Sara regularly visits patients in her community in Kiandutu, treating cases of malaria and diarrhea, or supporting pregnant women and newborns. She is one of 64 000 Community Health Workers (CHWs) in Kenya. For Sara, the COVID-19 outbreak has led to a lot of stress and anxiety. She is worried that she might be infected herself, or even spread the disease. Her patients often come to her in a panic, especially with the spread of fake news and misinformation. But Sara is motivated to keep the community safe. She and her peers are the pillars of the health system in low-income contexts. They could also form a crucial part of the response to the COVID-19 pandemic.

The first line of defense: Community Health Workers

In many African countries, CHWs take care of the most vulnerable patients by providing basic health services. They are members of the communities they serve, and have gone through basic healthcare training. CHWs serve millions of families, and often act as volunteers or receive only a small compensation. Thus, to improve incentives and retention of these highly valuable workers, social enterprises such as Living Goods in Kenya or Live Well in Zambia, link the provision of health education and basic health services with income generation opportunities through sale of commodities, which range from basic medicines or water treatment tablets to solar lamps.

As the frontline of the healthcare system, CHWs could play a pivotal role in reducing the devastating impact of COVID-19:

• Preventing: Promoting critical hygiene and behavioral change is key for prevention. In low-income communities, however, access to clean water, soap or sanitizers can be a challenge. CHWs can help by setting up handwashing stations or the distribution of buckets and soap.
• Detecting and responding: Where social distancing is not possible, early detection and isolation is key. Supervised by nurses, CHWs can be trained to identify early signs and symptoms, supporting isolation and referring more severe cases. They may even be engaged in coordinating, collecting and – if well trained and protected – in conducting (rapid diagnostic) tests.
• Maintaining essential services: It makes little sense to divert all CHW resources to prevent and combat COVID-19 if this happens at the expense of other essential services, such as prevention and primary treatment of malaria, tuberculosis or diarrhea. Thus, governments, NGOs and social enterprises operating CHW programs need to strike a balance, while quickly scaling capacity. 

Technology can help ramp up CHW capacity in times of urgency 

Combatting the spread and impact of COVID-19 requires an urgent increase of healthcare workers and capacity. CHWs can be the answer in many countries. But, quickly training thousands of CHWs is a humongous task, particularly in times of social distancing. Organizations who have already established systems for e-learning and training have an advantage. For example, the launch of the Community Health Academy by Last Mile Health is very timely. Established online platforms or apps, like the one from Living Goods, can also help with remote, data-driven supervision of CHWs.

Digital tools can also improve the efficiency of CHWs, and they need not be fancy: Some CHWs already send regular text messages to mothers with information on how to stay healthy. This channel could also be used for prevention of COVID-19, providing information about measures to prevent the disease, raising awareness of its symptoms and what to do – also countering the spread of misinformation. Through SMS, CHWs could also receive requests for care, or follow-up with patients in self-isolation.

Through the Smart Health app, Living Goods can further track and report every customer contact, and create dashboards for supervisors or government officials. This aggregated data is not only useful to track performance of CHWs. It can also help identify disease hotspots early.

Radical innovation needs radical collaboration

Few CHW programs have the resources and capacity to explore new technologies, like Artificial Intelligence, IoT, or the use of Big Data. However, in times of capacity shortages and difficult decision making, they could be a game changer. Technological solutions could also partly substitute for the physical presence of CHWs, preventing them from becoming vectors of spreading COVID-19.

• Intelligent decision making: Living Goods’ Smart Health App already uses simple algorithms, which help with diagnosis and early triage. An artificial symptom checker, such as the one developed by Ada, could help a CHW distinguish a patient with COVID-19 from one with tuberculosis. Patients who own a smartphone could even use a COVID-19 screener or symptom checker themselves.
• Monitoring disease outbreaks by leveraging big data: Some CHW programs already collect patient data in an electronic health record, and perform basic predictive analysis, for example to identify high-risk pregnancies. More intelligent systems could quickly interpret tracked symptoms, such as cough, fever or loss of smell, to predict COVID-19 disease hotspots early. Similarly, CHWs could use smart devices. In the US, a company producing smart, internet-connected thermometers were able to predict influenza outbreaks two weeks earlier than even the CDC. With proper protection for individual health data, such solutions offer immense potential for monitoring and combatting the spread of this and other diseases.
• Platforms for better referrals: With access to electronic patient records maintained by CHWs, doctors in nearby clinics or hospitals would safe time and be able to understand patient histories better when receiving a referred case. Again, individual health data would need to be protected and managed by the patient. UNUMED, for example, uses an iris scan for unique biometric registration of patients.
• Patient tracking and tracing: Living Goods’ Smart Health App can already capture every patient touchpoint – providing names, mobile numbers, GPS locations. In South Africa, CHWs use a community screening App developed by Vantage. Some patients – an estimated 42% percent in LMICs (2017) – already have a smartphone themselves. Novel contact trackers – like the one currently being developed by Apple and Google – could instantly allow CHWs or patients to know whether they have been in touch with a COVID-19 patient.

To help CHW programs benefit from these disruptive innovations, radical collaboration is needed. Ministries of Health, NGOs and social enterprises operating CHW programs and health start-ups or medical device companies can work together to bring these and other solutions to those who need them – at scale. However, they do not naturally come together to co-create. While a few encouraging examples exist, new methodologies to facilitate such collaboration are needed.

At Endeva, we facilitate collaboration for systems change. Do you have a good example which could inspire others? Or ideas who needs to come together to help the most vulnerable patients counter COVID-19? Share your experiences in the discussion on LinkedIn!

This blogpost is part of Endeva’s blogpost series on the role of inclusive businesses to tackle COVID-19. We are currently supporting various social enterprises in their response to COVID-19, with the aim to build systems which are more inclusive, resilient and future-fit. If you would like to partner with us or learn more, please reach out to Aline (a.menden@endeva.org)!