Community Health Research Round-Up 038

28 July, 2020

This issue of the Round-Up is about protecting CHWs against COVID-19,  what small vs. large CHW programs can learn from each other, and so much more!

Hello all,

Welcome to the latest edition of the Community Health Research Round-up. You are one of over a thousand people who have made the commitment to be evidence-based staying up-to-date with the latest evidence!

This issue covers papers indexed (largely!) since July 14.

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* As always, previous editions of the round-up are available in our archive here (

All the best,

Carey Westgate

Deputy Director | Community Health Impact Coalition

Community Health Research Round-Up, Issue 038

July 14 - July 27, 2020

1. Community health workers reveal COVID-19 disaster in Brazil (

* Comments: A frustrating and sobering assessment of the current situation with CHWs and COVID-19 in Brazil.

* Methods: Comment

* Takeaway: Brazil's COVID-19 disaster is a partial consequence of neglecting the country's 286,000 CHWs. Because CHWs in Brazil are not considered to be health professionals, only an estimated 9% have received infection control training and personal protective equipment (PPE). Unions estimate that at least 50 CHWs have died from COVID-19. The authors call on the Brazilian Government and international community to "recognize and support the role of CHWs in the COVID-19 response and to ensure their health and safety."


2. COVID-19: Africa needs unprecedented attention to strengthen community health systems (

* Comments: Adding to the chorus calling for PPE for CHWs (See RR's 032 ( , 035 ( , 036 ( , and 037 ( ) this Lancet comment from colleagues at CHAP and LMH argues that CHWs - key health workers in Africa's pandemic response - urgently require PPE and merit additional attention/investment.

* Methods: Comment

* Takeaway: Against the trillions of dollars that have already been committed in the COVID-19 response, multi-billion dollar investments in CHWs to strengthen PHC and achieve UHC is merely a drop in the bucket. "Now is the time to invest in community health systems in sub-Saharan Africa and avert a greater crisis."


3. Assessing and reducing risk to healthcare workers in outbreaks (

* Comments: Yet another perspective and urgent call to action to protect health workers during COVID-19 and against future outbreaks. We're noticing a trend! #PPEforAll

* Methods: Comment

* Takeaway: High rates of healthcare-associated and healthcare worker infection (physicians, clinical officers, nurses, midwives, AND CHWs) during outbreaks suggests that our current risk mitigation strategies - including infection prevention and control practices - are insufficient. The authors recommend a 2-pronged solution to address long-term gaps in the health system that impact infection control and emergency response.


4. COVID-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. (

* Comments: A candid and scathing critique of how COVID-19 has revealed glaring weaknesses in the USA health system - and what we can do about it (hint: involves professionalized CHWs).

* Methods: Comment

* Takeaway: The USA needs a paradigm shift away from a patient-centered care system towards community-centered, population-based healthcare. Key to this grand vision is integrating CHWs into our COVID response (phase 1) and determining a plan to incorporate these CHWs as a key element in a new community-centered, population-based healthcare system (phase 2).


5. Community-based surveillance in Cote d'Ivoire. (What works? lessons learned in global health security implementation.) (

* Comments: In a priorities paper published earlier this year ( , CHIC identified a critical role for CHWs in disease surveillance. This article describes how CHWs were engaged for disease surveillance in Cote d'Ivoire in the post-Ebola period, and what lessons we can learn.

* Methods: Rapid review (retrospective) of a pre/post intervention w/ control

* Takeaway: Intervention sites saw a significant increase in reporting of unusual health events by CHWs (consistent w/ other studies demonstrating the value of community-based surveillance as an early warning system). However, false positive rates were high; less sensitive signal definitions could reduce some burden on public health systems.


6. Geographic Barriers to Achieving Universal Health Coverage in a rural district of Madagascar (

* Comments: This pre-print from friends at PIVOT Madagascar explores how “utilization at community health sites compensates distance decay observed for PHC use” - if that's not reason enough to check it out, the beautiful data visualizations certainly are!

* Methods: Analysis of geographic information from nearly 300,000 primary care visits

* Takeaway: Facility-based interventions achieve high coverage among populations living nearby. However, to achieve UHC we need professionalized community health programs that increase utilization for all, regardless of proximity to facility.


7. Effectiveness and cost-effectiveness of home-based postpartum care on neonatal mortality and exclusive breastfeeding practice in low-and-middle-income countries: a systematic review and meta-analysis (

* Comments: Speed of post-natal care home visits is one of several indicators CHIC is tracking to promote quality of care. This systematic review confirms the importance of prompt home visits and community mobilization to promote neonatal care practices.

* Methods: Systematic review & meta-analysis (based on n=14 randomized trials or quasi-experimental studies)

* Takeaway: CHWs conducting home visits and community mobilization activities to promote neonatal care practices is associated with reduced neonatal mortality, increased practice of exclusive breastfeeding, and is cost-effective in improving newborn health outcomes for LMICs. Further evaluation is needed to determine the optimal package and timing of these home visits.


8. Development and Initial Validation of a Frontline Health Worker mHealth Assessment Platform (MEDSINC) for Children 2-60 Months of Age (

* Comments: From Coalition Member THINKMD and friends, this article describes the development of a next-generation mHealth point-of-care clinical assessment, triage, treatment, and recommendation platform, called MEDSINC, designed to support frontline health workers (FLWs).

* Methods: Field-based testing in three countries (Burkina Faso, Ethiopia, Bangladesh) comparing MEDSINC-generated diagnoses by FLWs vs. blinded "gold standard" clinical diagnosis by local healthcare professionals assessing the same children; plus usability & acceptability testing

* Takeaway: The MEDSINC clinical assessment logic, triage recommendations, and user interface are conducive to mHealth technology adoption and scaling. The study found high overall clinical correlations and specificity between MEDSINC evaluations by FLWs compared with “gold standard” assessments; usability and acceptability of the tool was rated highly by FLWs in all three countries.


9. Learning from Community Health Worker Programs, Big and Small (

* Comments: For all our readers thinking about what smaller programs can teach large-scale programs (and vice-versa), this brief editorial is for you! For further reading, check out the article by Nepal et al. in issue 037 ( of the Round-Up, which the author of this editorial (Stephen Hodgins) cites as a strong example of how small-scale programs can potentially inform large government programs.

* Methods: Editorial

* Takeaway: "Small, well-implemented, well-evaluated community health worker programs can provide useful insights and inspiration. Testing, learning, and adapting at progressively larger scale can ultimately lead to national-scale programs that achieve sustainable impact."


10. What are the roles of community health workers? Looking back at the philosophies of primary health care (

* Comments: Building on the previous edition of the Round-Up (037 ( , Articles 1 & 2), this article explores the different roles of CHWs in a historical context (i.e., Alma Ata = community development actors vs 1980s = extension of health system)

* Methods: Comment

* Takeaway: These roles can co-exist: "CHWs can work in continuity with the health system, but they should not be considered as affordable labor" and require significant support in order to develop their communities.

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