Salve Solomon, Raven Joanna, Das Priya, Srinivasan Shuchi, Khaled Adiba, Hayee Mahwish, Olisenekwu Gloria, Gooding Kate
Oxford Policy Management, Delhi, India.
Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
PLOS Glob Public Health. 2023 Jan 4;3(1):e0001447. doi: 10.1371/journal.pgph.0001447. eCollection 2023.
Community health workers (CHWs) are a key part of the health workforce, with particular importance for reaching the most marginalised. CHWs' contributions during pandemics have received growing attention, including for COVID-19. This paper contributes to learning about CHWs' experiences during COVID-19, based on evidence from India, Bangladesh, Pakistan, Sierra Leone, Kenya and Ethiopia. The paper synthesises evidence from a set of research projects undertaken over 2020-2021. A thematic framework based on the research focus and related literature was used to code material from the reports. Following further analysis, interpretations were verified with the original research teams. CHWs made important contributions to the COVID-19 response, including in surveillance, community education, and support for people with COVID-19. There was some support for CHWs' work, including training, personal protective equipment and financial incentives. However, support varied between countries, cadres and individual CHWs, and there were significant gaps, leaving CHWs vulnerable to infection and stress. CHWs also faced a range of other challenges, including health system issues such as disrupted medical supply chains, insufficient staff and high workloads, a particular difficulty for female CHWs who were balancing domestic responsibilities. Their work was also affected by COVID-19 public health measures, such as restrictions on gatherings and travel; and by supply-side constraints related to community access and attitudes, including distrust and stigmatization of CHWs as infectious or informers. CHWs demonstrated commitment in adapting their work, for example ensuring patients had adequate drugs in advance of lockdowns, and using their own money and time to address increased transport costs and higher workloads. Effectiveness of these adaptations varied, and some involved coping in a context of inadequate support. CHW are critical for effective response to disease outbreaks, including pandemics like COVID-19. To support CHWs' contribution and protect their wellbeing, CHWs need adequate resources, managerial support, and motivation.
社区卫生工作者是卫生人力的关键组成部分，对于服务最边缘化人群尤为重要。在包括新冠疫情在内的大流行期间，社区卫生工作者的贡献受到了越来越多的关注。本文基于来自印度、孟加拉国、巴基斯坦、塞拉利昂、肯尼亚和埃塞俄比亚的证据，有助于了解社区卫生工作者在新冠疫情期间的经历。本文综合了2020年至2021年期间开展的一系列研究项目的证据。一个基于研究重点和相关文献的主题框架被用于对报告中的材料进行编码。经过进一步分析后，与原始研究团队核实了解读结果。社区卫生工作者对新冠疫情应对做出了重要贡献，包括监测、社区教育以及对新冠患者的支持。对社区卫生工作者的工作有一些支持，包括培训、个人防护装备和经济激励。然而，不同国家、不同干部群体以及个体社区卫生工作者获得的支持存在差异，且存在重大差距，这使得社区卫生工作者易受感染和压力影响。社区卫生工作者还面临一系列其他挑战，包括卫生系统问题，如医疗供应链中断、人员不足和工作量大，对于兼顾家庭责任的女性社区卫生工作者来说这一困难尤为突出。他们的工作还受到新冠公共卫生措施的影响，如对集会和旅行的限制；以及与社区准入和态度相关的供应方限制，包括对社区卫生工作者作为感染者或告密者的不信任和污名化。社区卫生工作者在调整工作方面表现出了奉献精神，例如在封锁前确保患者有足够的药物，并动用自己的资金和时间来应对交通成本增加和工作量加大的问题。这些调整的效果各不相同，有些是在支持不足的情况下进行应对。社区卫生工作者对于有效应对疾病爆发（包括如新冠疫情这样的大流行）至关重要。为了支持社区卫生工作者的贡献并保护他们的福祉，社区卫生工作者需要充足的资源、管理支持和激励。
