THE COALITION’S RESPONSE TO COVID-19.

By mid-March 2020, the Coalition recognized that COVID-19 would disproportionately affect vulnerable and impoverished communities. We knew that taking decisive action was necessary to mitigate the impact of the pandemic.

As a result, we used this crisis as an opportunity to advance the professional community health workers (proCHWs) movement. Our working hypothesis was that protecting and supporting CHWs during the pandemic would strengthen the case for post-crisis investments in their pay, training, equipment, and supervision.

We understood that CHWs are an integral part of primary healthcare systems, and without them, the decline in essential health service utilization could kill more people than the virus. Unfortunately, we also recognized that CHWs were not equally resourced, despite their potential to improve health outcomes. To fully realize the benefits of CHWs, they must be treated as professionals, with adequate salaries, skills, supervision, and supplies.

As a result, we rapidly adapted our research and advocacy initiatives to further our mission of making proCHWs the norm globally.

We acted early and together to ensure that CHWs remained protected and safe during the pandemic while fulfilling their essential roles in community health. We launched a systematic campaign to support and educate the global health community on the many ways CHWs could assist in efforts to prevent, detect, and respond to the spread of COVID-19. And we promoted long-term changes to strengthen the community health workforce, enhancing countries’ resilience in the face of future health crises.

WHAT WE DID

During the early days of the pandemic, we took the following steps to achieve our goals:

Set the agenda
Convened the wider field for action
Responded Together: CAF-Africa
Shaped Global Guidance

A Community Health Worker extracting liquid from a vial with a syringe

Community Health Impact Coalition

SET THE AGENDA.

To prioritize support for Community Health Workers (CHWs) during the COVID-19 pandemic, the Coalition took several steps. First, we published a special edition of the Community Health Research Round-up that highlighted the evidence for the crucial role of CHWs during the pandemic.

Using this evidence, along with practitioner expertise from four WHO regions, we created a white paper in English, French, and Spanish. The paper outlined priorities for the COVID-19 response:

PROTECT health care workers
INTERRUPT the virus
MAINTAIN existing health care services while surging their capacity
SHIELD the most vulnerable from socioeconomic shocks

The white paper was accessed over 2,000 times within the first 24 hours and was used by organizations such as the Gates Foundation, Google.org, and the Ministry of Health of Malawi to inform their response. It was also cited in USAID’s COVID-19 Community Health RFP. To ensure that our work was indexed in academic literature used by norm-setting entities to set guidelines, the white paper was published in BMJ Global Health. It was also used to inform a BMJ opinion piece on the many ways CHWs can prevent, detect, and respond to the spread of COVID-19.

Overall, our goal was to advocate for rapid action in response to the evolving COVID-19 pandemic by outlining targeted actions that could be taken at different stages to support CHWs and protect vulnerable populations.

RESPONDED TOGETHER

CONVENED THE WIDER FIELD FOR ACTION.

Next, we convened a weekly Community Health Programs and Operations Call, which connected hundreds of implementers to share challenges, success stories, solve for COVID-19 adaptations and additions to CHW workflow. Not only did these calls offer a much-needed information sharing and support platform, but they also helped shape our strategic response for CHICs’ (then) two tactics: Research to equip international norm setters with evidence; and advocate to influence global financing institutions.

This group rapidly assembled a COVID-19 wiki, updated an average of 15 times per day. The wiki was curated by the Coalition and contained important information to help practitioners navigate the pandemic and adjust workflows to support CHWs during each stage of the pandemic. The wiki included emerging data, COVID-19 explainers, public communications, helpful articles, blog posts, and webinars, internal policies and procedures, guidance and best practices for supporting Ministries of Health, shared resources, including clinical protocols and training materials, resources for overcoming pandemic-triggered supply chain issues, and answers to frequently asked questions.

CAF AFRICA.

While proCHWs are particularly well placed to respond to a disease outbreak like COVID-19, to do so, they must be protected.

Global shortages of personal protective equipment (PPE) meant that CHWs, often the “last in line” for medical supplies, were being placed in the impossible position of being expected to work without adequate protection, or withhold their vital services. This not only depletes worker morale, but has the potential to drastically deplete the health workforce when CHWs contract COVID-19.

The Coalition knew achieving personal protective equipment (PPE) for all is not only necessary, but possible. The Coalition identified three main issues: an absolute shortage of personal protective equipment (PPE), a shortage of PPE in low- and middle-income countries (LMICs), and inequitable distribution of PPE.

In response, the Coalition quantified and published the PPE gap for CHWs, organized pooled procurement among the members of the Friday Operational and Programmatic Response Calls, and ultimately organized a team of 40+ organizations, including 20+ Ministries of Health, to launch the COVID-19 Action Fund for Africa to procure and distribute PPE to CHWs in 18 sub-Saharan African countries.

CAF-Africa ultimately provided 121 million pieces of PPE to almost half a million CHWs. The fund was differentiated in various ways: (1) filling a gap in global response efforts by providing funds for PPE specifically for CHWs, (2) evidence-based and responding to a quantified gap, (3) radically collaborative, (4) integrated with national responses, and (5) focused on the last mile. CAF-Africa was able to mobilize quickly to supply PPE on a larger scale than any one partner could have done alone, making it the fifth largest procurement mechanism for PPE in the world and the third largest user of free cargo flights offered by the World Food Program (WFP) from August to December 2020. Read the full story here.

SHAPED GLOBAL GUIDANCE.

In late 2020, the Coalition was invited by UNICEF and the WHO to create global guidance on the roles of CHWs in distributing COVID vaccines. CHWs have a role to play in every stage of COVID-19 vaccine roll out, including in planning, identifying target groups, engaging and mobilizing communities, delivering services, and tracking and following up with patients. The Coalition worked to ensure that planners were aware of the recommended roles for CHWs in COVID-19 vaccine distribution and as a result, CHWs were vaccinated as part of the initial allocation in countries such as Rwanda, Bangladesh, and Kenya.

This same group remained together to target one of the systematic issues underlying the crisis: that few governments know how many CHWs exist, where, and doing what. Together, the Coalition convened UNICEF, Global Fund and others to publish the first ever global guidance on counting CHWs.

Community Health Worker holding a booklet that reads

Last Mile Health

Legacy

FINDING OPPORTUNITY IN CRISIS.

To prevent the next pandemic, investments in compensation, training, and performance management for community health workers (CHWs) must be made. Strengthening healthcare systems not only benefits COVID-19 response, but also saves lives in the long-term.

We deliberately oriented our COVID response work to have impacts over the long term. For example, CAF-Africa’s impact on PPE access also strengthened health systems. By working with country partners and governments to plan for a nationwide PPE supply, CAF-Africa catalyzed reviews of CHW country registries and encouraged their inclusion in supply planning for COVID-19 response. This process not only helped put the idea of CHW master lists on the table, but also helped to build longer-term partnerships and collaboration between community health and supply planning sectors Ultimately, CAF-Africa was able to provide PPE to community health workers in a moment of acute need, and also contribute to recognition, equality and pay for CHWs across the continent. For more on how solidarity turned into long-term systems change, see our piece via GAVI.

Through the COVID-19 crisis, the Coalition lived into its role as a catalyst for change and worked towards making proCHWs the norm worldwide. We set the agenda and convened the field for action across research, advocacy, and organizing. The legacy of this is health systems more resilient and flexible in the face of the ongoing challenge of COVID-19 and future disease outbreaks.

RESOURCE LIBRARY

Count CHWs.

Learn more about the first ever implementation guide to support national governments and their technical and financial partners to develop a functional, continuously maintained, shared and institutionalized CHW master list hosted in a national registry.

Service Doesn’t Stop: CHWs Maintain Continuity of Care During COVID-19.

Paid and protected CHWs continued to provide health services to 5.2 million people during COVID-19.

The COVID-19 Action Fund for Africa.

Key activities, outcomes, and future directions in the fight to protect community health workers (CHWs) during the pandemic and beyond.

COVID-19.