHC services during an epidemic in the context of a weak CH system, the second demonstrating the alternative!
  • Methods: x-sectional (Guinea), repeated cross-sectional cluster surveys before (Liberia)
  • Takeaway: (i) The reduction in the delivery of malaria care because of the Ebola-virus-disease epidemic threatened malaria control in Guinea. (ii) Despite the Ebola virus disease outbreak, which caused substantial declines in health-care utilization
    in other regions of Liberia, a district with a strong CHW program showed increases in health-care use from formal providers for fever, acute respiratory infection and diarrhoea among children and facility-based delivery among pregnant women.
  1. PREPRINT: Prevent, Detect, Respond: Rapidly expanding healthcare teams through community health workers in the fight against COVID-19
  • Comments: Rapidly expanding healthcare teams through community health workers (CHWs) has
    proven fundamental in effective epidemic response. This article explores how lessons from Liberia’s ebola response are being applied to fight COVID-19
  • Methods: Commentary
  • Takeaway: CHWs can (i) Prevent: infection prevention/control measures (social distancing, hand hygiene stations, education) (ii) Detect: signs and symptoms as part of Liberia’s community event-based surveillance system (MOH may alsl involve them in testing), (iii) Respond: support self-isolation, monitor for clinical deterioration & organize rapid referral