Frontline health workers, who are to be honoured during the World Health Organization’s international Year of the Healthcare Worker in 2021, must be better supported in their vital role to beat back the global COVID-19 pandemic on community level, according to global health technology experts, BroadReach Group.

Frontline health workers, and in particular Community Health Workers (CHWs) help educate communities, collect grassroots data and provide vital firstline health interventions in response to the COVID-19 outbreak.

They can only continue to play a vital role in the global pandemic response if they get the proper support, according to BroadReach Group, a global health social enterprise that uses innovation and technology to empower human action. BroadReach in partnership with South African health authorities and thanks to the support of PEPFAR and USAID has provided technology-enablement, staff training and man-power during the pandemic.

First in-field community screening app

The role of Community Health Workers (CHWs)

“Disease starts in our communities and the solutions are also there. Our CHWs enable our vulnerable rural and urban communities to take care of their own health and assist with early infection detection and speedy referral to nearby health facilities. Working in communities during a public health crisis, you need buy-in and participation, and CHWs are vital in achieving that. We can’t take on this pandemic without our CHWs. In fact, we need to train more local people to do this kind of work in vulnerable communities,” says public health physician and BroadReach epidemiologist Dr. Lerato Pitso.

During the pandemic, the BroadReach Group was particularly active in South Africa, where an estimated 60 000 public sector CHWs have put their lives on the line to work in their communities during the pandemic to help limit infections as part of the USAID APACE award.

BroadReach assisted the Mpumalanga and KwaZulu-Natal provincial health departments to deploy an army of trained CHWs armed with the Vantage cloud-based screening app into rural and urban communities during the pandemic to perform more than 3.2 million COVID-19 screenings.

“All health workers are important, but CHWs particularly so, because they work on the frontlines and often receive the least amount of attention, education, capabilities-building and remuneration – yet in the global pandemic we put so much pressure on them to go actively seek out those people who’ve been infected.

They carry a burden like a mother, because they go out there and look after their communities, even when it is hard. They are the essence of where fighting disease begins, at grassroots level,” says Ilona Smart, Client Director at Vantage Health Technologies – part of BroadReach Group.

Smart said many CHWs had to be redirected from TB, HIV and other serious conditions in 2020 towards COVID-19, which had become the greatest public health crisis of the year.

These field workers had to be trained to use new processes and technologies in record time, including the Vantage application, a cloud-based AI platform that was used by CHW for real-time screening and contact tracing. This data consolidated and available instantly for provincial leadership to make crucial resource allocation and care decisions as the pandemic evolves. Vantage also connected to the national COVID command center.

In his address to the nation in mid-December, South African President Cyril Ramaphosa said more than 38 000 health workers in the public sector had tested positive for Coronavirus. Of these, nearly 5 000 were admitted to hospital and 391 died. These numbers have spiked further during the second wave. “As a nation, we owe so much to these brave and dedicated people and to their families, for without them, we would not have come this far,” Ramaphosa said. At BroadReach, over 240 of its health care workers tested positive and one colleague was tragically lost to the virus.

Smart said exhaustion amongst CHWs and other frontline workers was a major concern. “Before the pandemic, the public health workers we trained and supported worked mostly with TB and HIV patients and their caseload was about two households a day. Now these same CHWs serve 10 households a day and survey each member of each household with a questionnaire of 33 questions to determine if they are presumed COVID cases or Persons Under Investigation, as we say. Special measures were put in place to recognise their challenges and support our CHWs.”

CHW challenges to overcome in 2021

Dr Pitso said it was critical to realise that 70% of healthcare workers globally are women, who also often do non-paid housework and are vulnerable in many ways. “Yet, they serve all mankind. Let’s show some compassion and do our part to keep them safe.”

“The grave shortage of healthcare workers is a global problem, even more so in Africa with existing limited resources. South Africa also has a chronic problem of shortage of CHWs and uneven distribution across provinces, yet we rely on them to shield the rest of the health system from being overburdened,” said Dr Pitso. Looking at the ideal ratio of health workers to population, the Sustainable Development Goal index threshold is 4.45 doctors, nurses and midwives per 1000 population, yet in many areas this number is seldom reached.

“For us to meet the required standards for Universal Health Coverage (UHC) by 2030 we need to have adequate human resources for health with the right skills mix. Unfortunately, our health system is overwhelmed with the current increase in patients. Healthcare workers are overworked and fatigued. Mental health should be given a priority and healthcare workers should be supported and provided with self-care training and debriefing sessions to equip them to deal with the increasing demands in healthcare.”

All World Health Organization (WHO) member states will celebrate the International Year of Health and Care Workers (YHCW) in 2021.

A Mpumalanga case study on how to support CHWs during the pandemic:
It is vital to support the work of Community Health Workers (CHWs) on three levels: human, processes, and technology. A recent collaboration between BroadReach Group and the Mpumalanga Health Department to train and deploy thousands of CHWs to be the first line of defence in their communities during the pandemic, is a case in point.

“Anxiety levels were very high in terms of our CHWs themselves contracting COVID, as well as with the new technology they had to use in the field having been used to paper-based systems in the past,” said Ilona Smart, Client Director responsible for COVID-19 intervention at BroadReach Group.

“The Mpumalanga Health Department was excellent at addressing the anxiety levels amongst CHWs head-on. They educated their CHWs on what COVID was, how to protect themselves, gave them the necessary protective gear, and arranged for virtual training. BroadReach then sent its expert change managers to assist with the adoption of the new technologies, for the very vital collection of data that CHWs need to do, so that we could get the full picture of what was happening on the ground.”

The 4500 CHWs in the province gave feedback to their supervisors via the Vantage app on any challenges they faced on the ground, mostly in rural settings, and these challenges were addressed in a daily meeting between the department and BroadReach. Daily data they gathered helped the province to determine where COVID hotspots were forming, how many citizens were likely to need hospitalisation, and which facilities had capacity or not. All of this grassroots data helped the province’s clinics and hospitals to prepare for influxes.

“A tribute really must go to the CHWs who were our frontline workers with this dreaded disease,” said Smart.

“End-to-end collaboration, where you see people, processes and technology coming together, from the grassroots level where our CHWs operate, to our hospitals and health systems at large, really is our only way out of this pandemic. CHWs need more credit, and our support, because we can’t do this without them.”