Roles of community health workers in advancing health security and resilient health systems: emerging lessons from the COVID-19 response in the South-East Asia Region

Abstract

To enhance public health emergency preparedness, countries have strengthened core capacities required by the International Health Regulations (2005). In addition, recent major public health emergencies, including the coronavirus disease 2019 (COVID-19) pandemic, have reiterated the critical importance of underlying health systems and their resilience, including the roles of community health workers (CHWs). The aim of this study was to summarize the situation of CHWs in the World Health Organization South-East Asia Region, including their roles and the challenges they have faced during the COVID-19 pandemic response. We reviewed journal articles, policy documents, national guidelines, reports and online publications from development agencies, governments and media houses. Our review results, including three identified case studies, suggest that CHWs in the region have expanded their usual roles to meet the need for both maintenance of regular health services and demand for COVID-19 response activities. During the response, the regular role of a CHW in health education and promotion focused on awareness-raising and the promotion of “new normal” behaviours; CHWs also played critical roles in assisting in surveillance and contact tracing, and in ensuring that people followed isolation and quarantine guidelines. Concurrently, CHWs ensured continuity of essential health services. However, there were challenges, such as stigma, a lack of adequate training or protective equipment, and limited levels of incentives and recognition. Based on these findings, we recommend the development and implementation of long-term plans across the region to strengthen and support CHWs and recognize CHWs as an integral component of resilient health systems. Planning for CHWs as part of the primary health care system will enable local authorities to ensure that an adequate level of resources (including capacity-building, incentives, necessary equipment and consumables) is allocated to CHWs.