Community health workers: the first line of defence against Covid-19 in Africa

Community health workers (CHWs) played a critical role in curbing and containing the Ebola outbreak in West Africa and more recently in the Democratic Republic of the Congo (DRC).

Fear, misinformation and stigma were rampant and stopped those showing symptoms from seeking help early on, while something could still be done – and while they could minimise the risk of infecting others.

These fears could only be allayed when information on preventing transmission and where to seek help came from people who community members knew and trusted. CHWs not only raised awareness about Ebola, but also mobilised help to transport people to Ebola Treatment Units, to get food to people who were self-isolating, and facilitated conversations on alternative income sources where the main income-earner had either died from Ebola or was quarantined.

Coronavirus (Covid-19) is yet to reach its peak in Africa. As of 22 April, the World Health Organization (WHO) had confirmed 24,137 cases in 52 African countries. But these cases have only been recorded where there is the capacity to do so, where the testing is available. The higher numbers of cases are found in countries such as Egypt and South Africa, which have the better developed and more widely accessible healthcare systems: a very likely contributing factor (though not the only one) to the higher figures recorded. It is entirely possible that the situation in African countries is far worse than the current figures suggest.

“The best advice for Africa is to prepare for the worst and prepare today,” said WHO director-general Dr Tedros Adhanom Ghebreyesus last month. Part of this preparation needs to be mobilising large numbers of CHWs who have the trust of the community they come from and who, in many African countries, bridge the gap between the formal health care system and their community.

Though not part of the formal health workforce and usually voluntary (unpaid), in sub-Saharan Africa – which contends with a quarter of the world’s disease burden and is home to only 3% of health workers – CHWs play an essential part in ensuring their communities stay healthy (and understand how to stay healthy). And like the global health and social workforce more generally, the majority (an estimated 70%) of them are women.

Building on learning from the Ebola crises, national governments need to mobilise CHWs, alongside nurses and other key health professionals, now in the response to Covid-19. These CHWs also need to be supported, paid, and protected. Their work requires them to be amongst people every day, which leaves them vulnerable to infection. So, alongside providing them with training in infection prevention and control, we should ensure they have access to personal protective equipment.

Currently, Amref Health Africa is working with ministries of health across the continent – in Ethiopia, Kenya, Malawi, Senegal, South Sudan, Uganda, Tanzania and Zambia – to support coronavirus preparedness and response, drawing on our decades of experience in strengthening health systems from the ground up.

In Kenya, we have developed coronavirus-specific training content that is already being used by CHWs to prevent transmission, identify suspected cases, and counter rumours and misinformation. This content is accessed through Leap, a mobile learning platform that works on a basic device or smartphone. We are aiming to deliver the content to all 70,000 of Kenya’s CHWs, and to roll out the platform to Ethiopia (at the time of writing, testing was underway).

The information I get from Leap is important because it’s connected to Ministry of Health guidelines. I teach my community to wash their hands regularly, avoid congested areas and handshakes to prevent spreading or getting coronavirus.

Margaret Kilonzo, CHW in Kibera, Nairobi

While the threat to countries like the UK is significant, we at least have a relatively robust and well-resourced health service. In Africa the threat is even greater, and it is CHWs who are the first line of defence. All organisations that are committed to stopping the virus’ spread must work in partnership with the WHO and ministries of health to mobilise and support community health workers across the continent.

Without them, we cannot hope to respond to this pandemic effectively, at scale, and while there is still time to stop the spread of the disease in Africa.