A conversation with: Dr. Pallab K Maulik, Rohina Joshi, Alyssa Chase-Vilchez, Emma Feeny, Dr. Kenneth Yakubu, David Musoke, Kingsley Chikaphupha, and Faye Moody
CHWs engaged in contact tracing, transport, screening, and follow-up of patients with COVID-19 are at risk of developing psychological distress and mental health symptoms. A mental health response is therefore needed to support CHWs during and after the coronavirus response reaches crisis levels in local regions. This response should recognize the unique needs and challenges of male and female providers. Around the world, some health systems are developing and implementing strategies to offer such support to formal frontline care workers. However, evidence-based guidelines to inform mental health care for CHWs, especially during public health emergencies, remain scarce.
How do organisations support the mental health and well-being of community health workers?
The George Institute, together with the Health Systems Global Thematic Working Group on Community Health workers, surveyed a CHW program to explore the availability of resources that support the mental wellbeing of CHWs in low and middle-income countries (LMICs) during the COVID-19 pandemic. We crowdsourced resources via a Google survey from 25th May to 8th June 2020. Overall, 103 participants responded from 23 countries (Figure 1). Sixty-one responses were included in the final analysis as the rest were either duplicates, from representatives of the same organisation, or empty responses. Both The George Institute and the Thematic Working Group thank all those who participated in the survey.
Fig 1: Countries where the responses came from
Representatives of 57.4% of the organisations responding to the survey reported noticing mental health symptoms among CHWs. Of those reporting mental health systems, 76.5% noted core mental health symptoms such as anxiety, depression, and increased stress, the second leading group of symptoms (70.5%) were undifferentiated (e.g. somatisation, fatigue, insomnia etc), followed by complaints of high workload and burnout (14.8%).
Approximately half (50.8%) of all organisations reported that they offered some mental health interventions such as training for mental health support (online or face-to-face) (22.8%), psychosocial support (WhatsApp group, peer support) (61.3%), pharmacotherapy (9.7%), increased supervision (6.5%), and rehabilitation for other mental health disorders (6.5%). Most of the mental health services were delivered in India (45.2%). We did not seek to explore the implementation and uptake of the reported interventions.
Of the 30 organisations offering support, six were international NGOs/foundations; two were universities/research centres; 18 were local hospitals/clinics/community-based organisations, three were government Ministries (all national-level), and one type was unknown. These data suggest that most mental health support is provided by local organisations and institutions.
Conclusion: CHWs working during COVID-19 must be given the space to talk about their feelings and take care of their own mental health. However, they are facing challenges while performing, therefore, their tasks need to be supported through low-cost, accessible, gender-sensitive, and easily implemented evidence-based interventions.
- Fifty-seven percent of organisations involved in the survey noticed mental health signs and symptoms such as anxiety, depression and stress among CHWs during the COVID-19 pandemic
- Approximately 50 percent of organisations provided some mental health support to CHWs such as online training and peer support via WhatsApp
- These interventions have not yet been evaluated
- More effort is needed to support the mental health and wellbeing of CHWs in LMICs during and after the pandemic
Next steps: The George Institute and the Thematic Working Group plan to have a workshop to identify strategies for:
- Disseminating gender-sensitive resources to CHWs, especially those working in LMICs, that can help them manage symptoms of anxiety, depression, and other symptoms of mental distress;
- Encouraging uptake of such resources, despite the stigma around mental illness and competing demands on the CHWs’ time;
- Developing a plan for evaluating the acceptability and effectiveness of these resources during the COVID-19 pandemic.
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- Dr Pallab K Maulik, Deputy Director and Director of Research, The George Institute
- Associate Professor Rohina Joshi, Senior Resarch Fellow, The George Institute
- Alyssa Chase-Vilchez, Global Womens Health UK Programme Manager, The George Institute
- Emma Feeny, Director Global Advocacy and Policy Engagement, The George Institute
- Dr Kenneth Yakubu, Research Assistant & PhD Candidate, Health Systems Science, The George Institute
- David Musoke, Co-chair, Community Health Workers Thematic Working Group, Health Systems Global
- Kingsley Chikaphupha, Co-chair, Community Health Workers Thematic Working Group, Health Systems Global
- Faye Moody, Coordinator, Community Health Workers Thematic Working Group, Health Systems Global