Burnout and mental distress among community health workers in low- and middle-income countries: a scoping review of studies during the COVID-19 pandemic

Abstract

Community health workers (CHWs) represent the backbone of primary health systems, especially in many low- and middle-income countries (LMICs). The coronavirus disease 2019 (COVID-19) pandemic stretched health systems and increased the workload for CHWs. The objective of this scoping review was to identify the mental health symptoms experienced among CHWs in LMICs during the COVID-19 pandemic. We searched PubMed for published literature, from January 1, 2020 to December 31, 2022 that focused on documenting the experiences of burnout, distress, and mental health symptoms among CHWs in LMICs. The quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Included studies were grouped into the following broad thematic categories: (1) symptoms experienced; (2) drivers of different mental health symptoms; and (3) strategies for coping with different symptoms. We identified 10 cross-sectional, qualitative, and observational studies from 11 LMICs in South and Southeast Asia, South America, and Eastern/Southern Africa that assessed the mental health burden CHWs faced during the pandemic. The studies identified disorders and symptoms such as depression, anxiety, fear, burnout, worsened stress, and fatigue. Contributing factors included increased workload, financial constraints, and an understaffed and underequipped workplace. CHWs reported using different adaptive responses like humor, support from family and colleagues, denial, and substance use, and asked for recommended regular mental health checkups and counseling. More research and policies should be targeted towards promoting the mental wellbeing of CHWs to help ensure responsive and resilient health systems in LMICs in the face of future emerging public health threats.