During the COVID-19 pandemic, one of our most urgent priorities is equipping community health workers (CHWs) with appropriate and adequate amounts of personal protective equipment (PPE). The reason that PPE for CHWs is so crucial is that, in normal times, CHWs are in constant contact with their communities. CHWs both respond to requests (“My son has a fever, can you come have a look at him?”), and proactively check in (“I haven’t seen you in a few days, how is the new baby?”). Typically, this means lots of up-close contact, some of it indoors—thus the need to take action to protect CHWs and their communities, so that CHWs can continue providing essential maternal and child health services while minimizing the spread of COVID-19. PPE is fundamental to providing that protection.

In this blog post, I want to share a little bit about the different ways Living Goods has gone about addressing this, what we’ve learned, and our current plans going forward.

First, some quick background on the different ways that we work in community health. In Kenya and Uganda, we provide support to networks of government CHWs. We tailor this support to specific circumstances, but we generally work with government partners to ensure that these CHWs are digitally-enabled, properly equipped, effectively supervised, and fairly compensated. Then, on top of that, we also do lot of advocacy and advisory work where we are promoting best-in-practice community health policies. These policies are then implemented at the state and national level, positively impacting the working conditions of CHWs beyond those we support directly.

When it comes to the CHWs we support, we are directly procuring and distributing the PPE they need to operate safely and effectively. Concurrently, we are also working with the Kenyan and Ugandan governments to ensure that all of these countries’ CHWs are included in nationwide PPE procurement plans. We aren’t the ones doing the procuring for CHWs beyond the networks we work with, but we are acting as advocates for their needs nationally.

Procuring and distributing PPE to CHWs we support

The global PPE supply chain is challenging. As high-income countries rush to procure PPE for their health care workers, the global price of these commodities increases and countries with fewer resources are outbid. Price and availability can also fluctuate rapidly as new guidance is issued on how best to protect against COVID-19—as we’ve seen with increasingly strong evidence for the benefits of wearing masks. Finally, the products where we are seeing the biggest supply issues are those that offer the most comprehensive protection—for example, N95 masks have seen larger price spikes and more stockouts than standard surgical masks.

We are also leveraging digital health technology to reduce the need for close contact between CHWs and patients, while maintaining high quality service delivery. For more details on these efforts please see our blog post on no and low-touch protocols. Basically, the less patient contact that CHWs have, the less their need for PPE. A CHW who is physically visiting one patient per month will need fewer facemasks than one who is visiting 10. With mobile phone technology and the adoption of no and low-touch approaches, Living Goods-supported CHWs can safely deliver most services via telemedicine during the COVID-19 pandemic.

Going forward, the PPE needs of individual CHWs will change depending on whether and how they are deployed by government as part of the COVID-19 response. So, we want to remain flexible, ensure we are fully aligned with government plans, and guarantee that we provide the PPE and training necessary to keep the CHWs we support safe. As of now, we have been able to procure sufficient PPE to support the CHWs with whom we work. In Uganda that includes cloth and surgical masks, gloves, rubbing alcohol and soap, which are suitable for no-touch engagements. CHWs in Kenya working will be equipped with additional PPEs including aprons and goggles, as the Kenya MOH has requested that CHWs continue to provide rapid malaria tests in endemic areas and has expressed interest in them potentially supporting home-based care of COVID patients that are asymptomatic or experiencing mild symptoms.

Advocacy work to support community health best practices

Governments need to make hard choices about where they allocate limited funding for often scarce and expensive PPE. Our goal is to ensure that governments take CHWs into account when creating their PPE plans. This does not mean necessarily prioritizing CHWs to receive the highest quality PPE first. Although N95 masks provide even more protection than surgical or cloth masks, we are not procuring these for CHWs or advocating that governments should, given the global shortage and need to ensure these remain on-hand for facility-based health care workers who are likelier to be in prolonged indoor contact with COVID-positive patients. Again, this could change if supplies become more reliable and/or if CHWs are asked to take on additional duties that increase their exposure. We want to be a resource for thinking through these issues and making sure that the PPE allocation for CHWs is sufficient to ensure that they are safe and can do the necessary work to keep their communities healthy.

I also want to note that we have been contributing to global efforts to highlight the pivotal role that CHWs can play in combatting COVID-19, to advocate for CHWs to be included in national PPE quantification, and to raise funds to address the unmet need for COVID-related supplies for CHWs across sub-Saharan Africa.

Looking ahead

We expect that the PPE picture is going to remain very complex, and that the needs of CHWs and communities may change dramatically in response to shifting guidance, government priorities, medical developments, and the course of the disease. We will have to learn and adjust. But our first priority will always be to protect CHWs and their communities in a way that serves their country’s larger health goals.

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