This article is the third of three reflections on community health workers (CHWs). The first post is here, and it introduces the general concept of what health workers can do. The second is here, and discusses what community health workers could be doing in homeless populations during the COVID-19 pandemic. These posts have drawn on The WHO guideline on health policy and system support to optimize community health worker programs.
Those guidelines provide recommendations on selecting, managing and supervising, and assuring that CHWs fit well within the communities they serve and have the support they need to succeed.
To bring the rate of transmission of SARS-CoV-2 down requires essential changes to personal behavior, but also the ability to identify cases rapidly. The latter involves a process known as contact tracing. It has four elements:
- Identify cases and reach out to them to discuss their positive status.
- Encourage those cases to isolate themselves until their symptoms have passed.
- Patiently work with them to identify people with whom they had contact (which is carefully defined).
- Reach out to all contacts to ask them to quarantine for a specified period.
CHWs may or not play the role of contact tracers, but we can train them to perform essential functions in interacting with cases and their contacts.
Asking people to isolate or quarantine is straightforward. Helping them to maintain that isolation and quarantine for days is not. Depending on their circumstances, they may face one or more of the following challenges:
- Loss of income due to lack of vacation days.
- Inability to obtain basic needs due to lack of income or need to stay home.
- Lack of connection to health services if their condition worsens.
- Support for other needs, such as caring for relatives who do not live with them.
If we do not address these issues, recommendations to isolate or quarantine will go unheeded, and the risk of viral spread will increase.
If we can select CHWs who can listen and ask probing questions, if we can support them to problem-solve issues that arrive, and if we can make sure they have access to critical services to which they can connect people, then they can be paired with contact tracers to increase the odds of compliance.
Imagine a CHW connecting immediately with a case or a contact–on the same call during which they receive recommendations for isolation or quarantine. If a CHW could walk through a checklist of potential needs, probe deeper to understand individual fears and constraints, and offer precise support services, they would begin to build a relationship with the individual that will make a huge difference.
Community health workers would then build on that initial contact to do daily or twice per day check-ins with those in isolation or quarantine to ensure they continue to receive the help they need. They would also help do daily symptom assessments and connect their clients to services required in case of emerging or worsening illness.
The role that they play will free contact tracers to reach out to more cases in a shorter period–a critical need to reduce spread.
It is time to develop position descriptions, training materials, and recruitment guidelines to bring on CHWs to play this role.