Zulu Joseph Mumba, Silumbwe Adam, Munakampe Margarate, Chavula Malizgani Paul, Mulubwa Chama, Sirili Nathanael, Zulu Wanga, Michelo Charles, Tetui Moses
Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Department of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
BMC Prim Care. 2025 May 14;26(1):163. doi: 10.1186/s12875-025-02853-7.
Global concerns regarding effective response strategies to the COVID-19 pandemic arose amid the swift spread of the virus to low- and middle-income country (LMIC) settings. Although LMICs instituted several measures to mitigate spread of the virus in low resource settings, including task shifting certain demand and supply functions to community actors such as community health workers (CHWs), there remains a lack of synthesized evidence on these experiences and lessons. This scoping review sought to synthesize evidence regarding the roles and challenges faced by CHWs during the fight against COVID-19, along with strategies to address these challenges.
We systematically searched several major electronic databases including PubMed, HINARI, Cochrane Library (Reviews and Trials), Science Direct and Google Scholar for relevant literature. The search strategy was designed to capture literature published in LMICs on CHWs roles during COVID-19 period spanning 2019-2023. Two researchers were responsible for retrieving these studies, and critically reviewed them in accordance with Arksey and O'Malley scoping review approach. In total, 22 articles were included and analysed using Clarke and Braun thematic analysis in NVivo 12 Pro Software.
Community health workers (CHWs) played a vital role during the COVID-19 pandemic. They engaged in health promotion and education, conducted surveillance and contact tracing, supported quarantine efforts, and maintained essential primary health services. They also facilitated referrals, advocated for clients and communities, and contributed to vaccination planning and coordination, including tracking and follow-up. However, CHWs faced significant challenges, including a lack of supplies, inadequate infection prevention and control measures, and stigma from community members. Additionally, they encountered limited supportive policies, insufficient remuneration and incentives. To enhance CHWs' performance, regular training on preventive measures is essential. Utilizing digital technology, such as mobile health, can be beneficial. Establishing collaborative groups through messaging platforms and prioritizing access to COVID-19 vaccines are important steps. Additionally, delivering wellness programs and providing quality protective equipment for CHWs are crucial for their effectiveness.
The study found that CHWs are vital actors within the health system during global pandemics like COVID-19. This entails the need for increased support and investment to better integrate CHWs into health systems during such crises, which could ultimately contribute to sustaining the credibility of CHWs programs and foster more inclusive community health systems (CHSs).
在新冠病毒迅速传播至低收入和中等收入国家（LMIC）之际，全球对新冠疫情的有效应对策略产生了担忧。尽管低收入和中等收入国家采取了多项措施来减缓病毒在资源匮乏地区的传播，包括将某些需求和供应职能转移给社区卫生工作者（CHW）等社区行为体，但对于这些经验和教训仍缺乏综合证据。本范围综述旨在综合关于社区卫生工作者在抗击新冠疫情期间所发挥的作用和面临的挑战的证据，以及应对这些挑战的策略。
我们系统地检索了多个主要电子数据库，包括PubMed、HINARI、Cochrane图书馆（综述和试验）、Science Direct和谷歌学术，以查找相关文献。检索策略旨在获取2019 - 2023年期间低收入和中等收入国家发表的关于社区卫生工作者在新冠疫情期间作用的文献。两名研究人员负责检索这些研究，并根据Arksey和O'Malley范围综述方法对其进行严格审查。总共纳入了22篇文章，并在NVivo 12 Pro软件中使用Clarke和Braun主题分析法进行分析。
社区卫生工作者在新冠疫情期间发挥了至关重要的作用。他们参与健康促进和教育、进行监测和接触者追踪、支持隔离工作，并维持基本的初级卫生服务。他们还协助转诊、为服务对象和社区进行倡导，并为疫苗接种计划和协调做出贡献，包括追踪和随访。然而，社区卫生工作者面临着重大挑战，包括物资短缺、感染预防和控制措施不足以及社区成员的污名化。此外，他们还遇到支持性政策有限、薪酬和激励不足的问题。为提高社区卫生工作者的绩效，定期进行预防措施培训至关重要。利用数字技术，如移动健康技术，可能会有所帮助。通过信息平台建立协作小组并优先提供新冠疫苗接种机会是重要步骤。此外，开展健康促进项目并为社区卫生工作者提供优质防护设备对其有效性至关重要。
该研究发现，在像新冠疫情这样的全球大流行期间，社区卫生工作者是卫生系统中的关键行为体。这意味着需要增加支持和投资，以便在此类危机期间更好地将社区卫生工作者纳入卫生系统，这最终可能有助于维持社区卫生工作者项目的可信度，并促进更具包容性的社区卫生系统（CHS）。
