Abstract
BackgroundPandemics often precipitate declines in essential health service utilisation, which can ultimately kill more people than the disease outbreak itself. There is some evidence, however, that the presence of adequately supported community health workers (CHWs), that is, financially remunerated, trained, supplied and supervised in line with WHO guidelines, may blunt the impact of health system shocks. Yet, adequate support for CHWs is often missing or uneven across countries. This study assesses whether adequately supported CHWs can maintain the continuity of essential community-based health service provision during the COVID-19 pandemic.MethodsInterrupted time series analysis. Monthly routine data from 27 districts across four countries in sub-Saharan Africa were extracted from CHW and facility reports for the period January 2018–June 2021. Descriptive analysis, null hypothesis testing, and segmented regression analysis were used to assess the presence and magnitude of a possible disruption in care utilisation after the earliest reported cases of COVID-19.ResultsCHWs across all sites were supported in line with the WHO Guideline and received COVID-19 adapted protocols, training and personal protective equipment within 45 days after the first case in each country. We found no disruptions to the coverage of proactive household visits or integrated community case management (iCCM) assessments provided by these prepared and protected CHWs, as well as no disruptions to the speed with which iCCM was received, pregnancies were registered or postnatal care received.ConclusionCHWs who were equipped and prepared for the pandemic were able to maintain speed and coverage of community-delivered care during the pandemic period. Given that the majority of CHWs globally remain unpaid and largely unsupported, this paper suggests that the opportunity cost of not professionalising CHWs may be larger than previously estimated, particularly in light of the inevitability of future pandemics.
Reference35 articles.
1. Utilization of non-Ebola health care services during Ebola outbreaks: a systematic review and meta-analysis;Wilhelm;J Glob Health,2019
2. The Impact of the SARS Epidemic on the Utilization of Medical Services: SARS and the Fear of SARS
3. Child health services during a COVID-19 outbreak in KwaZulu-Natal Province, South Africa;Jensen;S Afr Med J,2020
4. Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review
5. World Health Organization . Pulse survey on continuity of essential health services during the COVID-19 pandemic: interim report, 27 August 2020 World Health Organization; 2020.