Community Health Workers (CHWs) also known as Community Health Volunteers (CHVs), have for decades delivered essential primary health services to populations in the world’s remotest regions.
In Kenya, the terms CHWs and CHVs are used interchangeably, and because of the word “volunteer”, these health workers are often expected to work without pay. CHWs/CHVs are not paid despite the vital health services they provide; shouldering the burden of an excessive workload often linked to rapid population growth.
Here, each CHW is expected to support 100 households. However, in many cases, these numbers are surpassed, with some CHWs covering over 200 households due to factors such as the vastness of some parts of the country as well as high attrition caused by lack of recognition and support from the formal health system.
Yet in many developing countries, CHWs bridge the gap between communities’ need for – and access to – formal health care systems, delivering primary health care where geographical, economic and cultural barriers prevent millions of people from accessing essential health services. CHVs are therefore a vital component of any robust health care system, and their contribution to effective prevention, monitoring, education and behaviour change should see them fairly compensated.
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The emergence of Covid-19 has highlighted the important role of CHWs as the most easily accessible workforce that can be deployed to reduce community transmission. This is critical to curbing the spread of the virus and reducing its devastating impact on communities, health systems and economies.
A global shortage of resources to equip healthcare workers for the Covid-19 response has caused fear among CHWs and other frontline respondents, due to their risk of exposure to the virus. However, CHWs continue to play a pivotal role in reducing the threat of transmission through contact tracing and referral to testing facilities with the support of local administration and national surveillance teams.
In South Africa, over 28,000 CHWs are involved in active case finding by going house-to-house in vulnerable communities where they carry out screening and testing. In Kenya, 63,350 CHWs have been sensitised on Covid-19. As of May 2020, they had reached over 5.5 million households with Covid-19 prevention messages, contributing to stemming the spread of the disease.
The government has developed clear protocols for CHWs in recognition of their role in aiding the Covid-19 response. CHWs are expected to follow up with anyone who has touched a Covid-19 patient’s body fluids, had physical contact with the body of the patient (alive/dead), touched or cleaned the linens or clothes of the patient, slept or eaten in the same household as the patient or been breastfed by the patient, as well as with health care workers who have suffered a needle-stick injury from a contaminated instrument while attending to a probable or confirmed Covid-19 patient.
To perform these tasks, CHWs need personal protective equipment (PPE), including face masks, gloves, gowns, face shields, and goggles; respiratory support supplies and equipment; 70 per cent of alcohol-based hand sanitisers; transport for on-spot response teams and ambulances for referrals.
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However, as global demand for PPE has risen more CHWs are having to make do with inadequate supplies. Considering that the majority of these volunteers work without pay, the compounded risks they face while contributing to the national Covid-19 response rise sharply with each day.
This is creating a situation where CHWs are forced to make a tough choice between working under increasingly risky conditions without the benefit of a financial cushion or abandoning their work in order to keep themselves – and their families – safe at a time when their services are needed most.
Amref Health Africa has long recognised the value of CHWs in creating lasting health change in Africa. That is why we support the Community Health Services Bill 2020, which will entrench CHWs into the formal health system, compel counties to hire more health workers, pay them allowances and provide them with resources to effectively deliver health care at the community level.
The ongoing debate on whether CHWs should be recognised for their services, and paid, not only does a great disservice to this group of frontline health workers; it also has a huge bearing on the nation’s response to Covid-19 and other emerging health issues. It is time to stand with CHWs.
-The writer is a community health specialist at Amref Health Africa.
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