Filling the Gaps: Our Neglected Army of Healthcare Workers
The Coronavirus pandemic undoubtedly exposed gaping holes within our healthcare systems. Frontline workers were overwhelmed by a continuous influx of patients, with little idea how to treat them. Crippled supply chains left healthcare workers without proper personal protective equipment (PPE). Testing malfunctions forfeited any advantage on flattening the curve. Contact tracing was errantly nonexistent. The United States (US) healthcare system proved itself woefully inadequate at handling a pandemic efficiently or effectively
One of our biggest mistakes was sideling community healthcare workers (CHWs). Initially, the Department of Homeland Security’s Cybersecurity and Infrastructure Security Agency included CHWs in the list of “essential critical infrastructure workers who are imperative during the response to the COVID-19 emergency.” Yet, according to a recent informal member poll by the National Association of Community Health Workers (NACHW), community-based organizations chose to lay off CHWs rather than organize this readied army. According to respondents, some CHWs working in clinical settings were told to “find something to do” because their supervisors are too occupied with patient care. Our 58,950 certified CHWs constitute an army of health workers waiting to fill these now self-evident gaps. In the few areas where CHWs have been employed, they operate as “boots on the ground” operatives tasked with food drop-offs, housing arrangements, patient advocating, mask collection and distribution, education, and contact tracing. These services go beyond physical care, and advocate for holistic wellbeing.
CHWs have been highly effective across the globe as well. Within the first month of their outbreak, South Africa deployed 28,000 CHWs focused on HIV and TB and retrained them for Covid screening. CHWs were provided proper PPE to go door-to-door and look for Covid patients. By not waiting for patients to come to clinics, South Africa screened 7 million in the first month, which is 1 out of 10 South Africans. This mode of screening limits exposure, prevents unnecessary hospital influxes, identifies infected populations, and isolates the infected from the general public.
Rwanda initiated a similar program with approximately 60,000 CHWs. Public awareness campaigns air on the radio and television to reach the most remote areas of the nation, while home visits from CHWs provide further details on accessing care when symptoms are present. If someone has symptoms, the CHW contacts the health center, who then gets in touch with the hospital to come pick up the patient. Again, we see minimal exposure to patients and healthcare workers, isolation of those potentially infected, and prevention of hospital influx. To date, Rwanda has had 1,113 cases, 575 recoveries, and 3 deaths since March 2020.
Several Indian state governments, such as in Punjab, Karnataka, Andhra Pradesh, Kerala, and Maharashtra, have also deployed CHWs. They have been tasked with tracking down returnees, monitoring symptoms for them and their families for 14 days, and going door-to-door teaching people how to practice social isolation. India’s ASHAs (Accredited Social Health Activists) are the nation's first line of defense against Coronavirus. However, state governments continually fail to take the safety of ASHA workers into account. Prior to the pandemic, ASHAs had gone on strike for being severely underpaid, not having worker rights because they are considered “honorary volunteers”, and constantly on the frontlines of both disease and violence. Susana Barria, of the global union federation, Public Services International, argued:
“It’s never been clearer that public healthcare needs community health workers. The skills and the capacity these women have, the way in which they are familiar with each community’s members — the sick, the elderly, the children — the ASHAs are the most likely to know when someone is displaying symptoms of Coronavirus, has been traveling abroad or is missing from the home. Without them, doctors will be operating blind.”
Non-governmental organizations, like Last Mile Health, have even begun ramping up CHW training for developing nations. Last Mile Health is committed to “supporting governments and local partners to leverage their health workforce to safely prevent, detect, and respond to the Coronavirus.” They are working with the Ministries of Health in Liberia and Malawi to contribute to their national COVID-19 response efforts by training 5,000 CHWs in Liberia’s National Community Health Assistant Program.
As we know, COVID-19 has disproportionately affected the poor and vulnerable. These are the same populations where we see high mistrust of healthcare and government. CHWs are positioned to play a pivotal role in fighting COVID-19. As social mobilizers, CHWs could supervise communities at risk while providing timely, accurate, and culturally relevant information. CHWs accrued monumental success as pandemic preparedness promoters during the Ebola and Zika epidemics. Prior to the epidemics, CHWs increased the access to health services and products within communities, communicated health concepts in a culturally appropriate fashion, and reduced the burden felt by formal healthcare systems. During the epidemics, CHWs acted as community-level educators and mobilizers, contributed to surveillance systems, and filled gaps.
CHWs are a critical human resource beckoning to be taken advantage of in the US. Some nonprofit organizations have jumped at the chance to utilize this resource to aid the surge seen in communities across the nation. Volunteer Surge, for example, a nonprofit consortium in conjunction with the Yale School of Public Health, launched a new initiative in April to recruit, train and deploy 1,000,000 volunteer CHWs to aid in the fight against COVID-19. According to Yale School of Public Health Dean, Sten Vermund, MD, PhD, an epidemiologist and pediatrician:
"Task-shifting, which allows tasks to be delegated from doctors and nurses to trained health workers, can reduce the burden on our system and save lives by allowing scarce medical workers to focus on the more serious COVID-19 care operations while trained health care volunteers pick up other tasks."
Volunteer Surge is still recruiting and training CHWs today.
CHWs have proven themselves to be effective and cost-efficient during pandemics. They have already been deployed in other areas across the world. So why hasn’t more of the US jumped at the opportunity to use them? Why have we not listened to our current healthcare workers? They need help. They are overwhelmed. And we have an untapped army ready to help them.