Examples of How CHWs Have Prevented, Detected, and Responded to Pandemics

PreventEducate communities regarding signs, symptoms, and transmission routes. Lead skill building for personal preventive measures such as social distancing, hand hygiene, coughing/sneezing into elbows, and water, sanitation, and hygiene interventions. Address public health misinformation as trusted messengers during in-person interactions.

DRC, Liberia: During the 2014–2016 Ebola epidemic, CHWs were part of the interdisciplinary teams of nurses, doctors, and other health workers who played a critical role in reducing transmission through promoting social distancing and other infection prevention and control measures.3

Global: By April 2020, CHWs reached 2.5 million households across 27 countries as part of countries’ national strategies during the COVID-19 epidemic.4

Supply: Support, lead, or reinforce community and facility-based infection prevention and control measures, such as construction of triage areas, use of personal protective equipment (e.g., face masks and gloves), and creation of hand hygiene stations.5 Distribute PPE to the community.Cote d’Ivoire employed CHWs during the 2014–2016 Ebola epidemic for disease prevention and control as did Liberia, Sierra Leone, and DRC.6

Vaccinate: CHWs have a critical role at every stage of vaccine rollout: planning; identifying target populations; outreach, engagement, and education; mobilization; and tracking and reporting outcomes.7

Critically, this requires that CHWs be protected with PPE and vaccinated as part of the initial allocation for health workers.

Ethiopia, India, Malawi, Pakistan: Health extension workers, accredited social health activists, HSAs, and lady health workers routinely provide intramuscular medicines.8,9 HSAs currently serve as COVID-19 vaccinators in some parts of Malawi.
DetectDetect signs and symptoms in community members and conduct rapid tests, where available.10South Africa deployed 28,000 CHWs to screen more than 7 million people for COVID-19.11
Facilitate safe sample collection in communities and health facilities of samples and rapid transport to laboratories for analysis, thus reducing risks of nosocomial transmission.Sierra Leone: As part of a post-Ebola laboratory strengthening, CHWs were enlisted to coordinate the collection and transport of sputum samples for tuberculosis testing from patients in the community to the laboratory.12
Alert through integration into community events-based surveillance systems.5

DRC: During the 2014–2016 Ebola epidemic, CHWs filed alerts that were investigated within 24 hours.13

Madagascar: During the 2017 plague outbreak, 4400 CHWs and 340 supervisors were trained to conduct community-based active surveillance, contact tracing, and follow-up activities across the country.14

Kenya: During the COVID-19 pandemic, 6000+ CHWs were trained to use a mobile tool for community event-based surveillance, which was applied across 10 counties.15

Modeling indicates that CHWs participating in disease surveillance systems detect outbreaks to a comparable degree and with better timeliness compared to professional health care data entry staff.16

RespondCommunicate rapidly and effectively to residents in pandemic areas, including taking the time needed to communicate health information in a tailored and relevant way and combat the spread of misinformation.17Malawi, Togo: As part of routine home visits, CHWs help track issues through community conversations and chats with informants, and tracking and media reporting, messaging, social media posts about COVID-19.
Enable self-isolation and Monitor patients in the community while ensuring delivery of food, social, and medical support. Monitor patients for clinical deterioration and support rapid referral of individuals who require hospitalization, reinforcing links between the health system and communities.Kenya, India: CHWs led home-based care for COVID-19 patients not requiring hospitalization.18,19
Conduct contact tracing, symptom reporting, and monitoring of contacts of COVID-19 patients to ensure access to testing and treatment for those who develop signs and symptoms.17

Nigeria: CHWs’ thorough knowledge of the landscape significantly shortened the commute time and led to more successful clinical outcomes. Their presence also served to facilitate community entry and acceptance among residents.20

Africa CDC’s PACT initiative supported over 18,000 CHWs across 27 countries to conduct contact tracing and testing referrals. A recent evaluation of the PACT CHW program, based on feedback from 10 countries, suggests that it positively influenced the COVID-19 response and elevated the importance of CHWs’ roles within primary care (Diana Nsubuga, PhD, email communication, July 28, 2021). As of August 2021, the 18,000 CHWs deployed supported 2.5 million household visits for risk communication and community engagement activities, active case search and contact tracing of more than 1.6 million contacts, and facilitation of testing referrals for 78% of suspect cases.

  • Abbreviations: CDC, Centers for Disease Control and Prevention; CHW, community health worker; COVID-19, coronavirus disease; DRC, Democratic Republic of the Congo; HSAs, health surveillance assistants; PACT, Prevention and Access to Care and Treatment; PPE, personal protective equipment.

  • aThe authors of the article work predominantly in South Asia and Africa, from which the majority of the examples are drawn.