Partners In Health, Kigali, Rwanda
Partners In Health, Kigali, Rwanda.
BMJ Open. 2022 Apr 29;12(4):e055119. doi: 10.1136/bmjopen-2021-055119.
During the COVID-19 pandemic, community health workers (CHWs) served as front-line workers in the COVID-19 response while maintaining community health services. We aimed to understand challenges faced by Rwanda's CHWs during a nationwide COVID-19 lockdown that occurred between March and May 2020 by assessing the availability of trainings, supplies and supervision while exploring perceived needs and challenges.
This study was a mixed-method study conducted in three Rwandan districts: Burera, Kirehe and Kayonza.
Using data collected via telephone, we assessed the availability of trainings, supplies and supervision during the first national lockdown, while exploring perceived needs and challenges of CHWs who were engaged in COVID-19 response, in addition to their existing duties of delivering health services in the community.
Among the 292 quantitative survey participants, CHWs were responsible for a median of 55 households (IQR: 42-79) and visited a median of 30 households (IQR: 11-52) in the month prior to the survey (July 2020). In the previous 12 months, only 164 (56.2%) CHWs reported being trained on any health topic. Gaps in supply availability, particularly for commodities, existed at the start of the lockdown and worsened over the course of the lockdown. Supervision during the lockdown was low, with nearly 10% of CHWs never receiving supervision and only 24% receiving at least three supervision visits during the 3-month lockdown. In qualitative interviews, CHWs additionally described increases in workload, lack of personal protective equipment and COVID-specific training, fear of COVID-19, and difficult working conditions.
Many challenges faced by CHWs during the lockdown predated COVID-19 and persisted or were exacerbated during the pandemic. To promote the resilience of Rwanda's CHW system, we recommend increased access to PPE; investment in training, supervision and supply chain management; and financial compensation for CHWs.
在 COVID-19 大流行期间，社区卫生工作者（CHW）在维持社区卫生服务的同时，充当了 COVID-19 应对的一线工作人员。我们旨在通过评估培训、用品和监督的可及性，了解 2020 年 3 月至 5 月期间卢旺达全国性 COVID-19 封锁期间社区卫生工作者所面临的挑战，同时探讨他们的感知需求和挑战。
这是一项在卢旺达三个地区（布塔雷、基里和卡扬扎）进行的混合方法研究。
通过电话收集数据，我们评估了第一次全国性封锁期间的培训、用品和监督的可及性，同时探讨了参与 COVID-19 应对工作的 CHW 的感知需求和挑战，以及他们在社区中提供卫生服务的现有职责。
在 292 名接受定量调查的参与者中，CHW 负责中位数为 55 户家庭（IQR：42-79），在调查前一个月（2020 年 7 月）中位数访问 30 户家庭（IQR：11-52）。在过去的 12 个月中，只有 164 名（56.2%）CHW 报告接受过任何健康主题的培训。在封锁开始时，供应品的供应存在差距，特别是商品供应，而且在封锁期间情况恶化。封锁期间监督力度低，近 10%的 CHW 从未接受过监督，只有 24%的 CHW 在 3 个月的封锁期间接受了至少三次监督访问。在定性访谈中，CHW 还描述了工作量增加、缺乏个人防护设备和 COVID-19 特定培训、对 COVID-19 的恐惧以及困难的工作条件。
封锁期间 CHW 面临的许多挑战在 COVID-19 之前就已经存在，并在大流行期间持续存在或加剧。为了增强卢旺达 CHW 系统的弹性，我们建议增加个人防护设备的供应；投资培训、监督和供应链管理；并为 CHW 提供财务补偿。
