Community health workers are heroes, too

March 11th marks one year since the World Health Organization declared the coronavirus outbreak a global pandemic. It’s time to recognize the community health workers on the frontlines as heroes.

By Dr. Muhammad Musa and Ray Offenheiser

Anjuman, a community health worker living in Nilphamari, a district in northern Bangladesh, has worked with BRAC’s health program for 15 years. She goes door-to-door in her community delivering lifesaving health information and services, and is the go-to person for about 450 families for key public health information, pregnancy care, child health, and health referrals.

The crucial role of frontline doctors and nurses in combating the devastating COVID-19 pandemic has rightly given them renewed recognition as “heroes.” This recognition is well deserved: doctors and nurses risk their personal safety daily to support the pandemic’s sickest patients. However, we should also heighten the stature of the community health workers — like Anjuman — who are the essential and often-overlooked backbone of the world’s public health infrastructure.

Community health workers, who are mostly women, are trusted sources of health information, advice, and monitoring. They typically live in and understand the communities they serve. In places where medical facilities are in short supply, especially in the Global South, community health workers are a critical public health resource, and often the only such resource nearby and accessible. 

The World Health Organization (WHO) estimates that there are more than 4 million community health workers worldwide. In Bangladesh alone, BRAC has a network of nearly 50,000 community health workers that is vital to the nation’s health care infrastructure. In addition, BRAC supports thousands more community health workers in contexts like Uganda and Afghanistan.

In the past, community health workers focused largely on maternal and child health, as well as non-communicable diseases like malaria and cholera. But in recent years, their role has dramatically expanded amid outbreaks of infectious disease, cementing their status has “heroes.” Amid the Ebola crisis in West Africa, they were thrust onto the frontline and played a decisive role in beating back infection rates. 

As the WHO reports, community health workers “worked with community leaders, going house to house to provide important information about Ebola and searching for active cases and contacts, and they helped local religious leaders to expand their education and outreach strategies, especially in efforts to reduce transmission during funerals and burials.”

This same trend is now happening on a global scale with COVID-19. During the pandemic, community health workers are raising awareness of COVID-19, its symptoms, and how to prevent infection. They refer people with symptoms to testing kiosks and instruct them to isolate if they test positive. They recommend quarantine for those exposed to reduce the risk of asymptomatic transmission. In some places, community health workers have also engaged with local communities to promote home-based care of COVID-19 cases.

In this expanded role, community health workers are risking infection to defeat the pandemic while taking precautions not to spread the disease themselves. This is truly heroic work, because they – like doctors and nurses – are putting themselves at risk for the sake of others. 

Their work is also vital for other reasons. With roughly 80 percent of COVID-19 cases not requiring hospitalization, most patients must be treated at home. Community health workers reach more deeply into the most remote and underserved communities than traditional medical institutions.

Fortunately, community health workers are well suited to respond to pandemics. They must be trained and supported, but they are an existing network that can be rapidly deployed. They act as the eyes, ears, and mouths of the public health system, reporting back on what they see and hear while conveying vital information to the public and to health care officials. In Bangladesh, community health workers are educating and mobilizing communities about the vaccine, and hundreds of community health workers in BRAC’s network have been trained to directly administer COVID-19 vaccinations at the government’s request.

Recognizing community health workers as “heroes” is not simply a sign of respect. It is necessary to motivating, perpetuating, and strengthening this key global health infrastructure.

The future of the world’s health depends on community health workers – particularly in places where health systems are weak.  But while the need is greatest in the Global South, the challenge of addressing the pandemic and other health care needs is worldwide in scope. 

Even in the most developed countries, access to health care  is increasingly fragile and challenged in rural areas and big cities alike. 

Health care providers who risk their lives for us on the frontlines of our health systems are rightly our heroes. Our world depends on community health workers like Anjuman, and they should be counted among those heroes and recognized for their courage and sacrifice.

Dr. Muhammad Musa is a physician, former community health worker, and Executive Director of BRAC International. Ray Offenheiser is Board Chair of BRAC USA, President Emeritus of Oxfam America, and Director of the Pulte Institute for Global Development at the University of Notre Dame.