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

The COVID-19 pandemic brought two truths to the attention of governments, community health organizations, and the general public across Africa:

Community health workers (CHWs) are an integral part of coordinated efforts to manage COVID-19. Put simply, without CHWs, the capacity of countries to prevent, detect, and respond to pandemics is limited.
A lack of adequate personal protective equipment (PPE) places CHWs and the community at risk. No PPE places CHWs in the impossible position of choosing between withholding their vital services, or continuing to operate in the knowledge that both they and the communities they serve could be at increased risk of viral transmission.

At the height of the pandemic in May 2020, with Africa’s healthcare system facing a “catastrophic shortage” of medical staff due to a 203% rise in COVID-19 infections among healthcare workers, the need for professional CHW (proCHW) programs had never been greater. But with nations across the globe scrambling to manage their domestic healthcare operations, international assistance was exceedingly difficult to mobilize.

Yet, as even high-income countries grappled with PPE shortages, Community Health Impact Coalition (CHIC) led the way in responding to the challenge. CHIC was instrumental in forming the COVID-19 Action Fund for Africa (CAF-Africa), which spearheaded a campaign to protect the community health workforce during the pandemic.

The Importance of CHWs During a Pandemic

In the early stages of the pandemic, the Coalition outlined four essential components of the response to COVID-19:

protecting healthcare workers.
interrupting the virus.
maintaining existing healthcare services while surging their capacity.
shielding the most vulnerable from socioeconomic shocks.

Measuring the impact of CHWs since the onset of the pandemic, rigorous research in 2022 determined that, “CHWs who were equipped and prepared for the pandemic were able to maintain speed and coverage of community-delivered care during the pandemic period.”

A Community Health Worker extracting liquid from a vial using a syringe while people stand behind her

CHWs Rise to the Challenge

Community health workers played a vital role in the 2014-2016 Ebola response, and continue to address up to 50% of the malaria burden.

They are often the first point of care for vulnerable and underserved populations in low and middle-income countries, yet are largely unpaid. CHWs often volunteer in order to access basic healthcare for themselves, their family and their community—a dynamic that’s not devoid of at least some element of coercion.

Considering many CHWs have literally provided a lifetime’s worth of free labor, to leave them in such a precarious position in the face of a worldwide pandemic is nothing short of disgraceful.

Before we move on to more facts and figures, please watch the short video below of CHWs advocating for PPE so they can safely continue supporting their communities.

People standing in line to have their babies weighed by a Community Health Worker

Village Reach

The CAF-Africa Response.

When COVID-19 began to spread around the world, five organizations came together to form CAF-Africa. Partners included:

Community Health Impact Coalition (CHIC)
Direct Relief
The Community Health Acceleration Partnership (CHAP)
Pandemic Action Network
VillageReach

Collectively, CAF-Africa set out on a mission to swiftly assess the extent of PPE shortages among CHWs in 24 sub-Saharan African countries, then mobilize support and resources to address the challenge.

Crunching the Numbers

Initial estimates determined that across target countries, there were approximately 1 million CHWs requiring PPE. Taking into account the 400 million people served by the identified CHWs, 448 million pieces of PPE would be required to support the identified CHWs.

CAF-Africa adopted the recommendations of the UNICEF/WHO/IFRC guidance for community care (2020), to settle on a basic package of PPE required to protect CHWs. The kit includes surgical masks, eye protection, gloves, gowns, and disposable bags.

A full count of the PPE required is detailed in the infographic.

A Community Health Worker in medical PPE holding a thumbs-up

Last Mile Health

Sourcing PPE.

As increased demand, global shortages, and supply chain issues pushed the price of PPE up to 20 times higher than average levels, members of CAF-Africa had to explore innovative strategies to secure affordable PPE.

There was no single solution to sourcing the PPE required. Through a combination of advocacy, negotiation, fundraising, proactive identification of local stock availability, and supporting new manufacturing sites, CHIC and CAF-Africa members used every means at their disposal to secure as much PPE as possible. And their efforts paid off.

In 2020, CAF-Africa was the fifth-largest procurement mechanism for PPE in the world. The coalition mobilized $18.5 million in financial aid to procure 81.6 million units of PPE.

Deploying Support.

The logistics of delivering unprecedented amounts of PPE to receiving nations was a mammoth undertaking. VillageReach, a CHIC member and CAF-Africa partner that focuses on improving health systems in low-income countries, worked tirelessly with governments and community health organizations to manage the extensive supply chain issues during COVID.

To obtain CAF-Africa assistance, countries were required to detail their supply chain capacity and plan for receiving supplies. This was no simple undertaking, as most countries weren’t used to receiving such large shipments. To exemplify the scale of the operation, for one shipment of masks, Uganda required 40 trucks to pick up the delivery, space to store 800 pallets, and a detailed plan to distribute supplies to the community.

To distribute PPE, CAF-Africa and participating countries relied heavily on free cargo flights offered by the World Food Program, becoming the third largest user of this service by late 2020.

Achievements

CAF-Africa was able to mobilize quickly to supply PPE to CHWs on a larger scale than any single partner could have alone. Between June 2020 and May 2021, CAF-Africa:

Mobilized more than $21.5 million in financial aid and in-kind contributions
Procured and distributed 121.3 million units of PPE (including surgical and non-surgical masks, KN95 masks, gloves, eye protection and gowns)
Reached nearly 480,000 CHWs in 18 sub-Saharan African countries

Social media graphic about the impact of Covid-19 Action Fund for Africa (CAFF)

Strengthen the ongoing operations of health systems in sub-Saharan Africa.

In addition to these immediate benefits, CAF-Africa undertook wide-ranging activities to strengthen the ongoing operations of health systems in sub-Saharan Africa and promote the professional CHW (proCHW) movement throughout the region. Longer term impacts of CAF-Africa include:

Data and learnings in support of PPE access were shared with Africa Medical Supplies Platform, Africa Centres for Disease Control and Prevention, UNICEF Supply Division, and several other key stakeholders.
A long overdue count of active CHWs in the region raised the profile of the profession with national governments.
CHIC encouraged governments to officially recognize CHWs as essential healthcare workers. This opened the door for further advocacy around the urgent need to pay CHWs for their work.
Advocacy was undertaken to add CHWs to priority lists for COVID-19 vaccines.
Once they were equipped with PPE, more than 8500 CHWs helped administer polio vaccines in the Democratic Republic of Congo to address concerns about a drop in vaccination rates while essential services were disrupted
Longer-term partnerships were facilitated between community health and supply planning sectors.

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.

Community Health Workers in Pandemics.

Toward financing practices for community health programs that avoid harm and accelerate impact.

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.