CHWs’ heroic role in the COVID-19 pandemic

South Africa was placed under National Alert Level 5 lockdown on March 26, 2020 following the outbreak of the COVID-19 pandemic. From the onset, community health workers (CHWs) were the foot soldiers at the forefront of the country’s response, continuing with their usual care services as well as adopting new ones – performing surveillance activities for early COVID-19 case identification, contact tracing, and facilitating referrals for COVID-19 testing. Initially, many CHWs felt overwhelmed, fearful and confused as to what their role was in the midst of a global crisis, especially with Cape Town being a hotspot for COVID-19 cases.
To prepare them to take on these important additional tasks, CHWs were provided with occupational guidance and training on COVID-19 (signs and symptoms, mode of spread, risk factors etc), and infection prevention and control principles (personal protective equipment, social distancing, etc). TB HIV Care’s Human Resources and wellness team availed themselves to provide debriefing.
The community health workers then assisted through these two main activities:
• Community and household COVID-19 screenings.
CHWs conducted mass screenings, educating the community about the COVID-19 virus, and encouraging community members to wear masks, wash their hands and maintain a physical distance to others. They identified those at risk (55 years and older, people with underlying health conditions) and alerted them of their risk.
They responded to referrals received from the health facilities to contact clients who had tested positive for COVID-19 and educate both client and family on self-isolation. CHWs were able to refer clients who could not self-isolate at home to quarantine and isolation facilities. They also referred all contacts and community members who were symptomatic to the health facility for testing. CHWs were also present at the health facilities to screen all patients before they entered the facility.
A total of 281 867 clients were screened. All these clients were also screened for TB.
• Distribution of chronic medication
Prior to COVID-19, CHWs would distribute chronic medication at sites away from the health facilities and clients would collect the medication from those sites. With the advent of the pandemic, and the need to reduce people congregating in particular areas, this activity evolved into CHWs making home deliveries with chronic medication. A total of 41 012 packages were delivered.
CHWs played a critical role in raising community awareness and supporting the health facilities to continue to provide services. The activities of the CHWs were key in reducing the spread of COVID-19.